Why does my anxious cat only pee once a day?
My cat only pees once a day.
A few months ago I started consistently monitoring Potato’s litter box usage. I already had a camera setup but honestly, I hardly ever checked it. I actually had so much anxiety over the thought of checking it, because I could feel in my gut that something was off, but I couldn’t face it yet.
Now, I know you’re probably thinking - wouldn’t you know what her litter box habits are from cleaning it everyday? Well guess what, I used to be absolute garbage at cleaning Potato’s litter box daily. There are many reasons for this and that’s a whole conversation we can have another time but just know that having untreated chronic illnesses makes living hard. Once I was able to start cleaning her litter box daily, I noticed the lack of pee and when I started to casually check the recorded videos - I saw exactly what I thought I was going to see. Potato was only going pee once a day.
At first I felt a lot of guilt and shame about this.
Feeling like I should’ve caught this sooner, if only I had done better with scooping the litter box everyday then I would’ve caught this. Is this actually my fault?? I sat with this and made it my dirty little secret. I kept thinking, no one can know that my cat is only peeing once a day and that I am just now figuring this out. I’m a terrible cat guardian! How long has this been going on and I’ve just been missing it???
So, before I could talk about this with anyone I had to do the thing that my neurodivergent brain loves to do. Try to solve the problem all by myself!
First, I started out with asking myself some questions.
Is Potato having a hard time accessing her litter boxes?
I had multiple (4) boxes for her that were all in one storage room and she had to jump over a short x-pen to get to them. Unfortunately, the x-pen has to stay because it’s the only way to keep Jinya from eating the litter. She’s a little freak. So I thought, how can I make this easier for her? I can’t remove the x-pen or else the tiny chihuahua will get an intestinal blockage from consuming litter all day everyday.
The first thing I did was put down yoga mats on each side of the x-pen to give her something softer to land on. And then I got a large plastic storage bin from the store, added some litter, and put that in the closet in my office since that’s where she spends a majority of her time. This way when the dogs aren’t in there she can have access to a litter box that she can just walk right up to.
Nothing changed. She still continued peeing once a day.
The next question I asked myself was, is she not hydrated enough?? So I got water fountains to try and encourage her to drink more, I started adding extra water to her wet food, giving her churu mixed with water, and splitting her wet food into 2 separate meals to make sure she’s getting hydration in throughout the day.
And… nothing changed. She still continued peeing once a day. Sigh.
Okay so then the next question I asked myself was, is this pain related? Maybe she’s experiencing some musculoskeletal pain and that’s causing her to hold her pee and only use the litter box once a day. There were other behaviors that I’ve been feeling point to underlying pain as well - that’ll have to be it’s own separate blog post. So, I started a pain trial with gabapentin. During the 2 weeks of trialing the gabapentin Potato did have multiple days where she would pee 2x a day! Success! More than once! But still not enough.
I was starting to really spiral and my fears through all of this have been that she’s going to destroy her kidneys and bladder and possibly end up blocked. We’ve already put 2 dogs under anesthesia in the past 4 months for different medical issues, the last thing I (and my wallet) need right now is for my cat to end up blocked and needing emergency medical attention. I also put of her annual exam for many months because of the dogs needing a lot of extra medical care and the guilt I was feeling from this was taking over my brain.
So, after I exhausted all possible options on my own and started working through my feelings of shame around not being a perfect pet guardian in therapy, I finally took Potato to the vet for her annual checkup.
First of all, my vet did not make me feel like a bad pet parent for putting this exam off. She knows our dogs and knows that they’re a lot 😅. My vet supported Potato staying on the gabapentin long term and validated my concerns about her pain while also mentioning that some of the behaviors I was seeing (not pee related) could also be because of anxiety and that Potato does have room to go up in her fluoxetine dose.
My gut was telling me that the fluoxetine wasn’t going to be the answer and I’ve already been seeing so many positive changes with the gabapentin so I wanted to see how long term gabapentin and occasional NSAIDs would impact her behavior. We ran bloodwork to make sure nothing was going on internally and thankfully everything came back normal! I was so dang relieved to see that her kidneys are still working properly.
And then I got home from her vet appt, logged into my Fear Free account to do some CE on cat behavior and low and behold the webinar I chose to watch gave me information that started to make everything make sense!
In the webinar, a large focus was on cats who urinated outside of the litter box. The Veterinary Behaviorist, Dr. Caludia Richter, discussed many different interventions - all of them being ones I’ve already been implementing for years. I’ll have to make a separate post about those. And then when she got to the medication portion and started discussing SSRIs, she mentioned that a potential side effect of fluoxetine is urine retention and that cats on fluoxetine should have their urine output monitored. She also stated that she avoids prescribing fluoxetine for male cats since they are more susceptible to becoming blocked and she doesn’t want to risk it.
Another medication that was mentioned that also had the potential for urine retention was venlafaxine.
First off - I wish I knew this information when I first got Potato on fluoxetine. But, I didn’t and unfortunately I feel like this is something many many many people are not aware of! I also got Potato on fluoxetine in 2019 so luckily there has been at least a little more research done since then plus we’re slowly seeing more medical and behavior professionals talk about cat behavior in general.
However, as soon as I heard that urine retention was a possible, although rare side effect I just knew I needed to explore this further. So, I emailed my vet about my discovery and asked her about weaning Potato off of the fluoxetine and switching her to a different SSRI. Dr. Richter stated that sertraline is her top SSRI and that she has seen great results in cats who had experienced urine retention on fluoxetine. Potato also has experienced some other side effects that haven’t been the greatest, the most impactful one being a decrease in appetite and increased pickiness with food.
My vet emailed me back and god I love her so much! She said that she hasn’t seen this side effect but that it’s likely because most people aren’t monitoring their cat’s urine output. She didn’t say that it’s not possible and that’s the most important part for me. She then gave me two options for approaching this situation. The first option being checking the specific gravity of her urine for a few days to see how concentrated her urine is. If her urine is highly concentrated then that will confirm the urine retention. The second option would be going straight into weaning Potato off of the fluoxetine, going through a wash out period, and then trialing the sertraline.
Because I am me I immediately ordered a refractometer and hydrophobic litter.
If you are not familiar with a refractometer, they are used to assess hydration status by measuring urine specific gravity. This is done by checking how much light bends as it is passing through the urine. They’re super cool devices!
I also went ahead and advocated for beginning the process of weaning her off the fluoxetine and switching her SSRI regardless. I’m trusting my gut and I also want to have data to be able to visually see the differences with her urine concentration throughout these phases.
Alright, future me here is here to edit this!
My plan was to check her USG (urine specific gravity) for a few days while being on her full dose of fluoxetine, after the first and second week of weaning her off the meds, after the first and second week of her washout period, and weekly once she starts the sertraline as long as I have the energy for it.
However… I switched her litter out for the very sad and very small amount of hydrophobic litter (if you’ve never had to use this kind of litter before for urine collection, it’s expensive and only comes in a small amount) and Potato came into my bedroom last night meowing like crazy and not being able to settle. I checked her litter box cameras and saw that about 10 minutes before she came into the bedroom she attempted to go to the bathroom and was very stressed out about the litter situation. So I immediately put her regular litter back and apologized profusely for my cruelty!
While this all may seem extra, I’m proud of that and I’m proud for even trying! I take a lot of pride in the care that I give my pets and I think having data is incredibly valuable, especially when it comes to my girl Potato’s urinary health. I’m also feeling hopeful and that I finally solved the problem!
I don’t want to scare anyone away from utilizing anxiety meds for their cat AND I want everyone out there who has a cat on anxiety meds to know about the potential side effect of urine retention with fluoxetine and venlafaxine.
Hopefully me sharing this experience will help at least one person get answers if they’re also dealing with this! But please don’t let these potential side effects cause fear in using medication with your cat. Potato has been on fluoxetine for 7 years and it has helped her a ton. I’m excited to trial a different SSRI with her especially after seeing so many of our client dogs thrive on sertraline after not having great experiences with other SSRIs.
To close things out I just want to add that there is still so much stigma around cats with anxiety and pain! Especially when it manifests as peeing outside of the litter box. I had to push so dang hard to even get her on the fluoxetine in the first place yet, getting my dogs on their anxiety and pain med combos was easy breezy beautiful cover girl! Cats deserve to have their discomfort and anxiety taken seriously so that they can live happy, comfortable, and full lives.
I’m lucky to have such an amazing vet now who listens, stays up to date on the latest research, and takes such a collaborative approach. If your vet isn’t taking your concerns about your cat seriously, get a new vet!!! It’s okay to switch vets until you find one that listens. I’ve had a couple of friends now who were dismissed by their regular general practice vets about their concerns with their cats and ended up seeking out cat only clinics. Their experiences with those clinics were way better and their cats ended up getting the treatments that they needed. Which we love!
Advocate for your cat!! Even when it’s hard!! And release the shame and guilt that comes with having any pet with complex behavior!!! It’s not your fault and your cat or dog having big feelings is not something to be embarrassed of!
P.S. Did you benefit from this article and want to learn more?
Check out this blog post all about Potato’s anxiety and peeing outside of the litter box: Anxiety medications as a long term solution for anxious and reactive dogs with a story about my cat peeing in the house!
