# Retrospective Analysis of Compulsive-like Long-Standing Unacceptable Urination in Cats

## TL;DR

This study found that cats with compulsive-like urination improved faster when treated with medication and behavior advice compared to behavior advice alone.

## Contribution

The study demonstrates that clomipramine improves outcomes in cats with compulsive-like urination behaviors.

## Key findings

- Cats treated with clomipramine had significantly better outcomes than those with behavior advice alone.
- All cats in the clomipramine group achieved a positive outcome within one year.
- Follow-up completion was higher in cats receiving clomipramine.

## Abstract

Unacceptable urination is a common reason for caregivers to seek help and, in severe cases, to give up the cat. In some cats, the behaviour becomes very repetitive, happening in the same way and in the same places every day, even when the original trigger has been removed. This study reviewed clinical records of 21 cats that had been urinating outside the litter box for at least one year and whose caregivers described the behaviour as rigid and repetitive. After ruling out medical causes with examinations and laboratory tests, cats were managed either with behavioural advice alone or with behavioural advice plus clomipramine, a medication commonly used for anxiety and compulsive-type behaviours. Cats receiving clomipramine improved more often and much faster than cats receiving behavioural advice alone. All cats in the clomipramine group achieved a positive outcome within one year, while only a minority in the behaviour-only group did. Cats treated with clomipramine also reached recovery sooner and caregivers were more likely to complete follow-up checks over one year. These results suggest that when unacceptable urination shows compulsive-like features, it may be more appropriately conceptualised and managed as a compulsive behaviour, with combined pharmacological and behavioural treatment leading to faster clinical resolution.

Unacceptable elimination is a common and frustrating feline behavioural complaint and, when expressed as a repetitive and rigid ritual, it may resemble a pattern of compulsive-like elimination. This retrospective case series reviewed medical records from a single veterinary behaviour service (July 2020–July 2025) to describe cats with longstanding unacceptable urination showing caregiver-reported compulsive features (repetitiveness, redundancy, and rigidity) and to compare outcomes between behavioural modification alone (group B) and behavioural modification plus clomipramine (group C). Twenty-one cats met the inclusion criteria (C, n = 11; B, n = 10) after relevant medical causes had been excluded via physical examination and laboratory testing. Baseline characteristics were comparable between groups, including age, sex distribution, and interval between onset of clinical signs and initiation of therapy. Clinical outcome and time to recovery differed markedly: a positive outcome was recorded in 1/10 cats in group B versus 10/11 in group C after 30 days of therapy (first follow-up). Follow-up completion was also consistently higher in group C across all time points. These findings might suggest a pattern of compulsive-like elimination, with the observed response to clomipramine providing further support for this conceptual framework.