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Summary
Inappropriate elimination is a general term used by veterinarians to describe urination and defecation that happens where it shouldn't. Cats and dogs that eliminate indoors in non-owner sanctioned locations are generally said to suffer from "inappropriate elimination" or an "elimination disorder."
In pets, the act of urinating or defecating in unwelcome locations is generally said to emerge from either a behavioral issue, a medical issue, or a confluence of both.
In dogs, the most common cause of behavior-related inappropriate elimination is incomplete housebreaking. The most common medical causes are detailed below, by category:
Disorders that cause an increased volume of urine: Diabetes mellitus, Cushing's disease, many kidney diseases, corticosteroid treatment
Disorders that lead to an increased frequency of urination: Bladder stones, bacterial cystitis
Disorders that cause urine or stool leakage or incontinence: Hormone-related incontinence, disorders affecting specific region of the spinal cord
Disorders that lead to inappropriate elimination of feces: Diarrheal diseases, constipation-causing disorders
Symptoms and Identification
Urinating or defecating in atypical or unwanted locations is evidence of inappropriate elimination. The following signs may also be in evidence:
Increased frequency of elimination
Increased volume of urine
Abnormal appearance or odor of urine
Blood in the urine or stool
Change in the consistency or color of the feces
Determining the cause of the abnormal elimination is paramount to appropriate treatment. Obtaining a detailed history of the problem is essential. Once described, the following tests are typically recommended to rule out any medical causes:
Urinalysis
Complete blood count (CBC)
Blood chemistry analysis
Fecal sample analysis (looking for blood, parasites, etc.)
Urine culture and sensitivity
Abdominal X-rays
Abdominal ultrasound is sometimes employed as well, particularly if the presence of certain kinds of stones is suspected.
Specific tests for Cushing's disease
Affected Breeds
Any breed of dog can be affected. Some breeds of dogs, however, may be predisposed to certain disease conditions that lead to inappropriate elimination. Diabetes mellitus and Cushing's disease, for example, are more common to certain breeds.
Treatment
The most common approach to treating dogs with signs of inappropriate elimination involves the treatment of any underlying disease. For example:
Urinary tract infection: appropriate antibiotic therapy
Urolithiasis (urinary stones): Diet change with or without surgical intervention
Hormone-related incontinence: phenylpropanolamine
Cushing's disease (pituitary dependent): mitotane or trilostane (most commonly)
Diabetes mellitus: Insulin therapy
Finding areas where the dog has urinated or defecated and eliminating the aroma is essential. The use of appropriate enzymatic cleaners is strongly recommended.
The use of psychoactive medication to limit anxiety-based behaviors that may lead to elimination disorders but is only rarely employed (compared to its more common use in cats).
In cases in which a purely behavioral cause is suspected, as with incompletely housetrained puppies and adults, appropriate training with behavior modification is recommended. Owners are urged to "go back to basics" on their housetraining tactics. Employing a licensed or certified behavior professional is typically in order for recalcitrant cases.
Veterinary Cost
The cost of veterinary care for this condition depends wholly on its cause.
Prevention
Depending on the disease process in play, preventing canine elimination issues isn't always possible. Starting early in puppyhood, using positive training methods to reduce negative associations with elimination, and staying on the lookout for early signs of diseases that can lead to inappropriate elimination are all useful -- if limited -- approaches to prevention.
References
Horwitz DF. A practitioner's guide to housebreaking puppies. Vet Med 1999;94:165-169.
Landsberg G, Hunthausen W, Ackerman L. Fears and phobias. In: Handbook of behavior problems of the dog and cat. 2nd ed. Philadelphia, Pa: WB Saunders Co, 2003;258-296.
Landsberg GM. The distribution of canine behavior cases at three behavior referral practices. Vet Med 1991;86:1011-1018.
Scott JP, Fuller JL. Development of behavior. In: Genetics and the social behavior of the dog. Chicago, Ill: University of Chicago Press, 1965;84-116.
Voith VL, Borchelt PL. Elimination behavior in dogs. In: Voith VL, Borchelt PL, eds. Readings in companion animal behavior. Trenton, NJ: Veterinary Learning Systems, 1996;169-178.