Inappropriate Elimination

Inappropriate elimination is a clinical sign, not a diagnosis. Medical causes must be ruled out first, especially in new-onset cases or senior dogs.

Urinary:

• UTI: Pollakiuria, stranguria, hematuria, periuria. UA + culture.
• Polyuria: DM (glucosuria, hyperglycemia), CKD (isosthenuria, elevated SDMA), Cushing (ALP, cholesterol), hypercalcemia.
• USMI: Incontinence while resting/sleeping in spayed females. Phenylpropanolamine or estrogen.
• Neurologic: IVDD, discospondylitis → loss of sphincter tone.

Fecal:

• GI disease: IBD, parasitism, food intolerance → urgency, diarrhea, tenesmus.
• Colitis: Mucoid, fresh blood, increased frequency.

Urine marking:

• Small amounts on vertical surfaces
• Intact males most common; can occur in neutered males and females
• Territorial or anxiety-related
• Treatment: neutering (if intact), environmental management, SSRIs if anxiety-driven

Substrate/location preference or aversion:

• Dog prefers carpet over grass, or grass over gravel
• Aversion to location (e.g., near loud appliances, where another dog eliminates)
• Treatment: manage access, retrain on preferred substrate, gradual transition

Incomplete housetraining:

• Dog does not understand the rule or has not generalized it
• Treatment: return to basic housetraining protocol — frequent outings, reward elimination in correct location, supervise or confine when indoors

History questions:

• Where? (specific room, random, near exits)
• When? (after owner leaves, during sleep, after eating)
• What? (urine vs feces, volume, posture)
• Signalment? (age, sex, neuter status, breed)

Minimum database:

• CBC/Chemistry
• Urinalysis ± culture
• Fecal flotation

If medical workup negative and behavioral suspected:

• Video recording to identify triggers
• Elimination diary (time, location, antecedents, consequences)
• Behavioral modification plan based on etiology