When It’s Time to Call the Vet: Is It Medical or Behavioural?

If you’ve found yourself scrubbing cat pee off the skirting boards — again — you’ve probably asked, “Is this behavioural… or is something wrong?”

It’s a good question. A vital one, actually.

As a breeder, GCCF judge, and feline behaviourist with over 25 years of litter tray troubleshooting under my belt (and under my fingernails), I can tell you this:
You should never assume inappropriate urination is “just a behaviour problem” without first ruling out medical causes.

Cats are champions at hiding illness. They’ll eat, purr, and climb the curtains — all while their bladder’s in turmoil. So before you start moving trays or changing litters, you need to know when to pick up the phone and call your vet.

Let’s break down when to do it, what to look for, and why the first step to fixing cat pee problems is often medical.

If Peeing Changes Suddenly — Get to the Vet

Cats are creatures of habit. If your feline friend suddenly:

• Starts weeing outside the tray
• Begins peeing more frequently or in larger volumes
• Is straining or vocalising in the litter tray
• Produces blood-tinged urine
• Starts peeing in front of you

…don’t wait. These are red flags, not just “bad behaviour.”

Need help working out whether the issue is physical, emotional, or both? My ebook Stop Cats Peeing: The Smart, Humorous Guide to Solving Inappropriate Urination in Pet Cats walks you through the process step-by-step — starting with the vet visit.

Common Medical Conditions That Cause Pee Problems

There’s a laundry list of health issues that can affect your cat’s toileting habits. Some are mild. Others are emergencies. Here are the most common culprits:

1. Urinary Tract Infections (UTIs)

Often the first thing people suspect, and for good reason. UTIs are painful and can make cats associate the litter tray with discomfort, leading them to go elsewhere.

2. Feline Lower Urinary Tract Disease (FLUTD)

This umbrella term includes various conditions — from infections to idiopathic cystitis and urethral blockages. It’s one of the leading causes of inappropriate urination, especially in young to middle-aged cats.

Male cats are at higher risk for blockages, which can be life-threatening within 24–48 hours. If your male cat is straining with little or no urine coming out, go straight to the vet.

Related article: [Medical Issues That Make Cats Pee Where They Shouldn’t] – a deeper dive into the physical causes of wee woes.

3. Bladder Stones and Crystals

These can irritate the bladder or even obstruct the urethra. Signs are similar to UTIs, and they’re more common than many people realise — particularly in certain breeds like Burmese or British Shorthair.

4. Chronic Kidney Disease (CKD)

One of the most common conditions in older cats. Symptoms include:

• Increased thirst
• Frequent urination
• Weight loss
• Bad breath
• Lethargy

These cats may not be avoiding the tray — they may just not make it there in time.

5. Arthritis

Older cats may find it physically difficult to climb into a high-sided tray or get to the usual litter location. This leads to accidents or deliberate avoidance.

6. Diabetes

Like CKD, diabetes leads to increased drinking and urination. A sudden spike in litter tray volume or new accidents should raise the alarm.

7. Cognitive Dysfunction (Cat Dementia)

In elderly cats, confusion can play a huge role. They may forget where the tray is, forget how to use it, or become disoriented during the night.

Behaviour or Medical? Sometimes It’s Both

Here’s the twist no one warns you about: medical issues can lead to behavioural problems.

If your cat had a painful bladder infection last month, they may now associate the litter tray with pain — even if the infection has cleared. The result? Ongoing accidents, stress, and frustration.

These cases need a dual approach: physical treatment and behavioural rehab.

What to Tell Your Vet

If you’ve booked a vet appointment, brilliant. But don’t just walk in saying, “My cat’s peeing everywhere.”

Bring helpful info:

• A urine sample (if possible)
• A timeline of changes (when it started, how often, any patterns)
• Changes in routine, diet, stress, or other cats
• Any other symptoms (thirst, appetite, weight loss)

If your vet doesn’t find anything obvious right away, push for a urinalysis and bloodwork — especially if your cat is over 7 years old. You know your cat better than anyone. If something feels wrong, trust your instincts.

When It’s an Emergency

Don’t wait for an appointment if:

• Your male cat is straining but not producing urine
• There’s visible blood in the urine
• Your cat seems lethargic, cries when touched, or hides excessively

These are critical emergencies. Delaying can mean permanent damage — or worse.

After the Vet: What Comes Next?

So, the vet’s ruled out illness — or you’ve treated the medical issue, but the peeing persists. Now what?

Now it’s time to look at the behavioural side. Because once pain becomes associated with the tray, you’ve got to rebuild trust. That means:

• Reviewing tray type, placement, and number
• Addressing stress or environmental triggers
• Using scent strategies to reset habits
• Possibly retraining your cat to use the tray

Sound daunting? It’s not — when you’ve got a plan.

Stop Cats Peeing: The Smart, Humorous Guide to Solving Inappropriate Urination in Pet Cats was written exactly for this reason. Real advice, real results, and plenty of laughs to get you through the wee wars.

Final Thought: Don’t Wait — Investigate

It’s easy to assume bad behaviour. It’s tempting to be annoyed. But inappropriate urination often starts as a cry for help — not rebellion. Cats don’t wee on your bed for fun. They’re trying to tell you something.

Your vet is your first ally in solving the mystery. The sooner you check, the sooner you can act — and the faster you and your cat can get back to a peaceful, pee-free life.