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70 CANINE HOUSE SOILING: BACK TO BASICS PEER REVIEWED • Every 2 to 3 hours • Immediately upon waking and before confinement • Within 10 to 15 minutes of meals and playtime Use of positive reinforcement—for example, giving a treat immediately after elimination in the desired location—can further strengthen preferences for elimination at the desired location. If the dog or puppy is caught in the act of eliminating indoors, the owner can attempt to interrupt by clapping or whistling, and then immediately bringing the pet to the desired location. Counsel clients to avoid verbal or physical punishment because it can cause fear, anxiety, and aggression and does not teach the dog or puppy where to eliminate. Any soiled indoor sites should be thoroughly treated with an odor-eliminating or enzymatic cleaner as residual odor may encourage resoiling. Once the dog has not soiled indoors for at least 8 weeks, the frequency of scheduled elimination trips and stringency of supervision can be gradually reduced. DIAGNOSTIC DIFFERENTIALS Medical conditions should be the top differentials for soiling in puppies refractory to house training, cases with acute onset, or soiling in adult and geriatric dogs that were previously house trained. Conditions that can contribute to house soiling include anything that increases the urgency or frequency of elimination, causes pain on elimination, or affects mobility or voluntary control of elimination. Cognitive dysfunction syndrome is a common condition affecting senior dogs that may result in loss of house training via progressive decline in cognitive functioning. 5,6 Lack of house training is a common behavioral cause of house soiling. 5,6 Soiling occurs for the purpose of relieving pressure on the bladder or bowels. Learned preferences for one or more indoor elimination sites may develop as elimination is a self-reinforcing behavior. Urine marking is elimination for the purpose of communication. 5,6 When urine marking, dogs typically deposit small amounts of urine on vertical surfaces. This behavior is most common in intact male dogs 5,6 but can be observed in intact females and neutered males and females. Urine marking may also be a sign of anxiety, triggered by stressful situations or territorial threats. Excitement or submissive urination occurs during interactions with other animals, including humans. In this context, a rapidly wagging tail or signs of appeasement, such as lip licking, lowered head, and caudally deflected ears, accompany urination. Excitement or submissive urination is most common in puppies 6 and young female dogs. 5,7 Fear and anxiety disorders that may result in house soiling include separation anxiety, noise aversions, and fear of the outdoors. 7 Dogs with separation anxiety may soil during even brief owner absences, whereas dogs with noise aversion may do so during loud noise events, such as thunderstorms or fireworks. Dogs with noise aversion or fear of the outdoors may refuse to go outdoors to eliminate, or their emotional state may prevent or interrupt complete elimination when outdoors. Treatment of the primary condition can help to decrease the frequency or resolve the house soiling. HISTORY A thorough history helps to differentiate these conditions. Specific questions to focus on include the following: • Who is soiling? In multidog/multianimal households, avoid making assumptions. If the soiling occurs only in the owner's absence, using a video camera to monitor the soiled area can definitively determine the culprit and ensure the correct patient receives treatment. • What is it: urine, feces, or both? Domestic dogs rarely mark with feces, so the presence of stool suggests a medical condition, lack of house training, or a fear or anxiety disorder. • Where is the dog soiling? A consistent location or surface pattern suggests lack of house training, 8 while in the author's experience an inconsistent pattern of soiling throughout the home may indicate a response to fear or anxiety. • When does the soiling occur, and are there identifiable triggers? Is the owner present, absent, or both? Soiling only in the absence of the owner, even for brief periods, suggests separation anxiety, while soiling during owner interactions suggests excitement or submissive urination. 5,6 Determining the frequency of house soiling will also establish the baseline with which to measure treatment success. • How does the timing of soiling relate to opportunities to eliminate and meal times? Learned preferences for indoor sites may develop when