If you’re a cat lover, you’re probably hard-pressed to find anything but “purrfection” with these furry felines. Cats are cuddly but aloof, sweet but sassy, and independent but funny.

That’s right — cats are marvelous pets. Cats even groom themselves. They are generally very clean creatures. Clean, that is, until they decide not to use the litter box. Oops.

If your Fluffy is urinating outside the box, you’re not alone. Urinary issues are a frequent feline problem. This may be frustrating, but keep in mind that your cat is not a “bad cat” and is not doing this to spite you.

Be patient with your kitty. Resolving the problem involves identifying and addressing the underlying cause.

Sometimes, cats urinate outside the box because they are sick. Their bladders may hurt, or they may have kidney disease or diabetes.

Contrary to common belief, cats with urinary issues do not always have an infection. Urine tests can help determine if an infection is present and if antibiotics are indicated.

Painful bladders in cats may be caused by inflammation, crystals, infection, stones or tumors. Affected cats may urinate frequently, straining and crying out while doing so. They may seek cool surfaces such as tile floors or bathtubs. If your cat urinates on a white surface, you may notice that it is blood-tinged.

Your veterinarian can help identify what is causing your cat’s painful bladder. Urine tests, blood tests, and imaging with X-rays and ultrasound may be needed. It is important to identify the cause of painful bladder because each has a different treatment.

Bladder inflammation in cats is complex and often caused by stress. Activities such as rearranging furniture, having guests or adding a new pet can trigger stress-induced bladder inflammation. This brain-to-body signal is very real for Fluffy, causing the bladder wall to thicken and become painful and bleed.

For many cats with bladder inflammation, environmental enrichment can reduce their stress and help their bladders heal. The Ohio State University has researched this extensively and has information online at indoorpet.osu.edu.

Sometimes, bladder inflammation can be managed with dietary changes. Your veterinarian can recommend a therapeutic diet designed to help with bladder issues such as urine crystals.

Bladder stones mimic other causes of bladder discomfort. Imaging with X-rays or ultrasound is necessary to diagnose stones. Although treatment for bladder stones depends on the mineral composition of the stones, many cats with bladder stones require surgery to get better.

In addition to bladder pain, cats may decide not to use the litter box because they are not happy with the “bathroom” you have provided for them. Cats may be finicky about litter type. There are choices regarding scent, clumping ability and texture. Find a brand your cat likes, and stick with it.

If your Fluffy likes to dig in the litter, that’s a good sign that you’ve made a good litter choice. Cats that do their business in the box, then hop out and scratch outside are telling you they are barely tolerating your litter choice. In general, cats like clumping, unscented litter, so that’s a good place to start.

Cats can also be particular about their litter box. Many commercial litter boxes are too small. If your cat doesn’t like the box you have chosen, try using a bigger plastic storage bin. Older arthritic cats appreciate a box with lower sides because high sides may be too painful to climb over.

Even litter box location can be an issue. Don’t hide your litter box in an inconvenient place, such as the basement. Fluffy may think it’s not worth the effort to climb all the way downstairs and may choose your closet or guest room as an easy bathroom alternative. Basements can also be scary for cats, with furnaces powering on without warning. Find quiet, convenient litter locations for your cat to encourage Fluffy to use them.

Also make sure you have enough litter boxes. Adhere to the Golden Rule: one more box than there are cats in your home. Each box should be in a different location in the house. This increases convenience for your cat and prevents a dominant cat from guarding all the boxes at one time. Daily scooping is also important because cats do not like dirty litter.

If your cat is senior and abnormal urinating issues are a new problem, a complete medical workup is warranted. Arthritis is common in older cats and can make litter box access painful. Diabetes, kidney infections or other kidney disease can cause cats to produce more urine, and may manifest as accidents outside the box. Identifying illness early is important in managing the disease.

You can help Fluffy maintain her clean habits by providing good litter box options. If your kitty continues to avoid the box, it’s time to see your veterinarian.

Dr. Heidi Bassler practices at Bassler Veterinary Hospital at Crossroads Plaza in Salisbury. Do you have questions for her? Send them to heidibasslerdvm@comcast.net.