Aloha! You're speaking with Dr. Michael Salkin
I'm sorry that your question wasn't answered in a timely manner. My moderator asked that I take a look at it because I have advanced training in feline behavior. I agree with you...her inappropriate urination is likely to be a behavioral problem rather than a medical one. If she's urinating nearby the box - on those pads you've been providing - she wants to use her box but has now associated it with an adverse event which isn't necessarily related to her urinary tract. The etiology can be difficult to diagnose, especially because the stimuli for her inappropriate eliminative behavior may be imperceptible to you because it occurred long before her current behavior - being frightened when urinating or suffering transient muscular cramping or hip pain when positioning to urinate, e.g. If emotional factors are influencing this behavior, you might notice other changes such as avoidance, aggression or an alteration in her general temperament.
Treatment involves two major considerations: 1) Remove the cause - easier said than done. You might have to be quite the detective to discern the stimuli for her inappropriate eliminative behavior 2) Prevent her from avoiding her box by confining her to a very small area with the box and only allowed out when she can be supervised 100% of the time. When confined to a relatively small area, most cats seem to prefer to eliminate in the box rather than soiling the floor. It’s then a matter of confining her long enough for a consistent habit to become established. As a rule of thumb, one week of confinement is usually recommended for every month of soiling. She should be removed from the confinement area as much as possible for socialization and play, but never allowed out of sight. Food
rewards may help when given after she uses her box. If she refuses to use the litterbox when confined to a small area, the confinement area should be changed to a large cage. The floor should be covered with litter, forcing her to use it for elimination. The litter is gradually removed and replaced with a litterbox. Once she has used the litterbox in a confined area for an appropriate amount of time, she can be allowed to have more freedom in the home.
The use of anxiolytic (anti-anxiety) medication such as paroxetine (Paxil) and fluoxetine (Prozac) might be considered. In fact, most behaviorists feel that without the use of psychotherapeutic drugs our chance of correcting this type of behavior is near nil. I admit that I'm not a fan of drugging these cats - particularly at her advanced age - and so I would first see if confining her as I mentioned will work.
Please respond with further questions or concerns if you wish.