Cat peeing on the sofa

We've been having this problem off and on for weeks now. My 3 and 1/2 year old cat, who is otherwise very well behaved, started peeing in places she shouldn't. At first, I noticed she was going to a room which we normally don't use, and since this cat's pee isn't strong smelling, I had no idea this was going on until one day I went into this room to do dusting and discovered sticky stuff on top of the table! I cleaned it all thoroughly and closed the room off completely. Then she started peeing on my leather loveseat in the living room. Another issue with her is that she throws her food up a lot, not every day, but more often than I've seen in other cats I've owned before. We went to the vet. They did a urine test and found crystals in her urine and elevated PH. Gave her antibiotics. While on the meds, she stopped peeing on the sofa and went back to the litterbox. The moment the meds ran out, two days later - back to the sofa. So we went back to the vet and back on the meds. Same story - no pee until the meds ran out. This went on three times! We changed her diet to urinary tract diet. First to over the counter urinary tract diet - helped for a little while - no pee on the sofa, no throwup, then back to the same thing. Changed to prescription diet, did an x-ray, another urinary analysis. All checked out normal on the test - good x-ray, no stones, no more crystals, no fever, and PH went back to normal. Prescription diet helped for 2 weeks. Now we are back to peeing on the sofa and throwing her food up every other day (not digested, and this happens soon after she eats, though not every day). I covered the sofa with plastic and sprinkled black pepper all over it. So frustrating! Black pepper and all - today she went back on it. 

We have three litter boxes in the house for her to choose from, all in easy access. She gets plenty of water. I feel like we've tried everything, and three vets at the clinic have looked at her and feel puzzled. Now they are talking about this being behavioral issue. I am not convinced, or maybe in denial. But I just want this household to get back to normal and my cat to start feeling like old self. Obviously if the meds have helped before and the diet helped temporarily, this says to me that the issue is medically related. I've been told also that she may have to end up being an outside cat. I've never owned an outside cat before and this isn't something I want to start. 

Any thoughts?

Thank you!

Since she uses the litter box when she feels fine, I don't think it's a behavioral problem. She is probably trying to tell you something, and there's no other way she can let you know.  If she is forming struvite crystals, her bladder is probably irritated.  Urinary pH changes throughout the day and is influenced by what a cat eats.

Eating meat and fat produces urine that is acidic, which is good.  Eating carbohydrates (grains, potatoes, starches, veggies, fruits) produces an alkaline urine which is the perfect solution for struvite crystals to form in.  Cats eating a meat based low carb wet food diet produce urine that is slightly acidic (pH 6.0 to 6.5) struvite crystals cannot form in an acidic solution, and in fact those that already formed when the urine was too alkaline will dissolve in it. 

I would suggest you try a low carb, primarily wet food diet which will naturally lower her urine pH and prevent her having crystals.  Most of the prescription diets, especially the dry food ones, are still full of carbs and short on real meat, but they add urinary acidifiers so you get quick results but as soon as you return to the original food, the problem returns. 

I have a cat that two vets had given up on because of recurring urinary problems and will send you her story by private message (it's long).  There were a few emergency measures I used at first, since she was a dry food addict and it took a little while to get her changed over to completely wet food (now she can have 6 or so pieces of Iams dry food on top of her wet meals, which keeps her happy).  It has been over a year and the problem has not returned.  She gets only PATE wet food (nothing with gravy as that is usually made up with some form of starch), Beech Nut baby food chicken or turkey mixed in (Gerbers adds corn starch to all their baby food meat!) and I use Sheba, 4Health Grain Free Turkey & Giblets (from Tractor Supply). Friskies poultry platter and Abound Turkey & Giblets (from Kroger). 

Thank you for your very informative post and the PM! I am definitely now switching her to canned food. She loves her dry food, but would eat canned if that's all she is given. 

One thing i have found that clears up crystals fast and effectively is a very mild solution of apple cider vinegar and cranberry juice strongly diluted with water. I used to give my cat a med size syringe of it when i noticed any problems and it was an almost instant cure.  I would mix around one cap full of a.c.v with around 2 cap fulls of cranberry juice in a normal sized coffee cup and then fill the rest with water.
 

Red Top is right though in that for the long term diet is key to controlling this problem. The food available at the supermarket is nasty for provoking this. Even the wet food they offer caused my cat problems. Once i put him on a prescription diet (royal canin s/o) his problem completely vanished. The good part was it cost only slightly more than the rubbish the supermarket offered. I noticed you already tried prescription diet. Was it wet food or dry? which brand?

The prescription diet we got that the vet prescribed is Hill's C/D for urinary health. Since our cat is a dry food addict, we got her dry food initially. She loved it, and for several weeks we were pee and throw up free. Two days ago though she had another accident and threw up the food undigested again, so it must not be helping anymore. Today we went back to the store and got her the same prescription diet, but this time in canned form. I looked on the label, and it is chicken vegetable stew. The other choice was chicken and rice, and after reading Red Top Rescue's post above I decided to avoid the rice. We'll see how this goes. Maybe she does better on wet prescription diet.

Thank you both for your very helpful comments!

Update: Well, she took one bite, maybe two of her wet diet and turned her nose up. How do you make a switch between dry and wet diets? She took that bite, then walked over to my other cat and stood there looking longingly at the other cat eating her dry food. 

I also used the cd for my cat to start with. He didn't like it at first but he started to eat it once he learned nothing else was coming. Maybe you could try another brand? Mine prefer royal canin s/o over the hills stuff.
Mine also prefer the dry food but they also sometimes seem to throw up on it. One thing you could try is mixing the food with something you know they like. As long as they are getting that prescription stuff in there somehow it will do it's job. The aim is to get the ph balance right and even a small amount of the prescription food should be able to do that.

The CD didn't work for my cat either. I found his struvite is caused due to stress/ hormones

  not diet related. My cat is now on Ovarid and it has solved his peeing problem. Side effect is weight gain and it could also cause diabetes though. So i am looking for another hormone alternative.

Wow that's interesting. My vet never mentioned that could be a cause. I was under the impression that it was 100% about ph balance and the only solution was to raise the acidity levels in the urine and balance out the alkaline ph via food. I had no idea hormones could also throw off the ph balance.

Did your cat have other symptoms that brought your vet to that conclusion? perhaps Happypaws pet has similar problems.

I tried Feliway, CD food, Endep anxiety medication, giving him more water to drink, salt in his food. Nothing helped.   Ovarid has solved every problem, but now he has gained 2kilo in weight

He is desexed and still thought he was a Tom Cat. Very teritorial.

Salt  has fairly strong alkalising effects so i would definitely avoid that. When you say he was very territorial and you tried feliway is that because he was spraying a lot? 

When my guy had issues he would pee blood with the urine and you could physically see crystals around the genitals afterwards. Never did any sort of spraying though.

Raising their water intake should definitely help with flushing but not for balancing out the ph. 
I don't know anything about Ovarid though. I have only had experience with crystals forming due to diet. The apple cider vinigar,cranberry juice and water was a life saver for my guy, maybe even literally. It stopped blockages a number of times but obviously a better solution is needed long term.

I lived next door to my friend once and her cat was very very territorial. He sprayed EVERYTHING and fought with all the cats in the neighbourhood. We had to work out a schedule for when her cat would be locked in so i could let mine out. Even then there were a couple of times where he got out and tore my cat to pieces, cost me hundreds in vet bills! When they moved house all that behaviour stopped and now he is as gentle as can be. We tried everything on that guy to calm him down but nothing worked. I think in the end it was that he had a problem with one of the cats in the area and felt threatened.

He was spraying a lot. Fighting, When he got an infection, when he did quite often, his wee was red with blood. He was eating CD canned food  for two years and it didn't help. We avoided dry food too.

PS I also feed him Kangaroo mince now

There was an interesting article in Catster magazine I just bought. It said that the water we give to the cats can also affect their urinary tract, and that hard water could cause problems. We live in hard water area. I hate the way our regular tap water tastes and we usually buy bottled water. I went to the store today and got a gallon of natural spring water to use for the cats. At this point I am willing to try anything.