Cats conceal their pain. It’s an instinct from the earliest years of their evolution. Pain means weakness and vulnerability, and for a small animal who could easily become prey to a larger one, showing pain is a death sentence. Although our house cats are safe in our care and don’t have to worry about being eaten, that instinct is still there, so it’s up to us to understand their "tells" in order to get them the care they need. Here are four behavioral cues that may mean you’re dealing with a cat in pain.

1. Grumpiness

If your cat is growling at other pets and swatting them for trivial offenses, and generally acting as if she doesn’t want to have anything to do with anyone, she may be hurting. This behavior change can come on so slowly that even the most experienced cat caretaker can mistake it for a natural personality change that might occur with aging. For example, I knew my cat, Siouxsie, got grumpier than usual on cold, damp days because it aggravated her arthritis, but I had no idea that her generally crotchety nature was due to aching teeth until she had a dental cleaning that included extraction of three teeth with painful resorptive lesions. There hasn’t been a grumpy bone in her body since the worst of the postsurgical pain abated.

2. Neediness

A painful cat may become very needy and desperately seek you out for comfort. If your formerly independent cat is suddenly in your face at all hours of the day and night, she may be trying to tell you she’s hurting.

3. Not using the litter box

If your cat is hurting, she may avoid the litter box because she associates it with pain. An arthritic cat may not be able to climb into the box without great pain, or she may be unable to hold the "poop squat" position long enough to get all her waste inside the box. Urinating outside the box can be a sign of a urinary tract infection or cystitis (inflammation of the bladder).

4. Hiding

It’s pretty normal for cats to hide when the vacuum cleaner comes out or as a reaction to other frightening stimuli. But if your cat starts spending a lot of time in the closet or under the bed, she may be telling you she’s in pain.

Going back to Siouxsie again, a few days after her dental surgery she began spending all her time parked in one of my closets. Even though she was eating, Siouxsie has never hidden from anything in her life. Since that behavior was obviously abnormal, I brought her to the vet because I was concerned about her behavior change. It turned out that she was developing an infection in one of the tooth extraction sites, so she got antibiotics and she’s doing better now.

You’ll only see obvious physical signs of pain such as not eating, rapid breathing, or favoring a limb if your cat is in such severe pain that she can no longer hide it. It’s crucial to know your cat’s normal behavior so you can see the subtle changes that may mean your kitty is hurting. You’ll certainly help her feel better, and your quick action may even save her life.