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Rule out medical causes first
Why the vet comes first
Cats don't avoid the box to spite anyone. Painful urination, an upset gut, or joints that hurt when climbing into a tray all push a cat to go somewhere easier - and no amount of box rearranging fixes a bladder that hurts. Cornell's house-soiling guidance is direct about it: medical problems come first in the workup, because treating a health problem as a behavior problem wastes time while the cat stays uncomfortable.
Medical issues vets commonly look for
Signs that make it urgent
Some house-soiling cases are emergencies, not routine appointments. Straining to urinate with little or nothing coming out, repeated trips to the box, or crying out while urinating - especially in a male cat - can mean a urinary obstruction, which Cornell calls an absolute emergency needing immediate veterinary treatment. Blood in the urine also needs a vet visit. If your cat seems unwell in any other way, or you are in doubt, call the vet promptly and describe what you're seeing.
What to bring to the appointment
A short written record beats a nervous retelling: when the accidents happen, where, urine or stool, and any changes in drinking, appetite, or energy. The accident log on this site keeps exactly that record on your phone or computer, and prints cleanly for the visit. It also helps to note whether the cat still uses the box sometimes - partial use can be a useful clue.
If the vet gives the all-clear
Then it's a setup or stress problem, and those are very fixable. Work through box count, size and placement, litter choice, and cleaning habits next, in that order - and read stress and territory if anything at home has changed recently.