One of the most perplexing conditions a dog owner can be faced with is
urinary incontinence. Urinary incontinence is the inability to hold urine
resulting in urine leakage, dripping and or pooling. This leakage can
become chronic and cause urine scalds. These scalds can lead to skin
infections, and skin infections can lead to kidney disease. Not only is
urinary incontinence unsanitary for the owner, it is unhealthy for the dog.
Urinary incontinence can be seen in both males and females. It can be associated with a
distended bladder, where the bladder is so full that the urine just leaks out on its own. This
is seen with disease or trauma to the spinal cord, or with urinary outflow obstruction (a bladder
stone or enlarged prostate blocking the way).
Urinary incontinence can also be seen with a small or normal sized bladder.
The bladder is normal sized but for some reason the urine drips out on its own.
This type of incontinence is seen with bladder inflammation, such as a bacterial infection.
It can also be seen as a result of congenital abnormalities where the bladder did not develop
properly. Such abnormalities include ectopic ureters, and persistent urachus. Normal sized
bladder incontinence can also be seen in post ovario-hysterctomized (spayed) bitches and
neutered males. This type of urinary incontinence is called hormone responsive incontinence.
Successful treatment of urinary incontinence depends on proper diagnosis.
Distended bladder incontinence can be diagnosed with complete physical and neurological
examinations along with radiographs and urinalyses. The presence of spinal cord lesion in the
areas of the nerves that effect the bladder function can help to diagnose the cause of the
incontinence. Likewise the presence of a stone in the uretha or a grossly enlarged prostrate
that is blocking urine flow from the bladder may help to diagnose the cause of distended bladder
incontinence. Treatment of distended bladder incontinence is aimed at removing the lesion
causing the distension. Although this may sound easy, the cause of causes of distended bladder
incontinence are often hard to determine.
Diagnosing the cause of normal size bladder incontinence starts with a thorough
history of the progression of the incontinence problem:
- When did the problem first appear?
- How long has the problem been going on?
- Has there been a change in food recently?
- Have you changed your job recently and cannot make it home as
frequently to let the dog out?
- Is there a new member to the household?
- Is the dog spayed or neutered?
If the problem has been going on since the puppy was brought home, there may be a chronic bladder
infection or there may be a congenital defect. This type of incontinence usually presents itself as
constant dripping and wet britches.
If there is a food change perhaps there is bladder inflammation due to a food sensitivity. If the bathroom
habits have changed perhaps there is an infection due to holding urine too long. If there is a new
member to the household, perhaps there is a bladder inflammation due to a bladder parasite. These
three types of incontinence present themselves as frequent attempts to urinate and only small dribbles
come out.
If the dog is spayed or neutered, perhaps there is urinary incontinence because of the change in
estrogen or testosterone levels post-surgically. The cardinal presentation of hormone dependent
incontinence is the dog that wakes up after a nap in a pool of urine and has no idea that it has urinated.
Diagnostic testing includes plain radio-graphs and dye studies of the bladder. Vainoscopy is useful.
Urinalysis with cultures are necessary. Complete blood counts and chemistries are helpful. As with
distended bladder incontinence, diagnosis will allow for the proper approach to treating normal sized
bladder incontinence.
How To Stop That Drip
Urinary incontinence is the inability of the bladder to retain urine. Urine retention is dependent upon:
- the normal expandability of the bladder wall,
- the ability of the neck of the bladder wall,
- and the normal structure of the urinary tract.
When any one of these three components is not functioning properly, urine can drip out of the bladder.
This leakage can cause urine scalding of the belly and the britches, and urinary infections.
TREATMENT:
SURGICAL: various surgical procedures have been used to treat urinary incontinence
with varying degrees of success. In the most common used procedure, colo suspension, the vagina is
sutured to the belly wall, compressing the neck of the bladder and directing it slightly toward the head of
the dog. This along with other surgical procedures, although appearing to be successful at first, usually
fail over time.
Any abnormality in the structure of the urinary tract that leads to incontinence must be corrected
surgically. The most frequently diagnosed problem is the ectopic ureter. When this occurs, the ureter
that carries the urine from the kidney to the bladder, enters the bladder behind the neck of the bladder.
The muscles in the neck of the bladder then contract in front of this ectopic ureter, not behind it. Because
of this, the ectopic ureter can continuously dribble urine.
A preventative surgical procedure that may lead to fewer cases of post spay incontinence, involves
removal of any remnants of the urachus that may persist in the adult female dog. The persistent urachus
is the tissue that often remains attached to the forward tip of the bladder and extends up to the umbilicus.
It represents part of the fetal-maternal urinary system. If this remains after spaying (or if it is present
before), urine may pool in the bladder leading to inflammation and/or infection. This inflammation can
decrease the expandability of the bladder leading to leakage.
MEDICAL: long-term medical treatment for incontinence has proved to be very effective in most cases.
The normal expandability of the bladder is affected by any irritant to the bladder wall, whether it is a
bacterial or yeast infection, a food allergy, a stone or a space occupying lesion (polyp or tumor).
Treatment is aimed at finding the cause of the irritant. Sterile cultures and sensitivities of the urine
should be done and appropriate antibiotic therapy should be instituted. Blood tests for food
hypersensitivities can determine if the inflammation of the bladder is a an allergy to the food the dog is
eating. Most allergy labs will then do a food matching search for each dog's individual food allergy. Just
switching to an appropriate food can resolve the inflammation in the bladder and allow for normal
expandability. Treatment for stones or space occupying lesions do require surgical intervention in most
cases.
The irritation of the muscles in the expanding bladder can also be helped with addition of anti-spasmodic
drugs. The most widely used in veterinary medicine are oxybutynin choride and dicyclomine
hydrochoride. Tolterodine tartrate (Detrol) has been used widely in human medicine. It may prove to be
helpful in veterinary medicine as well.
As with all therapies successful treatment starts with successful diagnosis. Whereas, the dog with
bladder expandability incontinence which show urgency to urinate and often frequent small urinations, the
dog with neck of the bladder incontinence will leave puddles after sleeping and often not realize it has
leaked urine. This type of incontinence is seen primarily in the post spay bitch. Medical treatment is
aimed primarily at enhancing the muscles in the neck of the bladder. Single drug or multiple drug
therapies have been used successfully. These therapies directly or indirectly affect the neuromuscular
receptors in the neck of the bladder.
Estrogen is used to increase the number of neuro-receptors in the neck of the bladder. By increasing the
number of neuro-receptors in the neck of the bladder a normal amount of nervous stimulation from the
brain and the spinal cord will cause a greater than normal contraction of the muscles in the neck of the
bladder. This increased contraction will squeeze the neck of the bladder closed tightly. Estrogen comes
in a variety of preparations. Among those available by prescription are Diethylstilbesterol, Premarin,
and Estriol. The dose range varies by individual as does the frequency of administration. Estrogen use
must be monitored carefully by the veterinarian. Side effects include overt signs of heat (estrus), bone
marrow suppression, hair loss, and behavioral changes.
Alpha agonists also work on the neuromuscular receptors in the neck of the bladder. Unlike estrogen
that increases the number of receptors to increase the response to brain and spinal cord stimulation, the
alpha agonists directly stimulate the receptors causing increase contraction. Although ephedrine and
psuedoephedrine have been used for urinary incontinence, the most widely used preparation in dogs is
pheylpropanolamine. Phenylpropanolamine is available from PRN Pharmaceutical under the brand
name Proin. It is no longer available in the human pharmaceutical market. As with estrogens, the dose
range is wide. Whereas, estrogen can often be administered two or three times daily. There are side
effects associated with the use of alpha agonists. They include loss of appetite, weight loss,
restlessness, stomach upsets and a fast heart rate.
It is already obvious from the above, that the use of each drug group individually can help treat urinary
incontinence associate with inadequate closure of the muscles in the neck of the bladder. The
combination of the estrogens with the alpha agonists can also be effective in treating incontinence. The
estrogens will increase the number of neuro-receptors in the neck of the bladder and the alpha agonists
will increase the stimulation of the neuro-receptors. The two drug groups can act synergistically to close
the neck of the bladder and aid in urine retention. They can stop the drip. Since the dose ranges are so
variable, it is often frustrating to the dog owner to continually adjust the drugs until the appropriate
dosages are determined.
- Treatment of urinary incontinence is possible.
- Determining the cause will lead to proper treatment.
- Remember, this condition requires treatment, NOT PUNISHMENT.
Article by Dr. Cindi Bossart, DVM
Incontinence may affect any animal for various reasons.
From The White Collie Chronicle Newsletter
Apri/May/June 2003 Volume 8, Issue 2
urinary incontinence. Urinary incontinence is the inability to hold urine
resulting in urine leakage, dripping and or pooling. This leakage can
become chronic and cause urine scalds. These scalds can lead to skin
infections, and skin infections can lead to kidney disease. Not only is
urinary incontinence unsanitary for the owner, it is unhealthy for the dog.
Urinary incontinence can be seen in both males and females. It can be associated with a
distended bladder, where the bladder is so full that the urine just leaks out on its own. This
is seen with disease or trauma to the spinal cord, or with urinary outflow obstruction (a bladder
stone or enlarged prostate blocking the way).
Urinary incontinence can also be seen with a small or normal sized bladder.
The bladder is normal sized but for some reason the urine drips out on its own.
This type of incontinence is seen with bladder inflammation, such as a bacterial infection.
It can also be seen as a result of congenital abnormalities where the bladder did not develop
properly. Such abnormalities include ectopic ureters, and persistent urachus. Normal sized
bladder incontinence can also be seen in post ovario-hysterctomized (spayed) bitches and
neutered males. This type of urinary incontinence is called hormone responsive incontinence.
Successful treatment of urinary incontinence depends on proper diagnosis.
Distended bladder incontinence can be diagnosed with complete physical and neurological
examinations along with radiographs and urinalyses. The presence of spinal cord lesion in the
areas of the nerves that effect the bladder function can help to diagnose the cause of the
incontinence. Likewise the presence of a stone in the uretha or a grossly enlarged prostrate
that is blocking urine flow from the bladder may help to diagnose the cause of distended bladder
incontinence. Treatment of distended bladder incontinence is aimed at removing the lesion
causing the distension. Although this may sound easy, the cause of causes of distended bladder
incontinence are often hard to determine.
Diagnosing the cause of normal size bladder incontinence starts with a thorough
history of the progression of the incontinence problem:
- When did the problem first appear?
- How long has the problem been going on?
- Has there been a change in food recently?
- Have you changed your job recently and cannot make it home as
frequently to let the dog out?
- Is there a new member to the household?
- Is the dog spayed or neutered?
If the problem has been going on since the puppy was brought home, there may be a chronic bladder
infection or there may be a congenital defect. This type of incontinence usually presents itself as
constant dripping and wet britches.
If there is a food change perhaps there is bladder inflammation due to a food sensitivity. If the bathroom
habits have changed perhaps there is an infection due to holding urine too long. If there is a new
member to the household, perhaps there is a bladder inflammation due to a bladder parasite. These
three types of incontinence present themselves as frequent attempts to urinate and only small dribbles
come out.
If the dog is spayed or neutered, perhaps there is urinary incontinence because of the change in
estrogen or testosterone levels post-surgically. The cardinal presentation of hormone dependent
incontinence is the dog that wakes up after a nap in a pool of urine and has no idea that it has urinated.
Diagnostic testing includes plain radio-graphs and dye studies of the bladder. Vainoscopy is useful.
Urinalysis with cultures are necessary. Complete blood counts and chemistries are helpful. As with
distended bladder incontinence, diagnosis will allow for the proper approach to treating normal sized
bladder incontinence.
How To Stop That Drip
Urinary incontinence is the inability of the bladder to retain urine. Urine retention is dependent upon:
- the normal expandability of the bladder wall,
- the ability of the neck of the bladder wall,
- and the normal structure of the urinary tract.
When any one of these three components is not functioning properly, urine can drip out of the bladder.
This leakage can cause urine scalding of the belly and the britches, and urinary infections.
TREATMENT:
SURGICAL: various surgical procedures have been used to treat urinary incontinence
with varying degrees of success. In the most common used procedure, colo suspension, the vagina is
sutured to the belly wall, compressing the neck of the bladder and directing it slightly toward the head of
the dog. This along with other surgical procedures, although appearing to be successful at first, usually
fail over time.
Any abnormality in the structure of the urinary tract that leads to incontinence must be corrected
surgically. The most frequently diagnosed problem is the ectopic ureter. When this occurs, the ureter
that carries the urine from the kidney to the bladder, enters the bladder behind the neck of the bladder.
The muscles in the neck of the bladder then contract in front of this ectopic ureter, not behind it. Because
of this, the ectopic ureter can continuously dribble urine.
A preventative surgical procedure that may lead to fewer cases of post spay incontinence, involves
removal of any remnants of the urachus that may persist in the adult female dog. The persistent urachus
is the tissue that often remains attached to the forward tip of the bladder and extends up to the umbilicus.
It represents part of the fetal-maternal urinary system. If this remains after spaying (or if it is present
before), urine may pool in the bladder leading to inflammation and/or infection. This inflammation can
decrease the expandability of the bladder leading to leakage.
MEDICAL: long-term medical treatment for incontinence has proved to be very effective in most cases.
The normal expandability of the bladder is affected by any irritant to the bladder wall, whether it is a
bacterial or yeast infection, a food allergy, a stone or a space occupying lesion (polyp or tumor).
Treatment is aimed at finding the cause of the irritant. Sterile cultures and sensitivities of the urine
should be done and appropriate antibiotic therapy should be instituted. Blood tests for food
hypersensitivities can determine if the inflammation of the bladder is a an allergy to the food the dog is
eating. Most allergy labs will then do a food matching search for each dog's individual food allergy. Just
switching to an appropriate food can resolve the inflammation in the bladder and allow for normal
expandability. Treatment for stones or space occupying lesions do require surgical intervention in most
cases.
The irritation of the muscles in the expanding bladder can also be helped with addition of anti-spasmodic
drugs. The most widely used in veterinary medicine are oxybutynin choride and dicyclomine
hydrochoride. Tolterodine tartrate (Detrol) has been used widely in human medicine. It may prove to be
helpful in veterinary medicine as well.
As with all therapies successful treatment starts with successful diagnosis. Whereas, the dog with
bladder expandability incontinence which show urgency to urinate and often frequent small urinations, the
dog with neck of the bladder incontinence will leave puddles after sleeping and often not realize it has
leaked urine. This type of incontinence is seen primarily in the post spay bitch. Medical treatment is
aimed primarily at enhancing the muscles in the neck of the bladder. Single drug or multiple drug
therapies have been used successfully. These therapies directly or indirectly affect the neuromuscular
receptors in the neck of the bladder.
Estrogen is used to increase the number of neuro-receptors in the neck of the bladder. By increasing the
number of neuro-receptors in the neck of the bladder a normal amount of nervous stimulation from the
brain and the spinal cord will cause a greater than normal contraction of the muscles in the neck of the
bladder. This increased contraction will squeeze the neck of the bladder closed tightly. Estrogen comes
in a variety of preparations. Among those available by prescription are Diethylstilbesterol, Premarin,
and Estriol. The dose range varies by individual as does the frequency of administration. Estrogen use
must be monitored carefully by the veterinarian. Side effects include overt signs of heat (estrus), bone
marrow suppression, hair loss, and behavioral changes.
Alpha agonists also work on the neuromuscular receptors in the neck of the bladder. Unlike estrogen
that increases the number of receptors to increase the response to brain and spinal cord stimulation, the
alpha agonists directly stimulate the receptors causing increase contraction. Although ephedrine and
psuedoephedrine have been used for urinary incontinence, the most widely used preparation in dogs is
pheylpropanolamine. Phenylpropanolamine is available from PRN Pharmaceutical under the brand
name Proin. It is no longer available in the human pharmaceutical market. As with estrogens, the dose
range is wide. Whereas, estrogen can often be administered two or three times daily. There are side
effects associated with the use of alpha agonists. They include loss of appetite, weight loss,
restlessness, stomach upsets and a fast heart rate.
It is already obvious from the above, that the use of each drug group individually can help treat urinary
incontinence associate with inadequate closure of the muscles in the neck of the bladder. The
combination of the estrogens with the alpha agonists can also be effective in treating incontinence. The
estrogens will increase the number of neuro-receptors in the neck of the bladder and the alpha agonists
will increase the stimulation of the neuro-receptors. The two drug groups can act synergistically to close
the neck of the bladder and aid in urine retention. They can stop the drip. Since the dose ranges are so
variable, it is often frustrating to the dog owner to continually adjust the drugs until the appropriate
dosages are determined.
- Treatment of urinary incontinence is possible.
- Determining the cause will lead to proper treatment.
- Remember, this condition requires treatment, NOT PUNISHMENT.
Article by Dr. Cindi Bossart, DVM
Incontinence may affect any animal for various reasons.
From The White Collie Chronicle Newsletter
Apri/May/June 2003 Volume 8, Issue 2
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| " Drip, Drip, Drip " |
by Dr. Cindi Bossart, DVM, Argent Collies, USA
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