Next to teaching your dog to do Kegel exercises, what do you do about urinary incontinence in dogs and leakage?

If your dog’s leaving little puddles of urine around the house, it it’s probably not just bad behavior. 

Whether it’s due to old age, injury or illness, incontinence is no fun for anyone. When your dog can’t hold her urine, accidents happen. 

So let’s talk about the possible causes of your dog’s incontinence, and what you can do to help her (and yourself). 

Urinary Incontinence In Dogs

Urinary incontinence in dogs, means your dog has the inability to retain urine in his bladder … in other words, bladder leaks. 

The urinary system is quite elegant. Urine is produced by the kidneys and fed through the ureters to the bladder. A sphincter (circular muscle) keeps the passage to outside closed until it’s voluntarily opened during urination. At that point, urine flows through the urethra to whatever object your dog decides to gift with his or her scent. 

When the sphincter doesn’t stay fully tightened, involuntary leakage occurs. If the bladder is too full, urine can overflow into the urethra and escape. This often happens while your dog is resting or sleeping, or when she gets up from lying down. 

Dribbling urine can also be a behavior issue if it happens when your dog is frightened or being submissive. 

Signs Of Incontinence In Dogs

I probably don’t need to tell you how you’ll know your dog is incontinent. It’s usually pretty obvious!  

The most common sign of urinary incontinence in dogs is wet spots wherever your dog sleeps. 

You might also notice …

  • Dampness around the hindquarters and thighs 
  • Dribbling urine as she walks
  • Irritated skin or redness from the dripping (urine is caustic and can burn)
  • Licking the vulva or penis more than usual 
  • Dribbling urine when she is excited, frightened, submissive, or stressed 

What Causes Incontinence In Dogs

There are many potential causes and contributors to incontinence, including:

What this adds up to is the need for adequate testing to pin down an accurate diagnosis.

Breeds Prone to Incontinence

Research shows that females are more prone to urinary incontinence in dogs than males. Two UK studies found that urinary incontinence affects 3% of females overall, but more than 15% in high risk breeds. These include …

  • Irish Setter
  • Doberman
  • Bearded Collie
  • Rough Collie
  • Dalmatian

Prevalence in males is less than 1%, with breeds affected including … 

  • Bull Mastiff
  • Irish Red Setter
  • Fox terrier
  • Bulldog
  • Boxer

Spay/Neuter Increases Incontinence

Urinary incontinence in dogs is more likely in spayed females, especially if they’re spayed early.  One study of 492 female dogs concluded that …

“Neutering itself and early-age neutering (<6 months) are major risk factors for early-onset urinary incontinence.”

Another study found that size was a factor in spayed females developing USMI (urinary sphincter incompetence). For every month neuter was delayed in the dogs’ first year, the risk of USMI was reduced in dogs weighing over 25 kg. The risk did not change for dogs under 15 kg.

So, if you decide to spay your dog of 50 lbs or more, it’s best to defer the procedure as long as you can. 

RELATED: Read about other risks of early spay/neuter.

How Vets Diagnose Incontinence

Your vet will do (at least) a thorough physical exam, standard blood tests and urinalysis. 

If these tests don’t point to an answer, your vet may do more specialized blood tests, urine culture, radiographs, ultrasound, or other types of scans. 

If leaks started when your dog was very young, and the vet suspects an anatomical abnormality like ectopic ureter (see below), she may do a dye “urography” that traces the course of the ureter.  

You want to determine the cause of your dog’s incontinence so you can treat it appropriately.  For example … 

  • An older spayed female dog is most likely to have estrogen-responsive incontinence from spaying. But you don’t want to waste time and money treating that when the real problem may be something else that requires very different therapies. 
  • Ectopic ureters or other anatomical issues may be corrected with surgery.
  • Incontinent dogs are more likely to develop urinary tract infections. That’s because the presence of urine in the urethra can provide a route for bacteria to climb up to the bladder and set up housekeeping.
  • If the problem is a urinary tract infection or uroliths (stones), then resolving that problem may quickly take care of the incontinence. 
  • The same applies to hormonal issues that can be treated appropriately.

PRO TIP

Before we get to the details, my #1 recommendation for any kind of bladder problem is protect your stuff! Managing a dog with incontinence, a UTI, or inappropriate urination for any reason is unpleasant and frustrating.

Waterproof dog beds and washable pee pads make clean-up easy and convenient. If your dog sleeps on the bed, at the very least get a waterproof mattress pad, and perhaps a flannel or comfy waterproof flat sheet to put over the covers. Temporary use of doggy diapers may also reduce the emotional toll on the human family. 

Conventional Treatments For Incontinence

There are several conventional approaches to treating incontinence problems. 

Phenylpropanolamine (Proin®, Propalin®)

This drug releases chemicals that strengthen the bladder sphincter muscles. It’s not a cure … so if your dog stops taking it, she’ll go back to leaking urine. 

Side effects in the manufacturer’s clinical trials included …

  • Vomiting
  • High blood pressure
  • Diarrhea
  • Lack of appetite
  • Weight loss
  • Proteinuria (protein in the urine)
  • Excessive thirst
  • Restlessness or difficulty sleeping
  • Irritability or anxiety
  • Lethargy

Some more serious side effects can occur, usually at higher dosages. These include cardiac issues, tremors and difficulty urinating. 

At low doses the risk of side effects is minimal, so some holistic vets may use this drug along with other alternative therapies. 

Estrogen (Estriol/Incurin, DES)

This synthetic estrogen drug is often used for females with spay incontinence.  It comes with quite a list of side effects. Studies show adverse effects like …

  • Vomiting
  • Swollen/itchy vulva
  • Lethargy
  • Aggression (leading to euthanasia in some cases)
  • Hyperpigmentation and lichenification of vulva (black skin spots and thickened skin)
  • Hair loss
  • Vaginal hemorrhage
  • Seizures

Those are quite unpleasant side effects. But this drug also has some even more serious risks. It may cause cancer and bone marrow toxicity. There are good non-pharmaceutical substitutes.

Surgery To Correct Anatomical Abnormalities

If your dog’s incontinence is caused by an anatomical abnormality, your vet may recommend surgery. 

The most likely kind of abnormality is ectopic ureter. It’s fairly rare, with reported incidence of less than 0.1%. 

The ureters transport urine from the kidneys to the bladder. Ectopic ureter means that one or both ureters by-pass the bladder and connect to the urethra, uterus or vagina. This can cause continual dripping of urine. 

This problem is usually seen in 3 to 6 month old dogs, and females are 8 times more prone than males. 

High risk breeds for this problem are …

  • Siberian Husky 
  • Miniature and Toy Poodle
  • Labrador Retriever
  • Collie
  • Welsh Corgi
  • Wire-haired Fox Terrier
  • West Highland White Terrier

This condition may be corrected with surgery to redirect the ureter into the bladder. 

A less invasive method is cystoscopic-guided laser ablation. It’s done under anesthesia and involves inserting a ureteral catheter into the ectopic ureter. A laser then “ablates” (removes) the wall of the ureter. This effectively moves the opening from the urethra to the bladder. One study showed a 47% success rate for this procedure.

PRO TIP

However you decide to treat your dog’s incontinence … adjust and increase your dog’s potty break time. This will help reduce the amount of urine in the bladder at any one time.  Make sure she goes out to pee before you leave for work or school, and right before bedtime.

Natural Treatments For Incontinence

These are some of my favorite alternative approaches for urinary incontinence In dogs. 

Chiropractic, Acupuncture, And Osteopathy

These hands-on treatments are excellent choices that can be very successful in resolving incontinence. They’re especially effective if urinary incontinence in dogs is due to physical issues like spine misalignment, muscle spasms, or nerve injury or impairment.

Read how to find a practitioner under the “Find A Holistic Vet” section below. You may also be able to find a local veterinary rehab facility that offers these modalities. 

Herbs And Nutraceuticals

These are some effective options, depending on the cause of your dog’s incontinence. 

  • Wild Yam extract has estrogenic and anti-spasmodic effects, but may require fairly high doses (100 mg per 25 lbs. body weight). It’s often included in herbal blends with Rehmannia, licorice, red clover, cranberry, and other herbs. Follow package directions for products intended for dogs. If using a human product, the dose is based on a 150 lb person, so reduce the dose proportionally for your dog’s weight.
  • Soy isoflavones are the best natural substitute for estrogen, but be sure you choose an organic product, since most soy in the U.S. is GMO (genetically engineered). Vetriscience Vetri-Bladder chews are a good choice; give 1 chew per 30 lbs. body weight once a day. The same dose applies to their canine Bladder Strength tablet, which also contains supportive herbs.
  • Estroven® contains Rheum raponiticum extract. he dose is based on a 150-lb person, so reduce the dose proportionally for your dog’s weight. It may work by itself or need to be combined with estrogenic herbs. Estrogenic herbs include soy, Mexican wild yam, black cohosh, dong quai, red clover.  It’s best to ask a holistic vet or herbalist for help using these herbs. 
  • Herbs that are good for urinary tract infections (if that’s the cause of your dog’s leakage) include cranberry, ginger, turmeric, olive leaf, and uva ursi. Cranberry prevents E. coli bacteria from attaching to the bladder wall; olive leaf has antibiotic properties; uva ursi is antiseptic and anti-inflammatory; turmeric and ginger are great antioxidant and anti-inflammatory herbs. They are available in a wide variety of combinations, usually with other natural antioxidants.
  • Anti-arthritic herbs, such as turmeric, ginger, Boswellia, yucca, and barberry, have antioxidant and anti-inflammatory effects. Antioxidants work best in combination; many such products are available, but my favorite (which I take myself!) is Boswellia Complex by Standard Process. A small or medium size dog can take 1/2 tablet twice a day; for large and giant breeds, give a whole tablet twice a day. CBD also relieves pain and may be a good adjunct.
  • Chinese herbs are very useful; but it’s important to work with a veterinarian trained and experienced in Traditional Chinese Veterinary Medicine. These herbs are powerful, and appropriate formulas must be individualized for your dog.
  • Glandular support. Here again, Standard Process shines. Symplex F is excellent as a replacement for hormones missing due to spaying. Symplex M is for neutered male dogs. Both products also support the thyroid, adrenal, and pituitary glands. Both synergize well with Vasculin, which contains a multitude of herbs and vitamins that support healthy blood vessel and nerve function.
  • Omega-3 fatty acids from a marine source have antioxidant and anti-inflammatory properties. 
  • Protein and collagen are both important for any muscle, including the bladder sphincter. The bladder itself is also a muscular organ. Protein is also a natural urinary acidifier. Bone broth and a higher protein diet may be helpful. 

Homeopathy

A good homeopath can work virtual miracles. There are many remedies indicated for urinary incontinence in dogs, but it’s important to work with a qualified homeopathic veterinarian. The choice of remedy and potency must be highly individualized for not only incontinence, but also for the dog’s personality, environment, history, and many other factors. 

I have seen homeopathy restore bladder and bowel control in a dog who had been hit by a car, after months of unsuccessful medical management. Find a homeopath at The Academy of Veterinary Homeopathy (AVH)

RELATED: Homeopathy Basic For Dogs

The next two approaches are newer and less common, but worth exploring with your holistic vet. Studies show promising results with these therapies. 

Botulinum Toxin Injections

Research has found that injections of Clostridium botulinum toxin into the bladder wall (50-100 botulinum toxin units per animal in 10 injections) successfully prevented recurrence of incontinence in dogs for up to 5 months. 

Electrical Stimulation

Researchers are currently experimenting with implants that provide electric stimulation to the nerves in dogs with a spinal cord injury. While it’s not likely to be coming to your local veterinary clinic, veterinary teaching hospitals may incorporate it in the not-too-distant future.

Support Your Dog’s Overall Health

Finally, as with all chronic health problems, it’s important to keep your dog as healthy overall as you can. 

Not all incontinent dogs can be completely cured. But with the right management and therapies, it can be well controlled … so you and your dog can enjoy a long, happy, and puddle-free life together.

References

O’Neill DG et al. Urinary incontinence in bitches under primary veterinary care in England: prevalence and risk factors. J Small Anim Pract. 2017 Dec;58(12):685-693. 

Hall JL et al. Urinary incontinence in male dogs under primary veterinary care in England: prevalence and risk factors. J Small Anim Pract. 2019 Feb;60(2):86-95

Pegram C et al. Associations between neutering and early-onset urinary incontinence in UK bitches under primary veterinary care. J Small Anim Pract. 2019 Dec;60(12):723-733. 

Byron JK et al. Urethral Sphincter Mechanism Incompetence in 163 Neutered Female Dogs: Diagnosis, Treatment, and Relationship of Weight and Age at Neuter to Development of Disease. J Vet Intern Med. 2017 Mar;31(2):442-448.

Berent AC et al. Evaluation of cystoscopic-guided laser ablation of intramural ectopic ureters in female dogs. J Am Vet Med Assoc. 2012 Mar 15;240(6):716-25. 

Smith AL, Radlinsky MG, Rawlings CA. Cystoscopic diagnosis and treatment of ectopic ureters in female dogs: 16 cases (2005-2008). J Am Vet Med Assoc. 2010 Jul 15;237(2):191-5.

Lee JC et al. Clinical application of Clostridium botulinum type A neurotoxin purified by a simple procedure for patients with urinary incontinence caused by refractory destrusor overactivity. FEMS Immunol Med Microbiol. 2007 Oct;51(1):201-11.

Tincello DG, Rashid T, Revicky V. Emerging treatments for overactive bladder: clinical potential of botulinum toxins. Res Rep Urol. 2014 May 21;6:51-7.

Bertapelle, M.P., Vottero, M., Popolo, G.D. et al. Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare SystemWorld J Urol 33, 1109–1117 (2015). 

Jan Groen, Bertil F.M. Blok, J.L.H. Ruud Bosch. Sacral Neuromodulation as Treatment for Refractory Idiopathic Urge Urinary Incontinence: 5-Year Results of a Longitudinal Study in 60 Women, The Journal of Urology, Volume 186, Issue 3, 2011, Pages 954-959, ISSN 0022-5347



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