Medical Conditions: Canine Incontinence

DESCRIPTION
Urinary incontinence is the uncontrolled dribbling or flow of urine from the bladder. Like a dripping faucet, it keeps your pet from staying dry.

PRESENTATION
It frequently begins as a bit of a mystery: a faint odor of urine surrounding the pet, a damp spot in the bed or an unexpected puddle on the floor. Then theories are developed. “Mom, the dog peed her bed!” or “Poor thing couldn’t hold it that long!” or even, “She is really angry with us! She started urinating in the house.” Sometimes that puzzlement gives way to frustration, and poor Brandy finds herself being yelled at or disciplined for who-knows-what. She hides or cowers when we come into the room, but she’s not embarrassed or angry – she just knows we are unhappy. And unfortunately, she probably has no idea why! What Brandy is experiencing and her owners are dealing with is an all too common problem called “urinary incontinence,” or more simply a leaky bladder. It is important that you raise this and all medical or behavioral concerns with your veterinarian. Urinary incontinence may only be apparent in the home environment.

INCIDENCE
This problem is actually a fairly common concern in humans, as witnessed by the increase in the market for adult absorptive pads or “diapers.” The odds are pretty good that we or someone we know suffers from urinary incontinence. Published studies indicate that daily incontinence occurs in 17 percent of elderly women and men alike. Among younger people, it is more than four times more likely to occur in females than males. In dogs, studies indicate the incidence of urinary incontinence particularly among spayed females is as high as 20 percent. That is alarmingly high when you consider how many dogs spend significant time indoors, and the impact urinary incontinence has on the human animal bond between pet and pet owner. Uncontrolled incontinence can lead to euthanasia of the pet. It is not surprising that people might find raising the subject embarrassing, but your veterinarian and your pet rely on you sharing your observations.

CAUSES
There are two basic causes of urinary incontinence: abnormal anatomy and abnormal function. Causes associated with anatomy may be a result of a partial obstruction of the urethra such as a stone or a tumor. Typically there is evidence of distress and the pet will be straining to urinate at times and dribbling at others. Another anatomic or mechanical abnormality is caused by an ectopic or misplaced connection from the kidney to the bladder. This condition occurs almost exclusively in females, and there is generally a history of dribbling urine sine birth. The problem is generally surgically correctable. Functional incontinence is most commonly associated with inadequate tone or contraction of the sphincter or valve apparatus of the urethra. Commonly called “hormone responsive incontinence,” it is most common in middle age and older female dogs. However, it has been seen in younger spayed females and occasionally in males. Hormone responsive incontinence typically occurs when dogs are asleep or laying down. Uncontrolled dribbling of urine can occur associated with urinary tract infections involving the bladder. Many people have had experience with the discomfort and spasm associated with “cystitis.” Cystitis results in a burning sensation in the bladder and a continual feeling of urgency to urinate. People find themselves going to the bathroom with great frequency. Outdoor dogs might be seen straining to urinate frequently, but indoor dogs without free access to an appropriate area outdoors might be unable to adequately control the urge to urinate. This can result in incontinence. Urinary tract infections frequently result in blood-tinged urine or a strong odor to urine. Cystitis can be easily eliminated as a cause of incontinence by performing a urinalysis. Bladder infections are generally easy to resolve by administering appropriate antibiotics, and should be considered and ruled out in any case of incontinence.

DIAGNOSIS
The diagnosis of mechanical incontinence frequently involves special radiographs, direct visualization of the vaginal tract and catheterization. Functional incontinence can be evaluated by measuring subtle pressures in the urethra but may not be readily available. Diagnosis by response to therapy is common and good response is likely confirmatory, but some dogs do not respond as expected and require dose adjustments or additional drugs to achieve control.

TREATMENT
Historically, treatment involved the use of estrogen therapy, which is thought to increase the natural tone of the sphincter. While some veterinarians still use estrogen, it has been shown in some dogs to have serious side effects including bone marrow damage. For that reason alone it is not the treatment of choice. Phenylpropanolamine given 2-3 times daily is generally accepted as the current treatment of choice. It is safe and effective in most cases. The FDA recently licensed a veterinary dosage formulation that eliminates the need for compounding or dosing with a limited range of human products. If your dog is showing signs of urinary incontinence, see your veterinarian for an evaluation and treatment. The condition is in itself non-life-threatening and generally easy to control. There is no reason for you or your pet to live with it.

About Dr. Mike Paul
A 1972 graduate of Kansas State University, Dr. Mike Paul has forty years of experience in companion animal practice, organized veterinary medicine, and not-for-profit organization leadership as well as corporate veterinary medicine. Dr. Paul is a sought after international speaker, author & columnist.

Dr. Paul served as president of the American Animal Hospital Association (AAHA) and has chaired and participated in numerous task forces for AAHA, the American Veterinary Medical Association (AVMA) and the California Veterinary Medical Association. Dr. Paul is also a founding member of NCVEI and the Companion Animal Parasite Council (CAPC) and was formerly the Executive Director and CEO of CAPC.

Dr. Paul has authored numerous columns, editorials, and articles on vaccine and parasite control matters for veterinarians and pet owners, and he has given numerous presentations at national and international programs on vaccinology, parasitology issues, pet-owner compliance, and consumer experiences as well as personal life balance issues.