Incontinence is a loss of voluntary control over the act of voiding. This medical condition must be differentiated from a house-training problem and/or submissive urination, especially in young dogs.
Incontinent dogs wet their bed or the floor where they are sleeping, urinate inappropriately in the house, sometimes dribble urine, and may void more frequently than normal. There may be an ammonia-like odor coming from the dog's bedding. The skin around the penis or the vulva may be scalded.
There are several types of urinary incontinence.
This common incontinence is seen most often in middle-aged and older spayed females, and less commonly in young females and older neutered males. It is caused by a deficiency of estrogen in females and testosterone in males. Both these hormones are important in maintaining muscle tone of the urethral sphincter.
Hormone-responsive incontinence is much like bed-wetting. The dog urinates normally, but wets when relaxed or asleep.
This is another common problem, characterized by the release of urine caused by contraction of the abdominal wall muscles along with relaxation of the muscles that support the urethra (the normal release process). The dog passes small amounts of urine when she is upset or in a stressful situation. It has also been called stress incontinence. This is most common in young puppies in their new homes, and many will simply grow out of it.
Spinal cord injuries, infections, tumors, and inherited neuropathies can interfere with the nerves that control the bladder. A bladder with a compromised nerve supply lacks muscle tone and cannot contract. The bladder continues to fill until the pressure exceeds the resistance of the sphincter mechanism that closes the urethra. This results in intermittent, uncontrolled dribbling.
Incontinence from Over-distention of the Bladder
This type of incontinence is due to a partially obstructed bladder, caused by urethral stones, tumor, or stricture. The signs and symptoms are similar to those of neurogenic incontinence, but the nerve supply to the bladder is undamaged.
Dogs with failing kidneys are unable to concentrate their urine. They have a large urinary output and must drink more than usual to replace fluid losses. If they are not allowed to go outside to urinate as often as necessary, they may begin to urinate in the house. It is important to check kidney function in all incontinent dogs to be sure the incontinence is not due to kidney failure.
Other Causes of Incontinence
Another cause of incontinence is ectopic ureters. Females are 8x more likely to suffer from this congenital problem than males. One or both ureters may enter the vagina instead of the bladder. This causes a continuous drainage of urine into the vagina. The incontinence of ectopic ureters is present from birth, but becomes more noticeable at 3 - 6 months of age when housetraining should be complete.
Breeds with a predisposition include West Highland Terriers, Fox Terriers, Miniature and Toy Poodles, Siberian Huskies, and Labrador Retrievers.
Incontinence in females shortly after spaying is usually caused by post-operative pelvic adhesions.
Neurogenic Incontinence can be confirmed with a cystometrogram. This is a test that measures how forcefully the bladder contracts in response to the introduction of incremental volumes of fluid into it through a catheter. The results also suggest the site of the neurologic deficit (the spinal cord or the bladder).
This condition is treated by giving phenylpropanolamine, a drug that increases the tone of the urethral sphincter. Diethylstilbestrol (estrogen) can be given if phenylpropanolamine is not successful. Diethylstilbestrol is no longer the first choice for treatment because of the risk of bone marrow suppression. Phenylpropanolamine is periodically taken off the market, because it is also used in human diet supplements and can be abused. If it is not available to you, your veterinarian will work out the lowest dose possible of estrogen to control your dog's incontinence.
Incontinence in neutered males responds well to testosterone. Phenylpropanolamine has also been used successfully used in males.
Submissive urination can be treated with Phenylpropanolamine and/or other drugs that increase urethral tone while behavior modification techniques are applied. Keep stress-provoking interactions low-key and brief, and avoid bending over the dog or making direct eye contact with her. DO NOT punish the dog, as this makes the incontinence worse. Working with a dog trainer or canine behaviorist is recommended to address this behavioral issue.
Treatment for this condition consists of long-term catheterization and antibiotics to treat and suppress infection. Drugs that act on the bladder may be of help. This type of incontinence is difficult to treat. However, the problem may totally resolve in dogs whose spinal cord injuries have been successfully treated.
Incontinence from Over-distention of the Bladder
Dribbling associated with an over-distended bladder is treated by correcting the cause of the obstruction and placing an indwelling catheter until the bladder regains its muscular tone. Drug therapy is also beneficial. Since the bladder is neurologically normal, treatment may eliminate the problem entirely.
Both an ectopic ureter and pelvic adhesions may be corrected surgically.
There is no prevention for this condition.
Please contact your veterinarian with questions regarding this condition.
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