Incontinence in dogs is a common problem, especially in middle aged, neutered, female dogs.
It’s not a nice condition to live with (for you or your dog!), but thankfully, for the majority of dogs, treating incontinence is a matter of working through a few simple steps to completely stop all urine leaking.
For the last 6 weeks Abby has been leaking urine, sometimes quite a bit. Abby will still go outside and urinate. Abby started 2 pills a day of Proin and was increased to 2 ½ pills a day with no change. The vet said we would stop the medication if it is not improving the situation. The vet is not sure what is causing this and I am looking for a solution and some answers. Thank you.
And then finally today Barb asks about her dog, Abby, who's developed urinary incontinence. The medication doesn’t seem to be working and Barb is looking for a solution because clearly a dog who is incontinent and leaking urine in the house is not a nice condition to live with. It’s also not very nice for your dog either as well as having the potential to cause other problems, which I'll come onto.
The best way to treat incontinence in dogs really depends on what is causing them to leak urine. Getting an accurate diagnosis is especially important if a trial treatment fails to stop your dog leaking. That said, medication can help up to 90% of dogs stop leaking urine completely!
Causes of Dog Urinary Incontinence
Urethral sphincter mechanism incompetence
I'll start off by saying that the most common cause of incontinence in older female dogs, especially in those that have been spayed, is something called urethral sphincter mechanism incompetence or (USMI).
What happens in this incontinence cause is that the urethra, which is the tube that drains the bladder to the outside world, loses its tone. It becomes a bit floppy and flaccid. As a result the resistance to flow of urine, and the ability to hold urine in the bladder drops.
The underlying cause of this reduced tone is hormonal, explaining why spayed female dogs are more likely to suffer from this incontinence.
What happens next, is that typically we get leakage of urine when a dog is lying down. Lying puts a little bit of increased pressure on the bladder compared to standing, although you can get leakage at other times. Examples would be if your dog is coughing or running. That said, leaking urine when your dog is lying down and sleeping is often the first sign of urinary incontinence.
Ectopic ureters
There are other causes of urinary incontinence in dogs. Ectopic ureters are where the tubes that come from the kidneys into the bladder enter the bladder in an unusual position. The ureters take the urine from where it's produced in the kidneys and transports it into the bladder.
Incontinence in dogs can occur if the ureters actually deliver urine to the urethra, bypassing the bladder completely, or enter the bladder too close to the outlet. If this happens, the normal mechanisms stopping the urine from leaking fail. Urinary incontinence is the result.
Intra-pelvic Bladder
We can also get the bladder actually sitting within the pelvis. So if it’s not quite into the abdomen and it's sitting within the pelvis, again, that change in pressure, especially when a dog's lying down can cause problems.
Nerve problems
A more sinister cause of incontinence in dogs is a problem with the nerves responsible for bladder control. This problem could more commonly be due to a traumatic event (like being hit by a car) or a slipped disc, where pressure on the spine means the nerves stop working properly.
Clearly with problems like this, there would be other symptoms present. You would unlikely simply be dealing with a dog who was leaking urine overnight yet otherwise “normal”
Producing more urine
Finally, it is possible to mistake urinary incontinence with a dog who is really just needing to urinate more and so having accidents overnight.
If your dog is actually urinating more, and if they're having accidents overnight, they’re generally peeing normally. You are less likely to find urine in their bed. If instead there's a big puddle of urine somewhere on the floor and their bed is dry, then the chances are that they might be drinking and peeing more.
The causes of drinking more and producing a lot more urine are numerous. They include diseases like diabetes, kidney failure and liver disease.
Diagnosing Incontinence
The first thing to do is run a urine test. We need to make sure that a dog is able to produce concentrated urine. If it is dilute there is the possibility that they could actually be suffering from a disease causing the production of more urine. The best way to check this is to collect a urine sample from your dog as soon as they wake up. Taking this into your vet can give very valuable information.
An incontinent dog is also at a much greater risk then normal of developing a urinary bladder infection. If an infection is present, it can actually also make incontinence worse and mean that a dog may not respond as well to the incontinence treatment that they’re being given.
It's never a bad idea if there's any doubt to send a urine sample to the laboratory for culture and sensitivity testing. To see if they can grow any bacteria and if so, find out what antibiotic is best to used. Depending on the urine sample that you take in, it might be that your vet can tell that there's a urine infection just by looking down the microscope and using a dipstick. Sometimes though we do need to send off a culture and sensitivity just to be 100% certain.
If your dog’s urine is dilute, or there is a suspicion that your dog could be suffering from a different disease, blood testing may also be needed. If there's any doubts that a dog may have kidney disease, they may have diabetes or what have you, then we should be running tests to exclude those things.
Finally, if your dog is young then either an ectopic ureter or intra-pelvic bladder are more likely. Diagnosis of these problems typically involved imaging, with xrays and ultrasound being the most common techniques used to diagnose these problems.
Treating Incontinence in Dogs
Once you are sure there are no complicating factors, and your dog is truely incontinent, without an infection being present, what is the best option for treating you dog’s incontinence?
Phenylpropanolamine
In the first instance, there are two different types of drugs that can be used to treat incontinence in dogs. The dog in question is receiving Proin, which is the trade name of a drug called phenylpropanolamine (a bit of a mouthful!). This is a very effective incontinence treatment with a response rate of between about 75 and 90%. Unfortunately not all dogs are going to respond as well as we would like, and not all dogs will continue to respond as well as they initially do even if they do initially.
This drug is typically given 2 to 3 times a day. So when a dog is on it twice a day and is still incontinent, we could consider giving it 3 times a day. Having said that, I would have expected some response to phenylpropanolamine if a dog was going to respond to this while they were on it twice a day.
Estriol
The other main medical treatment of incontinence in dogs is a drug called estriol. This is a hormone treatment that has a complete response rate of 65%. A further 17% of dogs will exhibit a partial responce.
Overall this isn’t quite as good as phenylpropanolamine, but the majority of dogs still will respond to this treatment and stop leaking for the most part.
Surgery
If a dog is still leaking despite trying both incontinence drug treatment options, surgery may be the next step.
There are various different surgical options that can be explored. The best one for your dog will depending on the specific problem causing them to leak urine, as well as the availability of a specific surgery in your area. In most cases these options require the input of specialist surgeons.
So those are really some of the things that we can think about in a dog who's got incontinence in general, but also those who doesn't seem to be responding well to the first medication that they've been tried on.
Weight Loss
Treating incontinence does not need to be all about complex surgery or long term drugs.
Being overweight can make any underlying predisposition to incontinence worse. It is thought that excessive fat around the urinary tract can cause the muscles responsible for bladder control much weaker. Obesity also plays a massive role in other diseases, such as diabetes, which could be making your dog produce more urine.
Weight loss may be enough by itself to stop your dog leaking urine everywhere. If treatment is still needed however, then weight loss could mean a lower dose or reduced frequency is needed of either phenylpropanolamine or estriol.
Weight loss will also have the knock-on effect of reducing the risk or severity of arthritis, improve general body health and have a huge impact on a dog’s quality of life.
The above is a transcript taken from “The Dr Alex Answers Show”.
If you would like me to answer any question you have about your pet’s health, simply fill in this form and I’ll try and get you the information that you need. It’s that simple!
