URINARY INCONTINENCE (Inability to Urinate) IN DOGS

Normal urination is a complex process that requires a structurally normal urinary tract as well as coordination of mental awareness, nerve function, and muscle relaxation and contraction. When some part of the process fails, your pet may become incontinent or have difficulty urinating.

If your dog or cat is incontinent, it’s probably dribbling urine around the house or in its bedding. In incontinent animals, urine leaks because the bladder doesn’t store urine properly or the urethra (a tube that carries urine from the bladder to the exterior) isn’t functioning correctly. The most common cause of urinary incontinence is urethral weakness, which is usually easily treated .Other causes of urinary incontinence include nerve or muscle damage, sometimes due to trauma; anatomic abnormalities; metabolic disorders; stones or tumors in the urinary tract; urinary tract infections; feline leukemia virus infection in cats; and prostate disease. Dogs and cats of any age or breed can become incontinent, but dogs are more susceptible to this problem. Spayed or neutered pets are at a greater risk for incontinence (but the benefits of spaying or neutering still far outweigh the risk of incontinence). Animals may be incontinent from birth, or incontinence may appear with age or obesity. Urinary problems are more common in male dogs, than female.

Incontinence can be confused with diseases that cause a pet to urinate frequently.

Incontinence can also be confused with submissive urination. Submissive urination occurs when a dog is acting submissive to a person or to another dog. Submissive urination occurs more frequently in young animals. The dog usually rolls on its back and urinates. These dogs can also urinate normally.

Young animals may have a birth defect causing incontinence. The most common birth defect that causes incontinence in young dogs is ectopic ureter(s). The ureters carry urine from the kidneys to the bladder. If one or both ureters by-pass the bladder and connect to an abnormal location such as the urethra or vagina, the puppy may drip urine. Siberian Huskies are most often affected. Other breeds that have a higher occurrence of this birth defect include:

• Miniature Poodle

• Labrador Retriever

• Collie

• Welsh Corgi

• Wire-haired Fox Terrier

• West Highland White Terrier

Female dogs are more commonly affected. If only one ureter is abnormal the dog will dribble urine but can also urinate normally. If both ureters are affected then the puppy will only dribble urine and cannot pass urine normally.

To diagnose this condition a dye study of the bladder is usually performed. Sometimes the abnormal opening into the vagina can be seen during a careful examination under anesthesia using special equipment.

Most puppies with ectopic ureter(s) also have a bladder infection that will improve with antibiotics but the infection will return until the problem is corrected.

In some cases the ureter can be surgically moved back to the normal location in the bladder and incontinence may resolve. In other cases, long standing infection of the kidney may have damaged the kidney requiring the removal of one kidney. In yet other cases the abnormality of the ureter can be corrected but the pet remains incontinent, probably due to the presence of other birth defects in the urinary system.

A bladder infection can cause either a strong urge to urinate or if the bladder infection is long standing it can cause scarring of the bladder preventing it from stretching to hold urine. In this case the pet is usually not truly incontinent in that they know they are urinating, but they have such a strong urge to empty their bladder that they may urinate in abnormal locations or urinate very frequently. It is common to evaluate incontinent pets for the presence of a bladder infection.

Pets with a partial blockage of the urethra with a stone or a tumor may show incontinence. If they cannot empty their bladder completely because something is blocking the path to the outside, the bladder may get so large that the back pressure of urine in the bladder actually forces some urine to leak around the blockage. In these pets the enlarged bladder can be felt on examination. Total blockage of urine flow is usually fatal in 3 to 4 days.

Hormone-responsive incontinence occurs in neutered dogs of both sexes and occasionally in spayed female cats but occurs most commonly in female dogs. The pet can urinate normally, but they leak urine while resting. Physical examination and blood and urine tests are usually normal in these pets. Hormone-responsive incontinence can occur months to years after a pet is neutered.

As pets age they may become incontinent. This may be due to a weakening of the muscles that hold urine in the bladder. There are many diseases that can cause a pet to create more urine than normal (polyuria) and several of these occur in older pets. If a pet has one of these diseases and often has a full bladder, the full bladder can push against the weakened sphincter and cause incontinence. Older pets can also develop senility and simply be unaware that they are dribbling urine.

Dogs and cats with brain or spinal cord disease may either dribble urine or be unable to pass urine. Most often they will have other signs of nervous system disease such as muscle weakness or paralysis.

Intermittent incontinence, primarily at rest, has been reported in cats of both sexes that are positive for the feline leukemia virus. How the virus causes incontinence is unknown.

A less common cause of incontinence in female dogs is called vulvovaginal stenosis. It is a condition in which the vagina at the level where the urethra ends is narrowed. Occasionally when the pet urinates, some urine will get trapped in the vagina in front of this narrowed area. Then when they rise after lying down the urine pours out. This condition can be diagnosed by feeling the vagina with a gloved finger. In some dogs the narrowing can be stretched under anesthesia. The incontinence may or may not resolve as sometimes other defects are also present.

The inability to urinate can quickly become an urgent situation. Do not delay in taking your dog to the veterinarian if you see any of the following symptoms: Urine that flows in spurts or trickles Frequent attempts to urinate (often delayed and without success) Showing strain when attempting to pass urine Leakage (this may happen because the bladder is so full that it cannot hold any more liquid) Blood in the urine Licking of urinary opening Low appetite Vomiting Tender abdominal area Lethargy Disinterest in normal activities

There can be numerous causes leading towards an eventual inability to urinate in dogs: Obstruction in urethra (this can be as a result of blockage caused by crystals in the urine, and can be brought on by something as simple as inadequate water intake) A dog who has had many urinary tract infections may begin to have trouble urinating due to numerous events of bladder distention A urinary tract infection may move into the bladder Scar tissue on urethra or bladder Anatomic abnormalities (congenital or contracted) Spinal cord injury, lesions or disease causing a compression Trauma or injury to nerves leading to compression Disk herniation Dysautonomia (a neurological disease also known as Key-Gaskell syndrome) Some surgeries may bring about an inability to urinate (which is most likely a temporary complication) Cancer Prostate disease

Upon arrival at the clinic or hospital, be prepared to relay to the veterinarian all symptoms and behavioral changes you have seen in your dog. The veterinarian will, in most cases, want to begin with a complete physical examination, followed by a urinalysis, which may show an infection or evidence of inflammation. Blood work, involving a CBC and chemistry profile may be included. If the veterinarian has not diagnosed a simple infection or feels that further investigation is needed, a urethral catheter may be inserted to rule out the possibility of a blockage. It is interesting to note that an obstruction of the urethra is more common in male canines, due to the narrowing of the urethra in the penis.

Abdominal palpation – if kidneys are full, and bladder is empty (anuria) it points to lack of urine production which is an illness within itself CT scan to assess caudal spine for tumor Myelography (radiography exam to look for spinal cord injury) Epidurography (radiography exam to check for spinal cysts) Abdominal ultrasound to check for kidney or bladder concerns Cystoscopy (insertion of a scope to view inside the lower urinary tract)

Treatment will correlate directly to the exact cause of the inability to urinate. The immediate relief of your dog’s discomfort, as well as the importance of eliminating the problem before the situation worsens, will be of paramount importance. Treatment may include: For a urinary tract infection, antibiotics will be administered Water intake may be increased Urinary acidifiers or alkalinizers may be given Your dog will be given medication to relax the bladder and urethra Catheterization of the bladder may be done up to three times per day Manual bladder expression at regular intervals (several times daily for example in the case of spinal cord injury) could be required, depending on the reason for the inability to urinate An obstruction may mean surgery if a retropulsion of the obstructing material back into the bladder is not possible A congenital abnormality could need surgical correction Non-neutered male dogs may be treated and then neutered if the problem is a prostate issue

Specific treatment of an underlying disease may resolve incontinence; for example, surgery to correct an ectopic ureter. Inappropriate urination caused by behavioral problems may be corrected with training that modifies the pet’s behavior.

When no specific cause can be identified for the incontinence drugs may be given that increase the tone of the muscles that hold urine in the bladder. Some drugs that are used for this purpose include estrogen, ephedrine and phenylpropanolamine.

Drug therapy for incontinence may be based on “trial” of different drugs in various doses. Since some of these drugs can have side effects so low doses are tried first. Some drugs may be slow to have an effect so as long as there are no undesirable side effects, a drug trial should continue for several weeks before the drug is considered not to be effective.

If your cat spends a lot of time in its litter box or your dog’s urine is a mere trickle, your pet may be straining to urinate. In these pets, urinating may be painful (and you may think your pet is constipated). Pets that can’t urinate adequately may vomit or stop eating. In pets that strain to urinate, the bladder doesn’t empty completely and becomes overdistended. The most common causes of this problem are an obstruc tion and bladder overdistention due to anatomic abnormalities, inflammation, stones or mucus plugs, cancer, prostate disease, or nerve damage or muscle dysfunction. Cats with feline lower urinary tract disease or dogs with urinary tract infections may also strain to urinate.

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