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When a house pet develops urinary incontinence, many owners fear the worst. Assumptions that incontinence signifies senility or irreparable age related change may lead to delay in medical consultation, relegation of the pet to an outdoor life, or even euthanasia. In reality, urinary incontinence is usually one of easiest problems to solve so it is crucial that veterinary assistance be sought before an owner’s patience is completely worn out and before any permanent decisions about the pet’s future become topical.
CAUSES OF INCONTINENCE
It is important to differentiate incontinence (involuntary urine leakage) from behavioral urinary issues (submissive urination), simple lack of house training, territorial marking of anxious cats or of unneutered males, or the senile loss of house-training from canine cognitive dysfunction. Animals may urinate in the house voluntarily and this is different from incontinence. Watch your pet closely to be sure what you are seeing is really incontinence and if it is, the good news is that most cases are easily resolved with simple inexpensive medications.
There are several important causes of incontinence and most of these are ruled in or out with a urinalysis and urine culture. The urinalysis reveals cell types and biochemical elements in the patient’s urine while the culture isolates the bacteria growing in the urine. The bacterial species grown are identified and tested for their sensitivity towards different antibiotics, the end result being confirmation of the presence of infection and a list of appropriate antibiotics.
Most cases of incontinence are due to:
This is a common cause of urinary incontinence in female dogs of all ages and in geriatric cats. This condition is usually easily diagnosed by urine culture, though often signs of infection such as white blood cells or bacteria are actually visible in the urinalysis. A urine culture will confirm the infection, identify the organism, and list usually several antibiotics which will be effective. An antibiotic is selected based on expense, potential for side effects, and convenience of usage. After a short course (generally somewhere between one and three weeks) of medication, ideally a second urine culture or urinalysis is done to confirm that the infection has truly been cleared up.
If a bladder infection is the cause of incontinence, most patients show improvement in their incontinence and comfort after only a few doses of antibiotics (but it is still important to finish the entire course so as to avoid recurrence). For more details on this condition click here.
EXCESSIVE WATER CONSUMPTION
Causes of excessive water consumption include:
There are other causes as well but 90% are ruled in or out by a blood panel and urine culture.
WEAK BLADDER SPHINCTER
Aging, obesity, reduced sensitivity of neurologic receptors in the sphincter and possibly other factors all contribute to this condition which is especially common (up to one in five affected) in female dogs. Once other more serious conditions have been ruled out, the weak sphincter may be treated symptomatically with one of several medications.
For especially resistant cases of incontinence,
Medication works for most patients with weak sphincters but when medication fails there are some surgical options to consider: colposuspension, and cystourethropexy.
Colposuspension, for females only, is the most commonly performed procedure. Here, the vagina is tacked to the bottom of the belly wall entrapping and compressing the urethra. In one study of dogs that had failed on medication, there was complete resolution of incontinence in 53% with colposuspension An additional 37% became less incontinent, and 25% of those without full resolution gained complete continence when therapy with phenylpropanolamine was added. Another recent study reported that complete continence lasted for 1 year in only 14% of affected dogs, although many dogs improved.
Cystourethropexy is the modification of the above procedure that can be performed in either males or females. Since there is no vagina to use in the male, the ductus deferens are tacked down to compress the urethra. Fibers from the urethral muscles can also be tacked down (in either male or female patients). Complications include an increased frequency in the need to urinate (occurring in 2/3 of the patients in one study) and straining to urinate (in about 1/3 of patients).
Urethral Lengthening works for patients for whom incontinence is caused by a short urethra. A short urethra causes a full bladder to be displaced into the pelvis and makes the urethra too short for either of the other two surgical procedures. This is a newer surgical procedure which has so far had good reports in the small number of dogs in which it has been studied. Further studies should be forthcoming.
Medications listed above are used in conjunction with surgery. Surgery alone improves approximately 50% of patients but often incontinence returns unless oral medication is restarted.
COLLAGEN INJECTIONS: THE NEWEST THERAPY
In this procedure an endoscope is inserted in the urethra and several injections of collagen (the same kind used for cosmetic injections in humans) are deposited. In a study of 40 dogs who had failed to become continent on medication alone, 27 became continent for an average of 17 months. Further, 10 dogs that experienced only partial improvement after the procedure became completely continent when oral medication was added, even though medication alone had been ineffective.
The procedure can alternatively be performed with medical grade collagen, with Teflon® (which does not last as well but is apparently considerably less costly) or with a reconstructive product called ACell®. Unfortunately, at this time there are few facilities that perform this procedure as special equipment (cystoscopy) is required.
UNUSUAL CAUSES OF INCONTINENCE
The list of causes of incontinence presented above is by no means exhaustive. While uncommon, other causes should not be entirely counted out. Some possible causes include:
Your veterinarian is in the best position to determine if it is worthwhile to pursue a rare disease or not. Do not hesitate to ask your veterinarian questions regarding your pet’s incontinence, the treatments or procedures described above.
WHEN ALL ELSE FAILS: DIAPERS
Diapers are available from a number of companies and are available in both male and female styles. Here are some links that may help:
Page last updated: 5/10/2019