The mechanisms behind UI in dogs are multilayered and poorly understood. Acquired causes can be hyperreflexia of the detrusor muscle, acquired urethral sphincter mechanism incompetence, detrusor atony because of bladder over distention, prostatic disease, neoplastic disease of the bladder, prostate or urethra, or neurologic disease (lower motor neuron disease). Urinary incontinence in dogs is treatable, even curable. Some dog breeds are also prone to urinary incontinence, such as:, Your vet should thoroughly review your dogs history and conduct a physical examination before making a diagnosis. Hypertension, or a predisposition to hypertension caused by concurrent disease, is a major contraindication to using PPA. Medical treatment for DUD generally consists of muscle relaxation and, occasionally, anxiolytic therapy (Table). Testosterone injections are sometimes used to treat urinary incontinence in male dogs. USMI is the most common non-neurogenic cause of urinary incontinence in female dogs and is referred to colloquially as spay incontinence. The hormones (testosterone in males and estrogen in females) impact a dog's ability to control the urethral sphincter, a band of muscular tissues near the base of the bladder. When evaluating the published success of these procedures, it is important to note that they have primarily been evaluated in patients that are not responding to medical therapy and thus may have a more severe form of urethral sphincter mechanism incompetence (USMI). Often it is initiated on an empirical basis, with minimal pretreatment diagnostics other than a urinalysis and urine culture. An official website of the United States government. There is also a possibility that the collagen content may be altered in females with USMI; however, further studies are needed. Rose SA, Adin CA, Ellison GW, et al. As a result, neutered male dogs are also more likely than unneutered dogs to experience urinary incontinence. Male spayed dogs might also suffer from "Spray incontinence" due to the decrease of testosterone. Median duration of continence without additional medical therapy ranged from 8 months to 2 years. USMI is the most common cause of UI in dogs, affecting up to 20% of all neutered females and 30% of neutered females weighing over 20 kg.2,3 It is less commonly reported in neutered males and intact dogs of both sexes. Less than 50% of male dogs respond to medical therapy, and the most successful treatment is phenylpropanolamine. The tests performed to evaluate a pet with incontinence depend upon the age of the pet and clinical signs. This review focuses on 2 of the most common causes of UI: urethral sphincter mechanism incompetence (USMI) and functional urethral obstruction, also known as detrusor urethral dyssynergia (DUD). This is because the urethral muscles are not as strong as they used to be. Management of urethral incompetence in dogs may require adjustments in their therapy as they age or develop additional health concerns. This creates a pressure gradient from bladder to urethra and leads to urine leakage. All rights reserved. Often, incontinence starts when dogs are mature or middle-aged. There is strong evidence that estrogen increases the baseline resting urethral pressure in animal models of incontinence.6 These compounds are usually well tolerated and are a good choice for female dogs with concurrent diseases that predispose them to hypertension or that are intolerant of -agonist treatment. Then when they rise after lying down the urine pours out. B. Gerber In most dogs, incontinence occurs within 3 to 4 years of neutering,1 although it may not become a major problem until later in life when it can be complicated by diseases that cause polyuria and polydipsia. Estrogen also appears to have a trophic effect on the periurethral tissues and vasculature and thus may reduce incontinence through improved urethral support. FSH and LH plasma levels in bitches with differences in risk for urinary incontinence. While it's not always immediately apparent why your dog has suddenly become incontinent, there are several possible reasons: Both male and female neutered dogs can experience hormone-responsive incontinence, but female dogs are more likely to have trouble with it. [Urinary incontinence in castrated female dogs. -Antagonists are a mainstay of smooth muscle relaxation, while the addition of low doses of diazepam just before urination can relax the skeletal muscles. UI must be distinguished from behavioral conditions and systemic problems (eg, polyuria, pollakiuria), and it is important to establish that the animal is unaware of the passage of urine. Both are affected after a severe spinal cord injury, as damaged nerves can't control full bladders. Hamaide AJ, Grand JG, Farnir F, et al. The hormone testosterone, in particular, is secreted by the male dog's testes and is known for producing several physiological and behavioral effects. Sometimes owners find small pools of where their dog was sitting or lying. Meet the Veterinary Teaching Hospital team: Cynthia Buss, WSU professor helps bring quality healthcare to agility dogs, Horses freak accident not fatal thanks to WSU veterinarians, Meet the Veterinary Teaching Hospital Team: Teri Olson, WSU helps dog recover from mystery lung condition. Urethral Sphincter Mechanism Incompetence in Dogs: An Update. Reichler IM, Hung E, Jochle W, et al. This can be accomplished easily with contrast cystourethrography, which may also assist in guiding therapy because the location of the most resistance usually sits just distal to an abnormally wide portion of the urethra. This is because estrogen and progesterone strengthen the muscles that keep urine in the bladder. It is often necessary to use both smooth and skeletal muscle relaxants in these patients to achieve the desired result. Urethral sphincter mechanism incompetence in male dogs: a retrospective analysis of 54 cases. 14 Alternative treatment in males that fail medical therapy include surgical placement of an artificial urethral sphincter and urethral collagen Adverse effects associated with testosterone supplementation include behavior changes and prostatic hyperplasia. No studies have evaluated them as first-line treatment options. Dogs deposit the urine in the bladder, where this will be held until the bladder is full and the dog will release it through the urethra. There are anecdotal reports of the successful use of conjugated estrogens in spayed female dogs with UI (Table 1); however, no studies have been published. Disclaimer. In cases like bladder stones and congenital abnormalities, your vet may recommend surgery. The underlying mechanism is likely multifactorial and involves the pituitary-gonadal axis, the anatomic structure of the lower urinary tract, and the integrity and tissue characteristics of the lower urinary tracts supporting structures. A dog that is dripping urine is not only an issue of smell and hygiene but often a symptom of underlying health issues. When they fall below .4ng/ml, the dog is considered infertile. Effects of ovariectomy and estrogen replacement on the urethral continence reflex during sneezing in rats. 8600 Rockville Pike Medically approved by Cathy Piche BA, RVT, CCRP. These drugs can affect the bone marrow; your vet will need to do frequent blood work with this therapy. In this case series, we report the effect of testosterone cypionate, given at a median dose of 1.5 mg/kg intramuscularly every 4 wk, in eight . Oftentimes the dogs only lose urine while sleeping. If the incontinence is caused by tumors of polyps, these should be examined and removed or treated with chemotherapy. The goal of hormone replacement therapy is to return tone to the urethra to decrease the incontinence. Dogs with low estrogen levels, obesity, and larger breed size can experience bladder sphincter and valve laxity, leading to urine leakage, especially while they sleep. Made with unconditional love in California, USA. You can also take steps to manage the effects of your dogs incontinence on your home, such as: Urinary incontinence can quickly develop into an infection. Urethral sphincter mechanism incompetence in adult dogs can be associated with neutering and is more common in large breed dogs than small breed dogs. In this case, the urethral closure is constantly overwhelmed. It can also soothe any irritation in your pet's urinary tract if infected and has a mild diuretic effect. No studies have been performed to assess its efficacy in male dogs with UI. Yes and no several smaller breeds are predisposed to arthritis, too. If your dog suffers from hormonal imbalance, the vet may recommend hormone therapy. It has been hypothesized that the increase in these gonadotropins has either a direct negative impact on the urethral closure pressure or results in decreased bladder function.11,12. A dog may become stressed for many reasons, such as a new environment, loud noises, strangers, the presence of another more intimidating dog, or changes at home. A newer procedure for canine urinary incontinence is gaining in popularity and availability. You can start by assessing your dog's lifestyle and diet. Oops! A careful history is essential when discussing UI with pet owners. DES has been used to treat UI in dogs for more than 40 years, although there are few studies evaluating its efficacy.9 Adverse effects are similar to those seen with other estrogens, such as mammary and vulvar swelling and attractiveness to males. At this time, the contribution of obesity to the development of incontinence is unknown. Adams WM, DiBartola SP. If the underlying reason for polyuria can be addressed, the UI may improve. While incontinence is common in aging dogs, it can also signify a more serious health problem. In this case series, we report the effect of testosterone cypionate, given at a median dose of 1.5 mg/kg intramuscularly every 4 wk, in eight male dogs with USMI. Phenylpropanolamine toxicosis in dogs: 170 cases (2004-2009). Residual urine volume should be measured after voiding in dogs that have a narrow urine stream, exhibit stranguria, or only drip urine. There is anecdotal evidence that the 2 drugs in combination may be synergistic and benefit patients that do not respond to either drug alone. Epub 2010 Jul 23. Estrogen supplementation is also an available option, where your vet may prescribe estrogen-based medications such as estriol. Male dogs with UI pose a more difficult challenge. Dog Incontinence: Its Causes and How You Can Cope, Do Not Sell or Share My Personal Information, Damage or injuries to the urethra or bladder muscles, Aging, which will result in reduced production of testosterone, even if the dog is not neutered. Best Friends Animal Society: Urinary incontinence in dogs., The Canadian Veterinary Journal: Estrogen-induced myelotoxicity in dogs: A review., Chewy: Understanding Senior Dog Incontinence., COLLEGE OF VETERINARY MEDICINE: MY DOG IS LEAKING, Covetrus: Tips for Clients of Dogs with Urinary Incontinence., Dallas Veterinary Surgical Center: INCONTINENCE: URETHRAL SPHINCTER MECHANISM INCOMPETENCE., Heaven at Home: Senior Pet Tips: Managing Incontinence in Senior Dogs & Cats, National Center for Biotechnology Information: Clinical Response and Side Effects Associated with Testosterone Cypionate for Urinary Incontinence in Male Dogs., Merck Animal Health: Incurin Tablets., PETMD: What Causes Urinary Incontinence in Dogs and How Do You Treat It?, The Spruce Pets: "How to Identify and Treat Urinary Incontinence in Female Dogs. Medical therapy of urinary incontinence in ovariectomised bitches: a comparison of the effectiveness of diethylstilboestrol and pseudoephedrine. If so, the treatment is simple; the dog can be treated with a non hormonal medication known as PPA or Phenylpropanolamine. 18 It is important to mention that benign prostatic hyperplasia was induced in beagles treated with testosterone . Dogs that do not respond to appropriate medical therapy should be evaluated for other lower urinary tract disease via imaging, including abdominal ultrasonography and/or contrast radiography. Older dogs without renal or kidney issues also have a greater need for protein. A dye study of the bladder is usually performed, and it is common to collect a urine sample for bacterial culture and to see if the urine is dilute or shows evidence of an infection that could be the cause of incontinence. Blood tests can detect evidence of kidney damage from infection or for the presence of diseases that might lead to increased urine production. Byron JK, March PA, Chew DJ, DiBartola SP. Danazol, mibolerone, and testosterone are all examples of androgens, a class of steroid hormones. Urodynamic and morphologic changes in the lower portion of the urogenital tract after administration of estriol alone and in combination with phenylpropanolamine in sexually intact and spayed female dogs. It is the most common cause of urinary incontinence in spayed female dogs.. Radiography, ultrasound, computer tomography, or cystoscopy might help to identify the cause of the incontinence. One of the most common causes of urinary incontinence in dogs is the Urethral Sphincter Mechanism Incontinence or USMI. Testosterone Starts in Mother Dog's Womb. Additionally, medical conditions can begin slowly or suddenly and become a chronic problem if left untreated. Based on owners assessments, a good to excellent response was reported in three of eight dogs (38%) (Palme et al. Int J Pharm Compd 2012;16(5):369-375. Treatment with reproductive hormones is often effective in treating the condition, which is commonly hormone-responsive. 2021 Mar 5;83(2):274-279. doi: 10.1292/jvms.20-0515. Urinalysis with sediment examination should be conducted for all patients with UI. With 2.1 mg deslorelin implants, oestrus can be suppressed for up to 27 months (Wright et al. Some of the observations you should note include: Early detection and treatment of urine incontinence can help prevent more serious complications. The low response rate in males might be due to the difficulty in differentiating detrusor weakness from urethral incompetence. If your dog's skin is exposed to urine for an extended period, they could suffer from discomfort or an infection. It is attached to a subcutaneous port with an injection membrane. The vet will examine the dog and ask you questions based on what you observed. In this case the urethral pressure is overcome by the bladder pressure only after a certain filling volume in the bladder. The .gov means its official. In rare cases, dogs can suffer a stroke. Not every dog needs a weekly appointment at their favorite groomer though, theres plenty you can do yourself at home. Hormone-responsive incontinence occurs in neutered dogs of both sexes but most commonly in female dogs. Bacterial prostatitis frequently coexists with urinary tract infections. government site. When you see your aging dog can't hold their pee any longer, it can be a distressing sign that your pet's quality of life is deteriorating. Dogs who have kidney or liver problems may need to move to a low-protein diet. Federal government websites often end in .gov or .mil. The most visible sign that your dog is incontinent is dripping urine. Older Dogs. . Reichler IM, Hubler M, Jochle W, et al. Storage and emptying are the two primary functions of the bladder and bowel. Epub 2017 Mar 3. In this case, it is vital to note when this happens and in what context. It is usually caused by a medical condition, and your dog likely is not aware its happening. Long-term evaluation of colposuspension in the treatment of urinary incontinence due to incompetence of the urethral sphincter mechanism in the bitch. In a recent study, I found that the age of ovariohysterectomy (OVH) did not appear to affect risk of development of UI in dogs with an expected adult weight of <15 kg. These effects generally resolve when the medication dose is decreased or stopped. Dogs that need to pee so much may become incontinent or unable to regulate how fast urine exits their bodies. Although it can happen at any age, it is more common in middle- to senior-aged dogs and females. Urethral bulking agent. In addition, phytoestrogens found in corn silk may help with spay incontinence. In addition, there is ongoing investigation into other hormones in the pituitary-gonadal axis and their role in urethral incompetence. Diethylstilbestrol (DES) is a synthetic, nonsteroidal estrogen first synthesized in 1938. So let's look at some of the causes and solutions for dogs who can't hold their pee. Similarly, other compounds like L-carnitine help build muscle and may prevent the muscles in the urinary tract from atrophying. In women, there have been significant complication rates with these procedures, frequently requiring removal of the tape. For example, dogs with separation anxiety may pee in the house while their owners are gone, or a dog with noise phobia might pee during a thunderstorm. The most serious potential adverse effect is hypertension, because of the lack of specificity of the agonists for the lower urinary tract and stimulation of vascular smooth muscle. Corn silk contains mucilage, a thick gel-like substance that coats the interior of the bladder. Phenylpropanolamine (PPA) (Proin, prnpharmacal.com) is the most widely used -agonist for the treatment of UI. Reichler IM, Jchle W, Pich CA, Roos M, Arnold S. Effect of a long acting GnRH analogue or placebo on plasma LH/FSH, urethral pressure profiles and clinical signs of urinary incontinence due to sphincter mechanism incompetence in bitches. If you notice your dog urinating while sleeping or resting, they may have urinary incontinence. Oh, we have cute dogs, too. You may see irritation and redness on the skin from the dripping. For urethral sphincter mechanism incompetence the alpha-adrenergic agonist phenylpropanolamine has been proposed. Urinary incontinence, or the involuntary passing of urine, is a fairly common problem in dogs. Injectable urethral bulking agents, particularly bovine crosslinked collagen, have been used to increase resting urethral pressure in dogs with UI. A bladder that is always small indicates continuous loss of urine, a bladder that is not empty after urination indicates an obstructive lesion or detrusor atony. Palerme JS, Mazepa A, Hutchins RG, Ziglioli V, Vaden SL. Bladder leaks are not an uncommon occurrence in older dogs. Urethral Sphincter Mechanism Incompetence in 163 Neutered Female Dogs: Diagnosis, Treatment, and Relationship of Weight and Age at Neuter to Development of Disease. It is likely that the efficacy and adverse effect profile are similar to those of DES. Radiographic and clinical features of pelvic bladder in the dog. Epub 2021 Jan 14. A variety of home remedies for dog incontinence can be very helpful in the fight against urinary incontinence. Urethral sphincter mechanism incompetence in 163 neutered female dogs: diagnosis, treatment, and relationship of weight and age at neuter to development of disease. A number of studies have evaluated the relationship of UI and age at spay or neuter. Typically, dogs respond well to medication; however, if your pet's incontinence persists, you may opt for diapers which can be purchased in pet stores. Problems like a UTI or kidney issues usually benefit from more moisture with their food. The outcome of combined urethropexy and colposuspension for management of bitches with urinary incontinence associated with urethral sphincter mechanism incompetence. In addition, during the night, dogs are most likely to go without a bathroom break for longer when sleeping, making a full bladder part of the problem. If you spot these symptoms, consider taking your dog to the vet. #2: Hormonal disruption in neutered male dogs heighten the risks of other growth centers. Incontinence only when the dog is excited might indicate detrusor hyperreflexia. Some dogs may have only a few mishaps, but others may lose their ability to contain their bladders completely. Barth A, Reichler IM, Hubler M, Hssig M, Arnold S. Evaluation of long-term effects of endoscopic injection of collagen into the urethral submucosa for treatment of urethral sphincter incompetence in female dogs: 40 cases (1993-2000). Hormone-responsive incontinence occurs in neutered dogs of both sexes but most commonly in female dogs. J Am Anim Hosp Assoc. The perineal urethra has the 2 types. Although this last example is not a bladder control problem, it could still be a reason why youre suddenly finding puddles around the house. Only about 15% of veterinary hospitals meet the evaluations high standards and carry this accreditation. Sometimes we can use testosterone in males. It is common to evaluate incontinent pets for the presence of a bladder infection. In some cases, urodynamic evaluation can be performed at specialized centers to rule out overactive bladder and confirm the diagnosis of USMI. X-rays or ultrasounds may be used to look at the parts of the urinary tract. Dr. Byron is a clinical professor in the Department of Veterinary Clinical Sciences at The Ohio State University. Dog diapers could be helpful to avoid messes, but you must be on the lookout for any signs of urine scalding or infection on the dog's skin. The diagnosis is made by assessing urine stream and residual urine volume. As an AAHA-accredited hospital since 1983, we voluntarily uphold the associations high standards in 18 areas, including patient care, cleanliness, and emergency services. Urinary incontinence and micturition disorders: pharmacologic management. Similar to male dogs, there is high individual variability. The condition must be carefully managed to avoid welfare issues for the affected dogs, such as urinary tract infections and skin sores from urine leakage. The need for monitoring for signs of bone marrow suppression with a complete blood count is controversial, and agreed-upon standard of care recommendations cannot be given. Cranberries added in dog food are usually not enough to prevent UTIs, so reliable, dog specific supplements are necessary. Cystoscopy is routinely performed in patients with urinary incontinence to rule out anatomic abnormalities that may be contributing to clinical signs. Sontas HB, Dokuzeylu B, Turna O, Ekici H. Estrogen-induced myelotoxicity in dogs: A review. If secondary bacterial infections are present, these should be treated with antibiotics. What Is Incontinence in a Dog? A normal amount of testosterone will prevent incontinence, while a low amount or no testosterone will cause urinary incontinence. One advantage of using DES to treat UI in dogs is the convenience of treating a patient on a weekly basis rather than daily (Table 1). Female dogs appear to have similar response rates to estriol and DES (89% and 87%, respectively).9,10 Adverse effects with its use include mammary and vulvar swelling and attractiveness to male dogs. The material is injected submucosally into the proximal urethra via cystoscopy (Figure 1). Medical therapy is considered the first line of management in dogs with acquired urethral incompetence (UI). In humans, this is often managed with procedures that stabilize the mid-urethra during increases in abdominal pressure, using a surgically placed tape to pull the vagina and urethra against the pubis. In some females, a combination of estrogen therapy and phenylpropanolamine, for controlling incontinence, may be more effective. The larger the dog, the more pronounced this alteration in risk becomes. Thrusfeld MV, Holt PE, Muirhead RH. Treatment must be tailored based on whether the problem involves an inability to hold urine during bladder filling or an inability to empty the bladder during active urination. However, these drugs can also have side effects on the bone marrow, so we monitor . FSH and LH plasma levels in bitches with differences in risk for urinary incontinence. Some practitioners avoid the use of estrogen compounds because of the potential for irreversible myelosuppression seen in dogs treated with estrogen compounds for mismating or to induce estrus.8,9 While this is a potential toxicosis, the doses associated with bone marrow suppression are generally at least 10 times higher than those recommended for management of UI. Other possible causes of male incontinence include: Damage or injuries to the urethra or bladder muscles Prostate disease or prostate cancer Issues like kidney stones also need diets specific to the dog's kind of stone, while a dog with diabetes often benefits from a high-fiber, high-protein diet. The ureters carry urine from the kidneys to the bladder, and if one or both ureters bypass the bladder and connect to an abnormal location, such as the urethra or vagina, the puppy may drip urine. Among the most commonly affected breeds are the Old English sheepdog, Doberman pinscher, boxer, German shepherd, and Weimeraner.3 Results from a recent study indicate that earlier neutering may increase the risk of USMI development in dogs with a projected adult body weight greater than 15 kg.1, Although many risk factors for the development of UI in dogs have been identified, the mechanism of development remains unclear. These medications provide a very low dose of estrogen to increase urethral tone and relieve urinary incontinence in many dogs. The dose and frequency needed for each animal tend to vary widely and may need to be increased over time to maintain continence (Table 1). Sometimes, males may benefit from testosterone injections, but this is less common. PPA has also been used safely in cats with UI, although there are little data available regarding its efficacy. This may be more common in breeds such as greyhounds, Doberman pinschers, and Weimeraners.6. All rights reserved. Medical therapy is most commonly aimed at increasing urethral tone by stimulating -receptors in the smooth muscle of the urethra with -agonists and/or increasing the number and sensitivity of those receptors with estrogen compounds. Intramuscular testosterone cypionate (1.5 mg/kg/month) was used to treat urinary incontinence in neutered male dogs. Byron JK, Chew DJ, McLoughlin ML. Canine incontinence. Anecdotally, some dogs have not needed addition of saline to the port postoperatively, since the placement of the sphincter itself appears to provide enough support and occlusion of the urethra to allow continence to be maintained. The results reported in this case series suggest that testosterone cypionate might be an effective and safe treatment option for male dogs with USMI. Holt PE. Other adverse effects, such as behavioral changes and decreased appetite, are related to sympathetic stimulation. Urethral incompetence is the most common reason for urinary incontinence in the dog. The absence of testosterone may be caused by the neutering procedure. Forsee KM, Davis G, Mouat EE, Salmeri KR, Bastian RP. These side effects are generally mild and resolve with appropriate dose reduction. It is well known that UI is most common in dogs that are spayed or neutered; however, the exact mechanism and relationship to estrogen and testosterone decline is unclear. AEs of estrogen therapy include mammary and vulvar swelling and attractiveness to male dogs. Radiographs can rule out urinary stones, and ultrasounds will rule out tumors or growth in the bladder. A variety of non-neurologic problems can cause urinary incontinence including: Hormone-responsive incontinence, which are estrogen-responsive incontinence in female dogs and testosterone-responsive in male dogs Urethral sphincter mechanism incompetence Congenital defects, such as a misplaced ureteral opening or ectopic ureter present at birth Unauthorized use of these marks is strictly prohibited. The timing of the onset of UI and the ability of a dog to empty its bladder are important in determining the underlying cause.