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Puddle Jumping: Canine Urinary Incontinence
From the Q4 2009 Edition<< Back to Newsletter
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Canine urinary incontinence is surprisingly common and can occur in any breed -- from Chihuahuas to Great Danes -- but there are many strategies to keep house and hound dry.
One Dog's Story: Delta the Greyhound
Last summer, Brooke Frautschy noticed something odd about Delta, the Greyhound she brought into her home about two years ago.
Although housetrained and fastidious, Delta had started having accidents inside, often on her own bed. Even odder, these incidents seemed to happen when the dog was fast asleep. "If she had an accident, she'd clearly get upset," says Frautschy. She'd jump up and start licking, or make a "mopey" face. "Sometimes she'd run into the other room," she says.
Luckily for Delta, Frautschy was a veterinary student. So she neither panicked nor jumped to the
conclusion that her dog had forgotten her training. Instead, she brought Delta to school, the University of Illinois College of Veterinary Medicine, to figure out what was wrong. It turned out that Delta was suffering from canine urinary incontinence. It's a relatively common condition; most veterinarians have treated at least a few cases. But it's also a condition that can be misunderstood by owners.
"It is a very frustrating problem for a lot of people, and it does lead to people giving their dogs up," says Julie Byron, DVM, MS, clinical assistant professor at the College of Veterinary Medicine, University of Illinois.
"People will tolerate a lot of different things, but they really don't want to deal with dogs who are wet all the time," adds Mary Labato, DVM, clinical professor at the Cummings School of Veterinary Medicine at Tufts University.
Incontinence can be the result of injury, neurological disorders, or diseases like Cushing's (see box below), and affects both males and females, whether or not they are neutered or spayed. Most often, however, it occurs apart from any disease process-many dogs with the condition are perfectly healthy-and is most often seen in one group of dogs.
Female Troubles
"It affects about 20 percent of spayed females," Byron says. Among large breeds, studies have suggested that the incidence may be as high as 30 percent. It may occur in the first few years after spaying, but is most commonly seen in middle-aged and elderly bitches.
"Most of these dogs will start to leak about three or four years after they've been spayed," says Byron, who specializes in urological diseases. Scientists are not sure exactly why these dogs start to leak, but most theories point to the role of one vital hormone-estrogen.
A lack of estrogen, which occurs when the ovaries are removed, can cause changes in pelvic structures designed to hold urine in the bladder. Byron notes that the same kinds of problems are seen in humans. "Just like women who undergo menopause, when the estrogen goes away there is some atrophy of those tissues, the tissues get thinner, the blood vessel numbers may drop, there may be a change in the type or content of the collagen, which may make tissues a little stiffer."
But estrogen is not the whole story, since not all spayed dogs become incontinent. A dog who starts to leak probably has a physical predisposition to the condition, such as weak pelvic muscles or ligaments, or a bladder positioned in a way that makes dribbling inevitable.
Several Options
The good news is that, for the majority of patients, incontinence can be kept under control with drug therapy.
The most commonly used medication is phenylpropanolmine (PPA). It belongs to a class of drugs known as alpha-agonists. They bind to receptors on smooth muscle cells, which causes the muscles to contract. "That's my first choice," says Byron, noting that the drug works for 70 to 90 percent of incontinence patients.
In some dogs, side effects rule out the use of this drug. These can include restlessness and loss of appetite, and in the most serious cases, high blood pressure. Byron always checks blood pressure before suggesting PPA.
If PPA can't be used, another option is estrogen supplementation, which is thought to reverse some of the changes that occur due to depletion of the hormone. Byron says this approach works in roughly 60 percent of patients.
Veterinarians sometimes prescribe both estrogen and PPA for dogs who are not helped by either drug alone. In a patient who experiences mild side effects to PPA, it may be possible to reduce the dose and add estrogen. "There may actually be a synergistic effect," Byron says.
"One thing that's frustrating is that sometimes dogs will respond very nicely to the drug for a year or two, and eventually, there's a decrease in response," Byron says. "We don't understand why that happens. But just because a drug stops working doesn't mean that all is lost."
There are a few other drugs, similar to PPA, that can help if the more commonly used treatments stop working. There are also a couple of surgical fixes. In some cases, an operation known as a colposuspension can reposition the bladder to reduce dribbling.
A relatively new procedure is collagen injection, in which the same material that plumps up starlets' lips is used to narrow the diameter of the urethra. Byron says this helps about 70 percent of the time, but there's no way to predict how long it will remain effective. For some dogs, it could last for years; in others, the collagen breaks down in a matter of months
Labato says in addition to these methods there are experimental techniques, such as artificial sphincter devices, that might work in severe cases. She notes that there is also research underway in humans exploring the use of stem cells to improve pelvic muscle tone. Labato's laboratory is planning to explore the role obesity may play in incontinence, because many dogs who have the problem are also overweight.
Matter of Degree
As veterinarians at large university hospitals, Byron and Labato generally see the most committed owners, and the more complicated cases. These are the ones that may require more than one kind of treatment, and the results may not be 100 percent.
Often, however, owners are happy with small changes. "If you have a dog that leaks every night, and you drop it down to once a week, that's an enormous improvement," Byron says.
That's the situation for Delta the Greyhound. PPA worked well for her, but she developed high blood pressure and had to stop treatment. Estrogen did not help, but another drug-imipramine, an antidepressant that is also used for separation anxiety-has reduced Delta's leaking to about once a week. "That's a level I can deal with," says Frautschy. In the future, she intends to explore other options. These may include surgery as well as dietary and herbal approaches that, according to anecdotal reports, have met with some success.
While Byron recognizes that incontinence often lands dogs in shelters, she's also been impressed by the commitment of the owners of dogs she treats. In one case, a male Dachshund, the owners tried PPA. It did not help. Testosterone treatment, which often works in males as estrogen does in females, only prompted him to start marking in the house. Collagen injections worked, but only for a short time. Their solution?
"They're living with it," says Byron. "They love this little guy." He spends most of his time in non-carpeted areas of the house, and he's taken outside frequently. Sometimes, he wears a diaper designed for dogs with this problem. "He still plays and runs around the yard, and goes on walks," she says. "He's a very happy, healthy dog."
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Diseases that Cause Incontinence Veterinarians will generally screen for several diseases when a dog is leaking. Many conditions, some serious, can cause a dog to have abnormal thirst, and to drink more than the bladder can hold. Some common conditions include: Urinary tract infections Bladder infections Cushing's Disease Bladder tumors or polyps Bladder stones Kidney disease Hormone responsive Prostate Disease Spinal damage When a Puppy Dribbles Sometimes, when incontinence develops in a puppy, the cause may be a congenital abnormality of the urinary tract, known as an ectopic ureter. Normally, urine is produced in the kidneys and transported to the bladder through a tube known as the ureter. Sometimes the ureter bypasses the bladder and empties directly into the vagina or the urethra, the tube that transports urine out of the body. Ectopic ureters will be evident in a very young puppy. They can be treated with surgery to put the opening of the ureter in the right place. When All Else Fails There are several products on the market that can help make the best of an imperfect situation. Doggy diapers, some with frills and fancy designs, are available from several manufacturers. Some companies like Bloomingtails Dog Boutique and Diapers for Dogs, will custom-fit them. Others make disposables and washable ones, like the SnuggEase. Tinkle Trousers are designed to solve the biggest problem with doggy diapers-keeping them on an active dog. Specially designed bedding is also available for incontinent dogs. The SleePee Time Bed offers an elevated sleeping pad over a tray to catch urine. Several companies make products for bed-wetting children, such as waterproof mattress pads, that can ease the burden of cleaning up after an incontinent pet. Many of these products, as well as cleaning solutions that neutralize the smell of urine, are available online, direct from the manufacturer, at pet stores, and at Web sites that focus on caring for senior and handicapped pets, such as handicappedpets.com. |
This feature by Mara Bovsun appeared in the April issue of The AKC Gazette, and is reprinted with permission. To subscribe, or for more information, visit http://www.akc.org/pubs/index.cfm
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ANNIEM | Posted Jan 15, 2010 06:00 PM
I have a 2.5yr old female doberman that is fixed that started having a leaking problem when she was about 1 year. My previous female doberman had the same problem effecting her at the same age. This is more common than you think. Both were treated with the hormone DES and that worked very well.Thanks for posting this for others to read, many may not know what to do or if there is a solution. My neighbors boxer has the same problem and DES helped her too.
Vincent | Posted Jan 06, 2010 05:46 PM
We also have adopted greyhounds in the house(4).At the time there were only 2 and I noticed a periodic drip from the female.She also was house trained and would get upset when she awoke to find herself wet.The solution was very,very simple.Although a large breed,we eliminated additional glucosimine from her diet.She was allergic to glucosimine derived from shellfish.The poor girl could tolerate the subtance derived from poultry without any problem.Moral,read the ingredient labels.There are foods readily available and easy to find.This has worked on more than 1 dog.Good luck.
Len | Posted Dec 31, 2009 09:33 AM
Our Aussie became incontinent while sleeping, at a young age - less than a year. PPA worked but she had such anxiety and nervousness we had to quit. But, we increased her exercise - she now has free range over 2 acres several times a day - and she loves to run, and after a few weeks she gained strength and lost fat. Now she is a very strong 4 year old and only has incontinence once or twice a week, much better than the every day or so before. So maybe muscle tone has an impact on this.
Lotta Chien | Posted Dec 24, 2009 12:30 AM
I like the belly bands for boys as you can use a stick on incontinence pad or just keep the bands well washed. http://www.pekeatzurescue.com/bellybands.htm way greener than diapers!
bestuvall | Posted Dec 23, 2009 01:52 PM
Maria is one vet that I imagine has her clients best interests at heart however her comments lead me to believe she perpetuating the myths so often found in vet schools. Male dogs that are contained do not "break through windows" to get to females. Breast cancer in bitches is easily kept track of by monthly breast exams on your pet.. just as on yourself... pyometra is a "risk" but not a huge one and most forms of pyometra are treatable. Animals that are bred do not get pyometra, that is why reproductive specialists like Dr Robert Hutchison recommend breeding your bitch on consecutive seasons and THEN spaying her. No dog should undergo early castration UNLESS the owner and veterinarian have a discussion about the pros and CONS of the procedure especially at a very young age. Not mentioned her.. but found in other studies are the risks of easy castration involving bone development and other structural problems leading to very serious consequences Castrating bitches and dogs at 8 weeks old seems extreme in even the worst case. I would never recommend this to anyone for their dog and don't know any ethical veterinarians who would.
Christina | Posted Dec 22, 2009 10:50 AM
My vet urged me to spay my German Shepherd Dog at the earliest possible age, claiming that it would make the procedure easier and safer. He never mentioned the possibility of urinary incontinence. My otherwise wonderful dog piddles every time she bounces. I wish I had known about this before making the decision to spay her so young.
Piper Light | Posted Dec 17, 2009 10:50 AM
What about Joybies Piddle Pants. They fit like a jumper so the dog or cat can't get out of them. Velcro attachments make them easy to put on and take off. Thow them in the washer and line dry them overnight. And they look so cute. I used them with 3 older dogs and plan to use them again when my current puppies get old.
Debbie McMurdie | Posted Dec 14, 2009 11:28 PM
I am wondering why you haven't mentioned a holistic approach here. I have a 4-year old spayed Great Dane that began incontinence about 6 months ago, we are managing it with herbs, and it is working quite well. Thank you, Debbie
Rosehound | Posted Dec 03, 2009 12:19 PM
I too blame early spay, after three consecutive spayed German Shorthair Pointers, unrelated genetically, who suffered from urinary incontinence. The worst is my 12 year old bitch who had to go outside at least once a night for the past three years, and still leaked onto her bedding many nights. Prion's side effects really troubled her, making her restless and preventing her from sleeping at night. Estrogen therapy was ineffective. What has worked (fingers crossed) for the past 6 months is a major change in diet: no kibble. I now feed my GSP only canned food. I made this change after my vet pointed out for the second time that she had seen some changes in the bitch's kidney function. My objective was to reduce the amount of protein in her diet. I'm not sure I did that, since comparing protein in ultra high quality dry kibble and protein in canned food is like comparing apples and oranges; however, within three days of the diet change, my bitch was sleeping through the night without any leaking. A canned food diet is expensive, but after being awakened at night, every night, for years, I gladly pay the price.
Julie Sorrell | Posted Dec 03, 2009 11:33 AM
My 12 year old spayed female developed urinary incontinence at about 11 years. The veterinarian urged me to try Proin twice daily to remedy nighttime "flooding." Within 2 days, the problem was resolved. During the following year, only one incident occured. This drug is available on the Internet at a much lower cost than my clinic charged and my veterinarian was agreeable to sending a prescription. I would recommend this approach to anyone who has not yet found a satisfactory solution!
Sue | Posted Dec 02, 2009 11:16 AM
This is a very interesting thread and thought I would share my experience. There was an article in a AKC magazine about a boxer who would leak, diagnosed psychogenic polydipsia, medications for his head didn't work and out of desperation they tried desmopressin (my pharmacist said it's sometimes used for bed-wetting in kids). Well I was going through something similar, many test and doctors could come up with nothing....out of desperation I asked my doctor to try the the desmopressin. Used in the nasal for humans my dog was given his dose in his eye. First dose he was completely normal. I'm on the forth bottle and now using a herb compound to try and get him of the medication. He can now stop taking the medication with out leaks but wants to drink to much water. If I limit his water to 3 cups 3X's a day he gets dehydrated. Anybody else experienced this?
Margaret | Posted Nov 19, 2009 02:00 PM
They didn't mention Diabetes Insipidus, the "water" diabetes. They say it is Very Rare in dogs, however after living a Doberman with the disease, I think this is much more common than generally acknowledged. It is very difficult to diagnose and very expensive to treat, but I think the condition is much more widespread than realized. Diabetes Insipidus should at least be mentioned in an article regarding "leaky" dogs.
Deborah Musgrove | Posted Nov 19, 2009 11:22 AM
I had my male yorkie neutered two years ago and he still feels the need to mark his territory. I would not mind when he is outside, however, he is doing it on the TV stand and furniture. What can I do to stop this behavior? Debbie
pamala lewis | Posted Nov 18, 2009 06:45 PM
I have found doggy diapers way too expensive..so I buy children pull-ups called "Goodnites underpants" for my 12 yr. old, 60 pound border collie mix. They are about $15.00 for 27 diapers at Wal-Mart.
Maria | Posted Nov 18, 2009 03:18 PM
As a veterinarian, I have to say that estrogen-responsive incontinence is an unfortunate but thankfully fairly uncommon sequela to early spay. The benefits of early spay--including eliminating the risk of potentially fatal uterine infection, reducing or eliminating (depending on how early spayed) of breast cancer, and preventing unintentional matings with all the problems associated with reproduction (aggressive males, trouble during pregnancy or birth, sick mother, sick puppies, unwanted puppies, etc etc). I always remind my clients that male dogs can be very persistent, breaking through fences or even windows to find an in-heat female, so even the most well-intentioned owner of an intact female can have problems. As Jan mentions, owners need to know that veterinarians are there to be an information source as well as help diagnose and treat problems, so taking an incontinent dog to the shelter should not be a first-line of recourse! Also, please remember that alternative therapies are not completely without adverse effects. Just like humans taking herbal supplements, they can cross-react with other herbs or medications or cause primary problems in and of themselves. Unfortunately, no remedy we put into our or our pets' bodies are completely benign. That said, alternative therapies can be a great complement or, well, alternative to traditional medications.
sherry holm | Posted Nov 16, 2009 09:14 PM
I agree with many of the comments here - what a dissappointment to not see even a mention of alternative therapies! I had Dobermans for many years, and learned the hard way that living with a leaking large breed dog is more than a "little inconvient", as one vet told me. I had great success using chiropractic, accupuncture, and different herbs suggested by my holistic vet. One of my Dobes, in particular, would be leak free for at least 3 weeks to a month after a chiropractic adjustment. I also learned NOT to spay until at least one heat cycle, preferably 2. I understand the push for early spay/neuter with a less than responsible owner, but give those of us who ARE all the facts we need to do the best we can for our dogs! Sadly, far too many vet schools are still uneducated about the latest research, and don't have the facts to even offer. Be a smart owner and do the research yourself, and take your findings to your vet and ASK QUESTIONS! If your vet is not willing to listen, find one who is!
Linda | Posted Nov 16, 2009 11:01 AM
My Lab used to dribble when he was excited or startled. I changed vets to one who also included alternative medicine in his "bag of tricks" and mentioned to him that my Rottie had been sniffing at a particular spot on my Labs side for years. My previous Vet disegarded it despite my concern, but as soon as I mentioned it to my new Vet he immediately began asking if the Lab dribbled. To make a long story short, he put my Lab on the hebal suppliment Suo Quan Wan. Within 3 days, my Rottie stoppd sniffing at the spot on the Labs side and he hasn't dribbled once since. He was on the supplement for a month. The reason I went to a Vet who incorporated alternative medicine for those clients who are open to it is because I believe if there is a safe alternative to medication or surgery, I want to know about it. Another example - my 3 year old Rottie has arthritis and is stiff in the mornings and on rainy days and had almost stopped running due to pain. I was told that I would have to medicate her for the rest of her life to reduce her obvious discomfort. Instead, my new Vet suggested that we first try an herbal supplement called Body Sore to see what happened. Within a week, she showed significant reduction in pain. Two months later, she is running beautifully, with no stiffness or discomfort.She won't need to be on medications that could have had side effects or possible long term negative impact. Thats worth it to me. I'm not at all suggesting throwing out traditional western medicine, but I am saying that sometimes there are natural alternatives that are less invasive. I would suggest that you very carefully screen any Vet who incorporates alternative medicine to ensure you find one who is properly trained and licensed in both western and alternative medicine and that you educate youself so you can best advocate for your animals needs and make informed, safe decisions. I never give my animals anything without carefully researching it - be it a medication, a supplement or herbal supplement.
Cynara Ridgebacks | Posted Nov 13, 2009 11:40 AM
Early spay and even early neuter can cause problems with large breed dogs which is why my puppy contracts are very clear that owners should wait until their Ridgeback is at least 1 year old and even better over 18 months old before doing the surgery. Vets are becoming relentless about pressuring owners to spay/neuter. A couple of my new owners had to tell their vet it would be a violation of their contract before he would leave them alone.
Mary Ann Wheeler | Posted Nov 13, 2009 09:51 AM
My puppy has from the day we got her been dribbling whenever someone greets her. She is now twelve months old and still dribbling. Any suggestions. Thanks
Patricia Roels | Posted Nov 13, 2009 08:45 AM
I adopted my lab mix from a rescue organization - they spay pups at 8 weeks before they allow them to be adopted - I now have a 3 year old 50lb dog with this problem. The medications has so far worked well but my vet says I must have bloodwork done at least annually potentially more often. What is bloodwork going to tell them or is this just a way to pad my bill everytime I walk in the door?
Jan | Posted Nov 11, 2009 11:59 AM
I find it very facinating that it does not mention the main cause of this recent dilemma (30years) until the very end of the article. The spay procedure is what causes this and the earlier the spay the more problems. But the community of vets decides not to even mention this side effect and unsuspecting people end up with a dog that wets without even knowing. So many good intentioned owners that think they are doing the right thing by early spay and neuter end up having to surrender the dog due to incontinence issues later on. The very diseases they say that early spay and neutering prevent are Now i can understand pushing the small dog early spay and neuter campaign. Usually the small breeds mature quickly and if they do develop incontinence it is easy to clean up. Medium and large breeds should never be fixed until the dog is done growing. Now a days with good enclosures it is easy to keep your animal in. If you cannot keep your animal in then by all means have the animal fixed. Because the incontinence in these breeds is harder to deal with. Vets should warn of this condition. So many dogs are surrendered without even getting a follow up about the condition with thier vet. It would be nice to get the word out so responsible owners can make an informed decision about this life changing procedure. And when problems arise they consult the vet first. Not try to handle the job by training or structure. The other thing the article did not mention that with the replacement harmones after a few rounds the condition stops all together. So that owners realize that there is an end in sight. Jan Gothan