 |
One of the most perplexing conditions a dog owner can be faced with is urinary incontinence. Urinary inconinence is the inability to hold urine resulting in urine leakage, dripping and or pooling. This leakage can become chronic and cause urine scalds. These scaqlds can lead to skin infections. And skin infections can lead to kidney disease. Not only is urinary incontinence unsanitary for the owner, it is unhealthy for the dog. Urinary incontinence can be seen in both males and females. It can bbe associated with a distended bladder, where the bladder is so full that the urine just leaks out on its own. This is seen with disease or trauma to the spinal cord, or with urinary outflow obstruction (a bladder stone or enlarged prostate blocking the way). Urinary incontinence can also be seen with a small or normal sized bladder. The bladder is normal sized but for some reason the urine drips out on its own. This type of inconinence is seen with bladder inflammation, such as a bacterial infeection. It can also be seen as a result of congenital abnormalities where the bladder did not develop properly. Such abnormalities include ectopic ureters, and persisitent urachus. Normal sized bladder incontinence can also be seen in post ovariohysterctomized (spayed) bitches and neutered males. This type of urinary incontinence is called hormone responsive incontinence. Successfujl treament of urinary incontinence depends on proper diagnosis. Distened bladder incontinence can be diagnosed with complete physical and neurological examinations along with radiographs and urinalyses. The presence of spinal cord lesion in the areas of the nerves that effect the bladder function can help to diagnose the cause of the incontinence. Likewise the presence of a stone in the uretha or a grossly enlarged protrate that is blocking urine flow from the bladder may help to diagnose the cause of distended bladder incontinence. Treatment of distended bladder incontinence is aimed at removing the lesion causing the distension. Although this may sound easy, the cause of causes of distended bladder incontinence are often hard to determine. Diagnosing the cause of normal size bladder incontinence starts with a thorough history of the progression of the incontinence problem: - When did the problem first appear? - How long has the problem been goin on? - Has there been a change in food recently? - Have you changed your job recently and cannot make it home as frequently to let the dog out? - Is there a new member to the household? - Is the dog spayed or nuetered? If the problem has been going on since the puppy was brought home, there may be a chronic bladder infection or there may be a congenital defect. This type of incontinence usually presents itself as constant dripping and wet britches. If there is a food change perhaps ther is bladder inflammation due to a food sensitivity. if the bathroom habits have changed perhaps there is an infection due to holding urine too long. If there is a new member to the household, perhaps there is a bladder inflammation due to a bladder parasite. These three types of incontinence present themselves as frequent attempts to urinate and only small dribbles come out. If the dog is spayed or neutered, perhaps there is urinary incontinence because of the change in estrogen or testosterone levels post-surgically. The cardinal presentation of hormone dependent incontinence is the dog that wakes up after a nap in a pool of urine and has no idea that it has urinated. Diagnostic testing includes plain radiographs and dye studies of the bladder. Vainoscopy is useful. Urinatlyses with cultures are necessary. Complete blood counts and chemistries are helpful. As with destended bladder incontinence, diagnosis will allow for the proper approach to treating normal sized bladder incontinence. How To Stop That Drip Urinary incontinence is the inability of the bladder to retain urine. Urine retention is dependent upon: - the normal expandability of the bladder wall, - the ablility of the neck of the bladder wall, - and the normal structure of the urinary tract. When any one of these three components is not functioning properly, urine can drip out of the bladder. This leakage can cause urine scalding of the belly and the britches, and urinary infections. TREATMENT: SURGICAL: various surgincal procedures have been used to treat urinary incontinence with varying degrees of success. In the most common used procedure, colposuspension, the vagina is sutured to the belly wall, compressing the neck of the bladder and directing it slightly toward the head of the dog. This along with other surgical procedures, although appearing to be successful at first, usually fail over time. Any abnormality in the structure of the urinary tract that leads to incontinence must be corrected surgically. The most frequently diagnosed problem is the ectopic ureter. When this occurs, the ureter that carries the urine from the kidney to the bladder, enters the bladder behind the neck of the bladder. The muscles in the neck of the bladder then contract in front of this ectopic ureter, not behind it. Because of this, the ectopic ureter can continuously dribble urine. A preventative surgical procedure that may lead to fewer cases of post spay incontinence, involves removal of any remnants of the urachus that may persist in the adult female dog. The persistent urachus is the tissue that often remains attached to the forward tip of the bladder and extends up to the umbilicus. It represents part of the fetal-maternal urinary system. If this remains after spaying (or if it is present before), urine may pool in the bladder leading to inflammation and/or infection. This inflammation can decrease the expandability of the bladder leading to leakage. MEDICAL: long-term medical treatment for incontinence has proved to be very effective in most cases. The normal expandability of the bladder is affected by any irritant to the bladder wall, whether it is a bacterial or yeast infection, a food allergy, a stone or a space occupying lesion (polyp or tumor). Treatment is aimed at finding the cause of the irritant. Sterile cultures and sensitivites of the urine should be done and appropriate antibiotic therapy should be instituted. Blood tests for food hypersensitivities can determine if the inflammation of the bladder isa an allergy to the food the dog is eating. Most allergy labs will then do a food matching search for each dog's individual food allergy. Just switching to an appropriate food can resolve the inflammation in the bladder and allow for normal expandability. Treatment for stones or space occupying lesions do require surgical intervention in most cases. The irritation of the muscles in the expanding bladder can also be helped with addition of antispasmotic drugs. The most widely used in veterinary medicine are oxybutynin choride and dicyclomine hydrochoride. Tolterodine tartrate (Detrol) has been used widely in human medicine. It may prove to be helpful in veterinary medicine as well. As with all therapies successful treatment starts with successful diagnosis. Whereas, the dog with bladder expandability incontinence which show urgency to urinate and often frequent small urinations, the dog with neck of the bladder incontinence will leave puddles after sleeping and often not realize it has leaked urine. This type of incontinence is seen primarily in the post spay bitch. Medical treatment is aimed primarily at enhancing the muscles in the neck of the bladder. Single drug or multiple drug therapies have been used successfully. These therapies directly or inderectly affect the neuromuscular receptors in the neck of the bladder. Estogen is used to increase the number of neuroreceptors in the neck of the bladder. By increasing the number of reurorecptors in the neck of the bladder a normal amount of nervous stimulation from the brain and the spinal cord will cause a greater than normal contration of the muscles in the neck of the bladder. This increased contration will squeeze the neck of the bladder closed tightly. Estrogen comes in a variety of prepartations. Among those available by presciption are Diethylstilbesterol, Premarin, and Estriol. The dose range varies by individual as does the frequency of administration. Estrogen use must be monitored carefully by the veterinarian. Side effects include overt signs of heat (estrus), bone marrow suppression, hair loss, and behavioral changes. Alpha agonists also work on the neuromuscular receptors in the neck of the bladder. Unlike estrogen that increases the number of receptors to increase the response to brain and spinal cord stimulation, the alpha agonists directly stimulate the receptors causing increase contraction. Although ephedrine and psuedoephedrine have been used for urinary incontinence, the most widely used preparation in dogs is pheylpropanolamine. Phenylpropanolamine is available from PRN Pharmaceutical under the brand name Proin. It is no longer available in the human pharmaceutical maret. As with estrogens, the dose range is wide. Whereas, estrogen can often be administered two or three times daily. There are side effects associated with the use of alpha agonists. They include loss of appetite, weight loss, restlessness, stomach upsets and a fast heart rate. It is already obvious from the above, that the use of each drug group individually can help treat urinary incontinence associate with inadequate closure of the muscles in the neck of the bladder. The combination of the estrogens with the alpha agonists can also be effective in treating incontinence. The estrogens will increase the number of neuroreceptors in the neck of the bladder and the alpha agonists will increase the stimulation of the neurorecptors. The two drug groups can act synergistically to close the neck of the bladder and aid in urine retention. They can stop the drip. Since the dose ranges are so variable, it is often frustrating to the dog owner to continually adjust the drugs until the appropriate dosages are determined. - Treatment of urinary incontinence is possible. - Determining the cause will lead to proper treatment. - Remember, this condition requires treatment, NOT PUNISHMENT. Article by Dr. Cindi Bossart, DVM |
| Incontinence can affect any canine for various reasons. |
| From The White Collie Chronicle Newsletter Apri/May/June 2003 Vikyne 8, Issue 2 |
 |