Bowel and Bladder Function In The DM Dog
How to Express a Dog
Message Board Comments

An injured animal often loses its ability to urinate. This is a critical, sometimes fatal problem unless the caretaker knows how to manually cause the animal to urinate, called 'expressing' the animal.

Your vet will show you how to do this and it is important that you follow your vet's instructions carefully. This page is a discussion of expressing and not intended to be a substitute for a vet's advice.

Your pet’s bladder needs to be completely emptied 'expressed' at least three times a day (every 8 hours). When an animal can't walk, urine can 'pool,' sitting in the bladder. Sometimes, when you find your pet’s bedding wet it does not mean that it is incontinent or peeing in its sleep but rather that the bladder has become so full that it is overflowing.

Following injury to the spine, or the rear area of an animal, cystitis of bladder can become a serious threat to your pet’s health. These infections can cause death in a few days if not treated. Bladder care plays a crucial part in the health of your pet, whether is has had surgery or not and whether it is completely, or partially disabled.

Here are the most common signs of a bladder problem or urinary tract infection:
Dribbling or urine evidence. Look for a wet rear and wet bedding.
Foul odor to urine and increased licking of the genital area as infection worsens (although licking behaviour is not always present).
Bloody or dark colored urine. Note that severe symptoms require immediate veterinary care.
Depression, loss of appetite, and a rise in temperature as infection progresses.
Treatment of Urinary Tract Infection

Prophylactic medical treatment before signs of infection occur offers the best route of treatment. Work with your veterinarian in prescribing the best medication, monitoring PH, culturing the urine, and and teaching you how to express your pet. Urine left in the bladder can become a place where bacteria breeds.

This describes how to express a bladder... but you MUST check with your veterinarian first.

 

How To Express your Pet’s Bladder
Smaller pets are easily managed by one person. Larger pets may require two people. Extremely obese pets may require a veterinarian. All of the photos below may be clicked on for larger views


 
Alternate Method.
On small pets, place one hand on either side of the pet’s side behind the rib cage and gently squeeze your hands together.

NOTE: The bladder must be manually expressed until your pet is able to fully urinate on its own. Having the bladder expressed at least three times daily, every 8 hours, is a permanent nursing care necessity for permanently impaired pets

Bladder Care is often a long-term nursing care need for months or years. The success of your nursing care program will hinge on how effective you become in this care.

"Dont Worry!" say hundreds of messages on our message board. This becomes so easy for you and your pet after a very short time.


Your Comments
Many of these comments have been posted on the discussion board at www.HandicappedPets.Net. This is a good place to post your questions and concerns.


Urinary: UTI's, meds, ph, etc Posted By: Anita
Date: Thursday, 7 July 2005, at 5:59 p.m.

Urinary Tract Infections
These subjects seem to always be coming up and there really isn't one answer for everybody.
I have been this route and have learned quite a bit through my experience. Here are some pointers and things to conside when dealing with uti's.
Remember that I am not a doctor but a mom of a wonderful critter that has been through it all.
1. Not all UTI's are the same. Each time that one is suspected a culture should be done to see what medicine will work. They all don't work for all infections. Sometimes you have to FORCE your vet to do a culture but it has to be done. Ask for a copy to keep in your files at home so that you can look at it later if need be.
2. Make sure that you understand how to express correctly and completely. Pooling urine is what causes some UTI's. If you are not sure, make an appointment with the vet, express them while you are there, then have the vet see if you got it all. It takes me less than 1 minute to express Sydney. Sometimes I can't get it all the first time but I let her rest for awhile, them try it again. I don't give up until I get what I beleive is all of it.
3. Keep the bottom areas as clean as possible. Roll them on their backs daily and clean it with a baby wipe, females especially. You will be amazed at all the yucky stuff that can build up. Just think of the bottom of your shoes!! Get into all the folds and crevices.
4. After you express them, especially females, make sure that you wipe them to dry them off. A wet bottom loves bacteria.
5. Try not to let them lick themselves down there (yeah right). That brings in bacteria too.
6. Cranberry tablets are good at preventing UTI's. You need a good one, like from a health food store or on line. Cranactin is a very good one. Use one capsule per 20 pounds of the regular Cranactin per day, not the super one. The ones you buy at Walmart or places like that aren't really strong enough. Solid Golds Berry Balance is good to, but it is in powder form and I found it hard to give. Remember too much cranberry can cause stones so you have to be careful.
7. You can check their ph balance and that will give you an idea what is going on in there. A good ph balance is 6.5-7.0. Bacteria will grow in the higher numbers. You can purchase strips on line. Check the ph early in the morning before breakfast. Certain types of foods cause higher ph balances. You can call the dog food company and ask them what ph their food causes. They know.
8. Remember that water is very important to flush out the urinary tract and the bladder. One good way to give water is to boil a whole chicken in plain water (no salt). Eat the chicken yourself but save the water. Freeze them in ice cube trays and when you feel that your baby needs more water or just isn't drinking enough, put one in a bowl and add some more water, put it in the micro for a few second and they will think that they are getting a wonderful treat. If they like ice cubes, just give them the cube. Make sure that you express them about 3-4 hours aferwards. When I have been gone a little to long and I know that Sydney has had a lot of urine in her bladder I give her chicken water to flush out her bladder.
9. Anti-biotics remove the bad bacteria and the good bacteria in the urinary tract so a good thing to give is a pro-biotic, like acidophilis (sp). Ask at your local health food store. Yogurt is good but sometimes not concentrated enough. Some believe that dogs should be on it all the time.
10. Remember that UTI's are just part of not having bladder control. They just happen sometimes no matter how hard we try to prevent them. If chronic UTI's are your problem ask your vet about "pulse therapy" which is giving the meds full strength for a certain amount of days during the week, then a few days off. I think it is 4 days on and 3 days off. Another thing that works is a daily dose of the meds for a long period of time. I know that sounds harsh but if it keeps the infections away it is worth it. Some people say that they will build up a resistant to the medicine. Sometimes yes, sometimes no. If they do, then there are a lot of different medicines out there that will work. That is why a culture is very important.
11. Once you have the infections under control, do a culture occasionally to make sure that it is working and to give you peace of mind.

WHEW!! That was a lot on info. I hope you all don't mind.

Let me tell you what happened to Sydney and her UTI's. She has been paralyzed since Sept of 2003. She went into surgery with a UTI and had one constantly for the next year and a half. I had did it all, Cranactin, Berry Balance,ph, cleaning, smelling, praying, etc to no avail.
Then one day I thought that maybe it was ME that was causing the infections because I wasn't expressing her the right way. I was here on this board and others, telling people how to express their babies and I wasn't even doing it the right way with Sydney myself. I wasn't practicing what I was preaching!! I was telling the correct way but wasn't doing it.
Well, once I realized that I wasn't doing it right I really concentrated on doing it the right way. Boy was I surpised at how much more urine was in there. To make a long story short, Sydney is no longer on ANY medication and doing just fine. She is due for another culture soon to make sure that nothing is growing. I have learned alot through all of this and hopefully what I have learned will help you out. Email me privately of you have any questions.
Anita and one UTI free Sydney


Expressing an animal is tricky the first few times, but gets much easier with patience and practice. Mom expresses mimosa twice a day even though she is not incontinent. She has trouble getting in and out of a litter box, so at about the same time each day, mom picks her up & expresses her over the box.
Put your hand just below the ribcage and squeeze, moving down towards the hips. You can usually feel the bladder as a hard roundish lump. The bladder is slippery and can get out of your grasp easily. For months Mimosa knew just when to wiggle to make us lose her bladder.
When the bladder is against the hips - and so doesn't have anywhere to escape to - you can squeeze the urine out.


My dog can't really feel a UTI so she does not lick. I'm sure it is a sign of cystitis (my non-disabled cat has done that when he had crystals) but I don't know if paralyzed pets who can't feel their urogenital area will do that.
Here are a few tips on expressing:
1) it is easier to express a pet that is not constipated.
2) it is easier to express on the bathroom counter in front of the mirror--it saves bending and you can see what you're doing.
3) you can express straight into the sink if you pour bleach down it once in a while.
4) be careful with a small bladder to avoid injury

The easiest way I found to do it was to hold him by his armpits so that his bottom and legs hang free over the toilet or outside and then with your finger trace his ribcage to the bottom of the ribcage, you should feel a little squishy bulb sometimes firmer depending how full his bladder is.
If you gently squeeze this between two fingers and move your fingers down while gently squeezing them together to his bottom he should pee freely as they say. Or her whichever the case may be... She may feel more comfortable with her feet on the ground in this position "standing" if she does have use of her back legs, or she might not mind the dangling, really is experimentation on that part. If you still have trouble don't be afraid to ask your vet to show you again, and again. IT'S IMPORTANT!
Heavy Dog: I created an "expressing station". My back porch has exposed rafters, so we put a small metal hook in the rafter, and used clothes line and small pulleys to hook up the line. We put a clip on one end of the line so that we could clip it to Porkchop's walking harness and step on the line to hold it steady.


Before expressing, check the size and location of the bladder. If it is not too full you can feel its firm roundess and dimensions. Sometimes it is round and sometimes it is elongated. If it is quite full, all you feel is what seems
like an abdomen that is big and tight as a drum.
The bladder is not in the same place every time. It depends on how full it is and what is in the GI tract. Therefore, you are not squeezing in exactly the same place every time.
Position your hand on the bladder and try a few gentle test squeezes, moving your fingers a quarter-inch this way and that way patiently until you hit the spot. If you are having trouble getting started or are getting only a small
dribble, try working your fingers farther up into the abdominal cavity toward the spine so you're squeezing higher on the bladder.
Often my dog tenses and straightens her back legs just as we are ready to begin. We wait a few seconds until she relaxes and try again. Sometimes she tries to pull away and I allow her to do so because I don't want to make it an
ordeal. Then I reposition her and try again. My vet suggested using treats if needed.
Taking care of the bowel helps with expressing the bladder.

Jennifer uses this "ragdoll" method to express a cat.
The easiest way I found to do it was to hold him by his armpits so that his bottom and legs hang free over the toilet. Then, with your finger, trace his ribcage to the bottom of the ribcage, you should feel a little squishy bulb sometimes firmer depending how full his bladder is. Gently squeeze this between two fingers and move your fingers down while gently squeezing them together to his bottom he should pee freely. The animal may feel more comfortable with her feet on the ground in this position "standing." If she does have use of her back legs, or she might not mind the dangling. It takes some patience and experimentation to find a way tat suits both of you.

Message Board
I have not cathaterized a female dog. I was attempting to express and cathaterize a male dog at home and all the people who where trying to help me via e-mail and phone all had female dogs, so... MAYBE I just ASSUMED the females were easier!!( But I could have swore the vet told me they were)
I know that cathaterizing the male dog is tricky when you get to that turn, as I had difficulty with it. It seemed part of my difficulties with expressing porkchop was due to the fact that he actually had muscle control and was resisiting....However, he was cathaterized at one vet and he screamed and it took four people to hold him down and the vet informed me of the need to sedate, euthanize, etc... at another vet, noone had to hold him down and he was perfectly well behaved while being cath'ed. He was even trying to give kisses to the vet doing the proceedure.

(In response to Beth's answer to "Does a Male dog raise his tail...)
Beth, that is so cool, because my dog does it too, but not as much. For example, she will be sitting on her bottom like a doll with her back legs pointing forward, and she will begin to bend one knee, then the other, bend, straighten, bend, straighten, and a few times (like maybe 5 times total?) she has actually expressed herself a little bit. I think it means she knows she needs to go, and if she really really tries, she can go a little bit. The problem is, since she is sitting most of the time, she is going to be urinating right where she is sitting, which spoils it because she feels like she has to scoot away from the forming puddle, so the panic probably interferes with her expressing herself. I wonder if down dogs would be able to get their bladder control back better if there was just some way they could urinate *when they want to* without risk of having to sit in it. You're not going to be encouraged to relearn to urinate if you're just going to wet yourself. The other thing she does routinely is when I express her, she raises her hind feet into a dainty mid-air squat. Tail up in a sickle, feet up in a squatting position. It's very neat. I was disappointed she didn't do it for our photo shoot of expressing at the vet. She was too nervous that day.
Anway, it sounds like Waffles has some bladder control and he is exercising it. :) It is delightful for me to read someone else describing this. Thank you.

Re: Urinary: Does anyone here express in a cart?
I express Waffles in his cart. I stand behind him with my legs on each side of his wheels (he uses Fixed Saddle. I put my hands inside of the bars of the cart (from the top) and with both hands open I press both sides of his bladder at the same time.
Question: It took me so long to figure out how to express him. It is easy now but I still catheter him before I go to bed (I express first then immediately catheter to see how much urine is still in him). There is always about 6 or 7oz left. Do you ever total empty a dogs bladder? Do you have any suggestions on how to get those last few ounces out?

Answer: I think maybe it's one of those situations where you have limitations that I don't. My dog is female. I understand expressing males is more technically challenging because of the curves in the urethra. If I had your dog, I'd probably be catheterizing him too. I wish I had a better answer. I've never tried to express a male dog.
In our case, yes I do get all of the urine out. She is small, she is thin, I have long fingers, and I can tell by feeling if we didn't get it all. Then we do it again to finish the job. I am keeping her skinny, and I give her lactulose so she doesn't get constipated, which allows me to be able to feel what's going on in there as well as possible.
The first half a year, she was *hard* to express, but a month or two after she started physical therapy that got better. I will never forget the Sunday morning I was very tired and wanted to sleep in, but I set the clock and got up to express her to keep her on schedule, intending to go back to bed afterward. We had such a hard time, it took 23 minutes, and I was pretty wide awake by then. Fortunately, after PT, or perhaps simply after she had more time to heal (don't know which) she became able to assist (I think?). If I could overcome the sphincter, she could help push the urine out.
I feel that most of the time we get her as empty as if she was not paralyzed. The only thing I can think on your dog is, can you dig into his sides and get your fingers any higher up toward the ceiling of the bladder? If he's like my dog, he will not feel you digging.
If I describe this, it wouldn't make sense to most people, but maybe it will to you. By pressing on her sides I can tell where her bladder is. There is a trigger point, and when I hit it I can tell because she raises her tail. If I squeeze there, she will empty if I don't lose it. Also, I learned to fish her bladder down into position. Sometimes it is in an accessible spot for squeezing. Other times is it nestled so high up near her spine and back by her tail that I have to really dig my fingers into both sides of her abdomen and fish it down into position. It sounds awful, but I'm careful when I maneuver the bladder down, and it makes it possible to get a proper grip and do a complete express. I fish her bladder down so the bulb of the bladder is in my palm and my thumb and forefingers are actually near the exit end of the bladder, not the ribs end (which seems counter-intuitive). However, it seems that her need is not for someone to squeeze on the big full end of the bladder near the ribs, but rather to squeeze closer to the sphincter so it will release.

Note: The link below will take you to a veterinary school website with a detailed and graphic tutorial on the use of a catheter. DO NOT PERFORM THIS PROCEDURE WITHOUT THE SUPPORT OF A VET. Improperly done, this can seriously, perhaps fatally injure your dog.


I checked out the catheter page. I think that it was good but maybe makes the procedure look a little more scary then it actually is. The catheters that I use are all kept in a tube with a solution called cold sterile. I re-use them and do not have that little finger grip thing as shown in the photo. I also do not use a sterilized hemostat to feed the catheter through. I just wash my hands well and then rub that antibacterial liquid on my hands right before I grab the catheter (that is the way I was taught by my vet). I just try to hold the catheter back as far as I can. Anyway, so I am not as sterile as those photos.
Waffles has been on a preventative antibiotic for the whole time and, knock wood, has not had an infection yet. It would probably be good to show how far the catheter goes in and how the syringe is connected and when to stop suctioning out urine. Just little things like that for the absolute beginner. Because really, it is the beginner that really needs to see step by step photos. I am so glad that my vet started me out with cathetering Waffles. It was so much less stress (once I got over my fear of hurting him) in the beginning of his recovery. I think anyone who has a male dog should be shown how to do it by their vet.
My cocker spaniel is 3 years old and had the surgery on 1/13. she is paralyzed in the back and does not have function of her pee and poop. She is 33 lbs. I'm sure others have a little easier time with the smaller dogs, but you will be able to do it with yours. I'm 115 lbs and I carry molly up to the bathroom and express her bladder in the toilet. She pretty much poops on demand too. She always has diapers on in case she does leak but if you express 3-4 times daily the leaking will be a minimum. i sometimes get 3-4 uses out of 1 diaper because it's totally dry. Our bathtub is right next to the toilet so I bought a handicapped chair for the tub and put it half in the tub and half on the floor outside the tub, then I put molly over my lap so her butt is over the toilet. I put my arm under her stomach close to her backlegs and lift up, while I lift up I also take my other hand and push down about 2-3 inches above her tail to kinda push her down on my arm and voila, she pees a good stream. I keep baby wipes on the tub to wipe. Generally she doesn't poop in her diaper (maybe 3 times a week) and will go over the toilet too. I help her there by lifting her tail straight up. You will learn when you think something may come out. During the day and night she is in the laundry room in a small area that we have cardened off. In the morning and when we get home from work, we express her by putting her on the washing machine with her butt over the laundry tub, she pees in there and down the drain it goes. Barely any clean up. When she poops, I catch it with toilet paper and throw it in the toilet. You will find what's best for you and your family.
I use the biggest diapers I can find from Pampers, 22-37 lbs. Since my cocker has a little tail, I just tuck it in. You can also take scissors and cut a little hole in them for the tail. Trust me this is way cheaper than buying doggie diapers and works really well. I too didn't know what to do but Molly is such a loving dog who has adapted so well. She has handled this way better than my husband and I. But we are getting adjusted. She eats, drinks, and loves just like before. She wants to play and have fun and has adapted. She doesn't even know she's handicapped. We have ordered her a cart from ebay and hopefully will get it next week.

Don't give up, it gets easier. And do go out and get the pampers, it make life easier on all of us and it's so surprising when she does pee in them that they keep her fur and skin sooo dry.
good luck,
sue