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Urinary
Incontinence and the Older Dog
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Urinary Incontinence
House Training the Elderly Dog
THE PET HEALTH LIBRARY
By Wendy C. Brooks, DVM, DipABVP
Educational Director, VeterinaryPartner.com
Urinary Incontinence
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 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 housetraining, territorial marking of unneutered males or anxious
cats, 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 and 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:
• Infection in the urinary tract (usually bladder infection)
• Excessive consumption of water
• Weak bladder sphincter (especially common in female dogs)
• Spinal cord disease
Bladder Infection
This is a common cause of urinary incontinence in young adult female
dogs and 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 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).
Excessive Water Consumption
Some animals drink so much water that their bladders simply overflow
too easily. While some owners have noticed that their pets seem to be
drinking more than usual, our experience is that most owners are surprised
when the urinalysis shows excessive water consumption. Dilute urine is
obvious on the urinalysis through a measurement called “specific gravity”
which compares the amount of dissolved biochemicals in the urine to that
of pure water (which has no dissolved biochemicals). A urine specific
gravity nearly the same as water, confirms excessive water consumption;
blood tests may be indicated to go with the urine tests to determine the
cause.
Causes of excessive water consumption include:
• Diabetes mellitus
• Cushing’s Syndrome
• Hyperthyroidism (cats)
• Bladder Infection (see above)
• Diabetes Insipidus
• Kidney failure
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.
• Estrogens
It is not entirely clear how estrogens are helpful in this treatment.
Originally, estrogens were given to post-menopausal women with urinary
incontinence and the treatment was simply extrapolated to dogs. It is possible
that estrogens are important in the maintenance of neuroreceptors in the
bladder sphincter and without estrogens the receptors become unresponsive
to the transmission of the “storage” message from higher neurologic centers.
In dogs, DES(diethylstilbestrol) is the most common estrogen used, though
it is now only available through compounding pharmacies. A higher
dose is used to begin therapy and finally a maintenance dose of usually
every few days is used to maintain continence. In male dogs, testosterones
seem to be more effective than estrogens, possibly through action on the
prostate which sits at the neck of the bladder and incorporates the sphincter.
• Alpha-Adrenergic Agonists
These medications act by enhancing release of the neurotransmitter
chemicals that act on the receptors of bladder sphincter. Effectively,
they turn up the volume dial on the “hold it” message from the high neurologic
areas. The usual medication for canine use is phenylpropanolamine, currently
available in liquid and chewable tablets and is typically given two
or three times daily. Ephedrine and pseudoephedrine, common decongestants,
may also be used. Side effects can include irritability, appetite suppression
(phenylpropanolamine was the active ingredient in many human diet pills
until recently), and blood pressure changes. Most dogs (male and female
alike) tolerate phenylpropanolamine uneventfully.
For especially resistant cases of incontinence, estrogens and alpha-adrenergic
agonists can be used together.
• Anticholinergics
Anticholinergic drugs are medications that work, not on the sphincter
of the bladder, but on the rest of the bladder where urine is stored,
relaxing the muscle fibers thus facilitating storage. A drug called
Imipramine is an anti-anxiety medication commonly used in humans. It has
anticholinergic properties and can be used in combination with phenylpropanolamine
in the treatment of animal incontinence. Imipramine is not commonly used
compared to the other two medication types which are extremely effective
but it may provide another choice for the few patients who do not respond
to traditional therapy.
Surgical Therapy
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 (located just above the urethra
as the dog stands) is tacked to the bottom of the belly wall entrapping
and compressing the urethra. In one study of 60 female dogs receiving
this surgery, 40% were cured of their incontinence and 42% were
improved. In another study, 23 spayed female dogs with incontinence
received colposuspension and 55% were cured at their 2 month recheck but
only 14% were still cured at the 1 year recheck. This number jumped to
43% fully continent when medication was added back in. Another 43% were
judged by their owners as greatly improved when medication was added back
in. Over all owner satisfaction with surgery was 86% in this study.
Cystourethropexy is the modification that can be performed
in males. Since there is no vagina to use, 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).
Medications listed above are used in conjunction with surgery.
Surgery alone improves approximately 50% of patients but often incontinence
returns unless medication is also used.
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:
• Ectopic ureter (instead of connecting to the urinary bladder,
the ureter transporting urine from the kidney connects to the vagina or
rectum so that there is no storage of urine. This condition is typically
noted in a puppy that simply cannot be house-broken and leaks urine. The
condition can be solved surgically.)
• Spinal damage especially in the lower lumbar area
• Infection higher in the urinary tract (kidney or ureter)
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.
This work was originally published by Veterinary
Information
Network, Inc. (VIN) and is republished with VIN's permission.
Copyright 2004 - 2007 by the Veterinary
Information Network, Inc. All rights reserved.
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***********************************
Q. Can
you advise me on a suitable bedding for a dog that wets its bed.
A. If the bed wetting is unavoidable due to incontinence
then to ensure your dog's comfort and well-being a good quality bedding
designed to allow the passage of urine through it, yet remain relatively
dry on the surface, is essential. When breeding puppies I have
found that Vetbed is excellent, with the properties to ensure puppies
remain as dry as possible even when accidents do occur. It can be
cleaned in a washing machine, tumbledried and, although expensive, it
will last a very long time. Absorbant materials such as shredded
paper should be avoided unless changed a minimum of once a day, as they
soon become saturated and smelly. If the bed wetting is not a medical
problem but behavioural, then re-training could be the answer. Diet,
exerciose or lack of free access to outside could all contribute to the
problem. A thorough assessment of the cause needs to be identified
before training begins.
Waterproof Dog Beds
http://www.jambopetbeds.co.uk/
'Richmond'
round dog beds
The Jambo Richmond range of waterproof dog beds brings a whole new
concept into the pet bed world. Its round design allows the dog's weight
to be centralised on the bed and at 12" deep the Richmond is undoubtedly
one of the most comfortable and practical dog beds on the market today.
Fully machine
washable at 30 degrees.
*********************
Housetraining
the Elderly Dog
Whether your dog of several
years is aging, or you have adopted a senior dog, housetraining issues
for the elderly dog are different from other life stages. Age puts new stresses
on the dog’s body and mind.
Since dogs instinctively conceal weakness as a survival instinct, it
could take extensive evaluation to find every possible medical issue. Sometimes
that much testing isn’t feasible, either due to expense or the stress it
would put on the dog.
Whatever the cause of the housetraining problem, certain management
and training strategies help. After your old friend is gone, you want happy
memories rather than regrets from harshness in the final years.
Physical Causes
The intent here is not to diagnose your dog’s veterinary issues, but
rather to help you understand some of the physical problems that might be
going on. These might aid you in watching for symptoms to report to the dog’s
veterinarian, as well as making it easier to forgive the accidents.
It’s dangerous to diagnose or medicate your dog at home without the
veterinarian’s guidance. Pain relievers for humans, including over-the-counter
preparations, are often toxic to dogs, and the same is true of some other
home remedies. Always consult your veterinarian first.
Old age predisposes dogs to more physical problems, but old age itself
is not an illness. Often there is treatment, sometimes simple treatment
that will provide incredible improvement. Don’t fall prey to the thinking
that a trip to the veterinarian with an older dog is inevitably to end it
all. Work with your veterinarian to keep your elderly dog comfortable.
Some physical problems that can cause housetraining accidents in
elderly dogs include:
1. Kidney failure. Failing kidneys may increase the amount of
water the dog needs to drink. Follow your veterinarian’s instructions.
Do not restrict the dog’s water intake for this or any other problem unless
the veterinarian specifically instructs you to do so, and exactly how to
do it. The extra water benefits the dog and aids survival, so don’t take it
away. Diet and other care may be able to relieve some of the symptoms.
2. Liver problems. The liver reacts to different things in various
ways, and treatment can be extremely beneficial. For both kidney and liver
problems, your veterinarian may change the dog’s diet and other routine
management in ways you would not think to do, that may bring improvement.
3. Prednisone therapy. Steroids often make a dog drink extra
water and they need to urinate more often. Your veterinarian may be able
to adjust the dosage or medication to greatly improve the housetraining
issue. Or, the medication may be needed only temporarily, and the housetraining
problem will be temporary, too.
4. Orthopedic pain that makes it difficult for the dog to squat.
Pain relief your veterinarian can provide may in this case clear up the
housetraining problem.
5. Pain at steps when going outdoors. If this is the problem,
medication might help, and you may also be able to provide the dog with
a ramp, or an alternate route to the potty area.
6. Vision or hearing problems that make the dog afraid outdoors.
This dog may do better if you go along on outdoor trips, stand at the back
door and talk to the dog, keep an outdoor light on, or let the dog back
inside quickly; knowing what the problem is will help you help your dog.
7. Medical conditions make control harder. A variety of conditions
can make the bladder and bowel muscles not work as well as they did in younger
days. It’s best to make it normal practice to increase the frequency of
potty outings for an older dog.
8. Digestive system can no longer handle certain foods or amounts
of foods that people share as treats. You may need to be quite stingy about
the treats you give your older dog, food you give when the dog begs, particularly
holiday foods and table scraps. For a dog of any age, a good rule of thumb
is not to let these foods make up more than 10% of a dog’s calories. The
older dog may not be able to handle even that much of some foods.
Check with your dog food manufacturer or other source to get the necessary
information to total up your dog’s daily calories. You’ll be surprised how
few calories a dog uses. This information will help you set better limits
on extras you give your dog. To a dog, a tiny bit is as much cause for
celebration as a big hunk. The scent and excitement and getting something
special are what provide enjoyment. Create more celebrations by giving tiny
treats.
9. Mental confusion. Dogs can develop cognitive dysfunction similar
to some humans in old age. Medications help some of these dogs greatly,
as do routines, and some even benefit from changes in their food and nutritional
supplements.
Coping Strategies
You are providing important and loving care by keeping the dog clean.
The easiest ways to do it are also the cleanest, but you’ll need to work
within the limits of the dog’s body.
Sometimes you can provide the extra help your oldster needs simply by
increasing the frequency of potty outings. Better to take a dog out two
times a day more than necessary than to miss a necessary time.
You can help the dog back into good habits by the same techniques that
work with younger dogs. When the dog has been having accidents, start escorting
the dog to the potty area. Prompt the dog to relieve by using a cue phrase
(such as “Better go now”).
Softly praise the dog when the deed is done, and perhaps give a tiny
treat. If the dog feels like having playtime, give playtime as a reward.
If the dog would rather go back inside immediately, take the dog back in.
If you do stay outside for playtime or a walk, give the dog another potty
opportunity before going in.
Housetraining, and that includes helping the dog to regain lost housetraining,
is a bonding opportunity with your dog. It’s a goal you are accomplishing
together. It’s loving care you provide for your dog. Take the time to savor
this closeness with a dog who may not be with you a lot longer. You’ll find
the dog appreciates your love and understanding, sometimes even more than
a younger dog does.
If your dog is mobile enough, you may be able to aid accident-reduction
by hustling the dog outside whenever you see an accident start. But don’t
hurt or frighten or confuse the old dog in the process. With some physical
conditions, this maneuver just isn’t a good option.
Remember to carefully treat any accident sites to neutralize the odor.
The most reliable way to do this is with a bacterial enzyme odor eliminator
product such as Nature’s Miracle. Often the products used to deodorize the
spots are not working, and the dog remains confused about where the bathroom
is! The scent message from an inadequately-treated accident site to the
dog’s instincts is powerful, and in a dog who is confused or sensory impaired,
it can make things much more difficult.
If your dog is frail or ill and just can’t make it outside, discuss
the nursing options you use with your veterinarian to make sure they fit
your dog’s condition and your climate. One possibility is diapers, but
these could be harmful under some circumstances, so check with your veterinarian.
Making the dog comfortable in an easily-cleaned area is another management
strategy. In this case, you’ll need to consider the dog’s ability to walk
comfortably on that floor. It can help to place some washable, rubber-backed
rugs around for the dog to walk on. And remember a place for the dog to
rest.
For the dog who has accidents while resting, a stack of old towels on
the dog’s bed makes cleanup easier. Remove the dirty ones on top and add
more towels at the bottom of the stack. A layer of plastic under the towels
can protect the underlying surface.
If cleaning the dog’s fur around the rear is a problem, talk to your
veterinarian about safe cleaning products and techniques to use that can
spare your dog a full bath after every accident.
When the need for cleansing is likely to last over time, you and the
dog may both be made more comfortable by trimming any long hair around the
rear area. Have your veterinarian’s staff do the trimming (if not comfortable
for you to do at home), rather than taking a dog in this condition to a groomer.
Tender Loving Care
When a dog has a housetraining accident, the automatic human reaction
can be moral outrage that the dog would do such a thing in the house. Getting
past this reaction will let you see more clearly what the dog needs.
Older dogs have earned extra patience and care from us. No dog lives
forever, and the time will come that the old dog will be with you no more.
This is when all the tender care and love you’ve given will come back as
a great comfort.
Copyright 2005 - 2007 by Kathy Diamond Davis. Used
with permission. All rights reserved.
Kathy Diamond Davis is the author of the book Therapy Dogs: Training
Your Dog to Reach Others. Should the training articles available here or
elsewhere not be effective, contact your veterinarian. Veterinarians not
specializing in behavior can eliminate medical causes of behavior problems.
If no medical cause is found, your veterinarian can refer you to a colleague
who specializes in behavior or a local behaviorist.
The above information is simply informational.
It's intent is not to replace the advice of a veterinarian nor to assist you
in making a diagnosis of your pet. Please consult with your own veterinarian
for confirmation of any diagnosis. Your pets life may depend on it.