Urine Leakage: A form of Canine Post-Menopause

As in a variety of professions, veterinarians are required to obtain a certain number of continuing education hours per year to maintain their license. I traveled to Orlando, Florida to attend one of the largest veterinary conferences in the world, the NAVC.   Upon arrival, I drove with a friend to see Cape Canaveral.

One of the more notable keynote speakers at the conference was Bert Jacobs, co-founder and Chief Executive Optimist of the Life is Good, Inc. t-shirt fame.

He combined innovative business lessons, humor, and inspirational stories to tell the saga of working with his brother to go from $78 to $100,000,000 in retail sales. Even more powerful was his promotion of corporate responsibility as a positive and moral obligation of capitalism or simply the right thing to do.

 In the evening was a concert with singer & activist, Sheryl Crow: talented song writer, cancer survivor, and accomplished musician. Her accolades include the selling of over 35 million records.

One interesting lecture pertained to urine leakage in dogs that often leads to very unhappy owners, odor, and risk of infections.


PLEASE DEFINE URINARY INCONTINENCE!

It is the loss of voluntary control of urination, especially when a pet has been resting or is relaxed. Often the most obvious first symptom is a wet spot on the dog's bed or floor after the dog has laid there. Sometimes prolonged contact with the urine irritates the skin around the vulva, causing redness and a rash (urine scald). The dog will lick at the area, which can make the rash even worse.


Your dog has no sensation of the urination occurring, and the urine leakage does NOT indicate a desire on the dog's part to annoy, take revenge, or otherwise deliberately urinate.

WHAT CAUSES URINE LEAKAGE INCONTINENCE IN DOGS?

Once infections, stones, and tumors have been eliminated, most are due to incomplete function of the exit point of urine from the bladder called the urethral sphincter or USMI (urethral sphincter mechanism incompetence).

Ninety percent are spayed females associated with a deficiency of estrogen as in post-menopausal women as early 10 months after the spay.

ARE THERE SOME COMMON DENOMINATORS?

Dogs with this issue tend to leak urine only when at rest, laying down, or sleeping. Unlike in urinary tract infections they do NOT: urinate more frequently, have no blood in the urine, produce a normal volume of urine, and do not have an increase in thirst.

ARE THERE SOME COMPLICATING FACTORS?

·         Bladder infections, stones, polyps, or tumors

·        Very dilute, high volume urine that overflows the bladder outlets with hormonal conditions such as conditions that causes a dog to drink excessively such as Diabetes Mellitus and Cushing’s disease.

·         Nerve damage to the bladder due to inappropriate innervation from the spinal cord

·        Anatomical or congenital malformations in the “plumbing” with conditions called ectopic ureters, vaginal strictures,  or pelvic bladder.

HOW IS CANINE INCONTINENCE DIAGNOSED?

-        Blood work, urinalysis, and a urine culture (should be within normal limits)

-     Depending on the gender and age of your dog, additional testing such as abdominal x-rays or an ultrasound (Leakage is rarely seen in male dog so they need to be evaluated carefully for urethral, bladder, and prostatic disease).

-    Older dogs need to be screened thoroughly for bladder cancer.

-   Male or female dogs who develop incontinence at less than one year of age should always be evaluated for developmental abnormalities.


WHY ARE SPAYED FEMALE DOGS AT RISK?

Muscle strength in the bladder sphincter(valve) is toned by estrogen. When dogs are spayed approximately 20% of spayed female dogs with develop leakage within 3 yrs of being spayed. It is more common in large dogs rather than small dogs.


 HOW IS URINARY INCONTINENCE DUE TO SUSPECT INSUFFICIENT HORMONAL LEVELS TREATED?

ESTROGEN PRODUCTS:   50 to 60% of incontinent spayed female dogs will respond.
     

1. Incurin (Estridiol) is a new, estrogen therapy option and the only one labedl FDA approved for use in dogs.

2.DES

3. Premarin

NON-HORMONAL PRODUCTS

1.   Phenylpropanolamine (Proin), a non-hormonal medication that also helps to improve bladder control daily to three times a day, especially at bedtime. It is sometimes combined with one of the above.

WHAT ABOUT TREATING MALE DOGS?

In some male dogs if DES or Proin fails, testosterone cypionate is administered once at 2.2mg/kg once, and it may be repeated every four to six weeks. Special application (handled as a controlled substance) as well as watching for signs of aggression and prostatic enlargement are two things that should be monitored.

IF THE MEDICATIONS FAIL TO CONTROL THE LEAKAGE, ARE THERE OPTIONS?

Collagen or bulking injections around the bladder opening ( urethral sphincter), surgical implantation of a urethral occluder device, and certain bladder/urethral tacking surgeries are available.  While some of these therapies have proven themselves successful, these techniques will not necessarily provide lifelong control, and a combination of surgical and medical options are often used for the best outcome.

Betsy T Sigmon, DVM, Diplomate ABVP Canine & Feline

Creature Comforts Animal Hospital

Cary, NC