Thursday, August 21, 2014

Call Your Veterinarian to Manage “Leaky Plumbing?”



                      A recent visit with my sister and her nearly 16 year old Pembroke Welsh Corgi, “Penny,” reminded me of the importance of healthy “plumbing” for pets.  In her golden period, Penny developed spinal degeneration that has compromised her ability to walk and contributed to her urinary incontinence.  Penny’s longevity is a tribute to the loving and constant care provided by my sister and her husband as they clean up puddles and wash throw rugs daily. 

                        Penny’s story is just one example of the multiple causes of canine urinary incontinence.  I am reminded also of Roxie, the spayed, female Boxer that began to leak small amounts of urine by two years of age.  The cause of her incontinence is likely associated with her breed, as well as being spayed.  Dobermans, Giant Schnauzers and Boxers all have a greater incidence of “Primary Sphincter Mechanism Incompetence,” whereby the sphincter or “valve” connecting the urinary bladder to the opening of the urethra does not always stop urine from flowing between urinations. 

                        Evidently, this sphincter also needs some input from sex hormones like estrogen and testosterone because sterilized female and male dogs are over-represented with urinary incontinence.  In fact, urinary incontinence is most likely to occur in spayed females and is sometimes referred to as “estrogen deficient urinary incontinence.”  Roxy was just lucky enough to be a Boxer and be spayed.

                        Then there is “Stella,” the female Giant Schnauzer puppy, whose owner has shown remarkable tolerance as Stella has been more than a challenge to housebreak.  Stella would urinate hourly while indoors or outside, could not consistently hold her urine for a period of even a few hours, and commonly “leaked” small amounts of urine when lying down.  Stella would even urinate during car rides.  She just wasn’t progressing with her bladder retention abilities like every properly housetrained puppy. 

                        At four months of age, Stella had not even approached puberty, nor been spayed, but she has been diagnosed with Primary Sphincter Mechanism Incompetence and has been started on incontinence medication.  We are expecting that the dose of her medication will need upward adjustment as she grows and that spaying her will result in the need for hormone replacement therapy to maintain control of her “plumbing.”

                        Finally, yet another patient, “Gracie,” the Labrador Retriever, was unfortunate enough to be born with her ureters (the tubes that transport urine from the kidneys to the bladder) connected to her lower urinary tract at inappropriate locations beyond her sphincter. As early as two months of age, it was evident that Gracie probably had an “ectopic” or misplaced ureter as she continuously leaked urine on herself, whether standing or lying down.

                        Gracie’s diagnosis was confirmed by excretory urography, a procedure that involves the injection of dye intravenously to highlight the entrance points of the ureters into the bladder on x-rays.  Ectopic ureters require surgical correction to transplant the ureter to its proper location.  More recently, veterinary specialists are also implanting devices to help the ureters and sphincter do their jobs more efficiently.

                        The common thread for all of these dogs is that they need to urinate more frequently and they leak urine, which results in unpleasant odors, urine scalding around the urethra and vulva, and the strong possibility of secondary skin and urinary tract infections.  Their owners are burdened with extra labor and expense to keep these pets and their homes socially acceptable.   

                        Treatment for urinary incontinence may be as simple as oral administration of a drug called phenylpropanolamine (PPA) or low doses of estrogen.  Some incontinent dogs require a combination of both drugs. The doses of these drugs may be gradually decreased once the incontinence appears controlled, but lifelong therapy is usually required.  Many incontinent dogs experience frequent urinary tract infections, making it important to have your incontinent pet’s urine periodically analyzed by your veterinarian.

                        Incontinence is more likely to occur in obese pets so prevention and treatment should also include maintenance of proper body weight.  More frequent trips outdoors to eliminate, especially at bed time and prior to being left alone, are very helpful, too, as it is difficult for incontinent pets to endure long time periods between urinations.

                        You and your pet do not need to suffer the consequences of urinary incontinence.  If your pet leaks even a small amount of urine (especially when lying down), dribbles urine while walking, persistently licks its urethral area, smells like urine, or has frequent urinary tract infections, ask your veterinarian if your pet could be incontinent.  With proper diagnosis and treatment, your dog’s incontinence can be managed for many years to come.

Author:  Dr. Bonnie Jones
Image courtesy of vectorolie at FreeDigitalPhotos.net

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