Urinary Incontinence: A weak bladder sphincter problem

thpeeing_dogA dog that has a wet bed in the morning, a dog that dribbles urine throughout the day, a dog that seems to just stand up and then pee uncontrollably, or a dog that is licking itself continuously can all have the problem of urinary incontinence. Urinary incontinence is a weakening of the sphincter that controls the emptying of the bladder, most commonly affecting females.

There is a lot to urinary incontinence and there is quite a bit that we do not fully understand about it but I am going to go over the most common issues and keep it simple. The first issue to contend with if you have a dog with a leaky bladder is be sure your pup does not have a urinary tract infection because this an cause inflammation in the entire urinary tract including the sphincter and your dog just is not going to be able to control itself. The best course of action when you first notice a leaking problem is to bring your dog to the vet for evaluation for blood tests and a urinalysis. If your dog has kidney issues, hormonal issues, or a urinary tract infection the cause of the leaking is secondary and treating the primary problem of the underlying disease should resolve the leaking issue.

Now if your dog does not have any illness found then it is most likely that yes your dog has a weakened bladder sphincter causing the urinary incontinence. To keep it simple there is two major reasons why your dog has a weakened muscle – neurologic or hormonal. If the nerve pathways are not optimal then your dog leaks because there is no or low nerve stimulation to the muscle. If the dog has been neutered, more likely if it has been neutered early in life, there has been a lack of hormones, which weakens the muscles in and around the genital area and specifically the bladder sphincter.

Traditional medicine typically uses two different types of drugs to correct this problem and there is a new surgical treatment available in some cases. The first drug is actually hormone replacement therapy using diethylstilbestrol (DES) in female dogs. It is used at low doses to try and avoid the side effects of the drug. Holistic practitioners have long been concerned with the use of this drug and its potential long term effects on the hormonal system and its possibility of causing certain types of cancer.  The other drug commonly used for urinary incontinence and this is used in female and male dogs is phenylpropanolamine (PPA). This drug is used to help stimulate the nervous system and increase tone in the bladder sphincter. This drug has many side effects although most are manageable or minor that they go unnoticed. It can have more side effects with drug interactions of commonly used drugs such as NSAIDs, some tick preventatives, and other drugs. It can cause anxiety in pets because it does stimulate a fight or flight response due to its effect on the nervous system. It also causes an increase in blood pressure for the first few weeks of using the drug so dogs with heart conditions should avoid using PPA. Many times vets will use both drugs together if they are not getting a response from either one and have some success with their use together, which usually indicates multiple system problems with urinary incontinence.

Alternative treatments focus on the same simple principles of either nervous system malfunction or hormonal system malfunction. The most common treatments I use are chiropractic, acupuncture, Chinese herbs and food supplements.

Chiropractic treatments usually focus on subluxations (joint dysfunction) at the Lumbosacral joint and/or the SI joints. Adjustments usually are needed at L6, L7, and Sacrum. I have had great success over the years with just chiropractic alone most of my patients will have to have return visits monthly to every other month to maintain urinary control.

Most of the time I will also place the pet on a nutritional supplement such as Symplex M (males) or Symplex F (females) from Standard Process. These are formulated from compounds extracted from glandulars. There are other products, which are direct glandular products that some holistic vets use instead of DES to lessen the risks associated with DES.

Many times I see immediate results using the chiropractic and the Standard Process supplements but if I see no results within 2-4 weeks then I will suggest adding acupuncture and/or Chinese herbs to see if we can stimulate the bladder sphincter to function better. Most chronic urinary incontinence is a Qi deficiency in Traditional Chinese Medicine and more specifically a Kidney Qi Deficiency so I choose points to help strengthen Qi. In western medical acupuncture terms, we try to stimulate the nervous system for the reproductive area of the body, similar points are used in both types of acupuncture. Common points used are BL22, BL23, BL26, ST36 and CV1

If all else fails there is a surgical treatment that is being tried. It is fairly new to use in dogs and has some success. Under anesthesia collagen is injected around the urethral opening causing a mechanical blockage, which then allows the dog to hold its urine easier. Some of these dogs still need to take PPA and many of them have to have the procedure repeated. Definitely not a first line of correction but when it means the life vs death because of urine leakage it is worth trying to find a vet to do the procedure.

There is a lot we do not understand about urinary incontinence. We do not know the true cause and why some treatments work for some dogs and not for others, but there are many treatments and hopefully if you have a dog with urinary incontinence, you can find one that works for your dog.