By Dr. Becker
Today I'd like to discuss incontinence in dogs and cats.
There are actually two types of incontinence -- urine and fecal. Urinary incontinence is the involuntary leakage of urine. Fecal incontinence is the inability of a dog or cat to control his bowels.
Involuntary passage of urine normally occurs while your pet is asleep or resting. When she stands, you may notice urine leakage. It can be just a small wet spot, or it can be a good-sized puddle.
It's important to understand that your pet is not intentionally leaking urine. She has no control over what's happening. It's not a behavioral problem; it's a medical issue. Trying to correct or punish your pet is a really bad idea. It's very important to treat urine dribbling as a medical problem requiring a medical diagnosis, rather than a behavioral problem.
There are many causes for urine leaking, including trauma to the central nervous system, damage to the pudendal nerve (the nerve that works the neck of the bladder), diseases of the bladder, kidney, or adrenal glands (for instance, Cushing's disease, hypothyroidism, or diabetes), as well as bladder stones, birth defects, and urethral obstruction.
Other known causes of urine dribbling are age-related incontinence, a hormone imbalance, and feline leukemia.
Hormone-Induced Urinary Incontinence
Hands down the most common reason for involuntary urine leakage, especially in dogs, is hormone-induced urinary incontinence.
After a pet is spayed or neutered, the sex hormones estrogen and testosterone (which are necessary to help close the external urethral sphincter) are no longer available. The result is often urine dribbling.
Hormone-induced urinary incontinence is extremely common in spayed female dogs and somewhat less common in neutered male dogs. These are typically very healthy, vibrant pets that just happen to dribble urine anywhere from multiple times a day to just once or twice a year.
A commonly prescribed drug for hormone-related urinary incontinence called DES, short for diethylstilbestrol, was pulled from the market about five years ago because it was linked to diseases like diabetes and cancer in dogs. Unfortunately, the drug is now once again available. Because of its overall systemic risk to health, I never recommend it.
Another commonly prescribed drug for urinary incontinence is called PPA, which is substantially safer than DES.
The biggest problem with these drugs is that many vets put dogs on them without investigating the cause of the urine dribbling. They just assume that it must be hormone-induced.
I see dogs on these drugs, who, when I run tests on them, have a disease process causing the leakage. Often I find urinary crystals or bladder stones, Cushing's disease, diabetes, or kidney disease in a dog being treated for hormone-induced urinary incontinence.
Treating Urinary Incontinence
The cause of your pet's urinary incontinence should always dictate what treatment she receives. If there's an underlying disease process or structural abnormality causing the problem, it can be corrected through medical or surgical management.
If your pet is diagnosed with hormone-induced urinary incontinence, I strongly recommend you try to treat the problem naturally. Some of the drugs used to treat urinary incontinence, specifically DES, are potentially toxic, with side effects that in my opinion are not worth the risk.
I successfully treat cases of hormone-induced urinary incontinence with glandular therapy, including Standard Process glandulars – Symplex-F for female dogs and Symplex-M for male dogs. I also use natural, biologically appropriate (which means non-synthetic) hormone replacement therapy.
Synthetic hormone replacement drugs can cause some of the same problems in female dogs as they do in women who take them. Natural plant-based hormone therapy is compounded for your pet's specific hormone imbalances based on sex hormone blood test results.
I also use a few excellent herbal remedies, including corn silk, lemon balm, and horse tail. There are some great nutraceuticals specifically formulated to help with incontinence. I also frequently use acupuncture to stimulate the pudendal nerve. And chiropractic can do a great job keeping the central nervous system working appropriately.
Dogs with urinary incontinence that can't be completely resolved can be fitted with belly bands, doggy bloomers or panties with absorbent pads. You can even use human disposable diapers, and just cut a hole out for the tail if that arrangement fits your pet's body shape. Just remember that urine is caustic and should not remain on your pet's skin for very long. It's important if you use diapers to change them regularly and disinfect your pet's skin.
Fecal incontinence is almost always due to the colon and brain not communicating effectively. The nerves that control the colon are supposed to send a message to the brain when it's time to go outside. If there's a problem with the lower back – for example, degenerative myelopathy, peripheral myopathy, arthritis, muscle weakness, atrophy, a spinal tumor, or a condition such as myasthenia gravis – the communication pathway is compromised, and the animal isn't aware nature is calling.
In older pets, the anal sphincter can lose its ability to hold in feces efficiently.
Parasites can also contribute to fecal incontinence. If you have a pet that has diarrhea for an extended period of time, there can be damage to the muscles of the rectum, which can lead to the problem as well.
Other causes of fecal incontinence can include an abscess or infection of the anal glands, a dietary issue, medications, or a perianal fistula.
Owners of pets with fecal incontinence might find accidents around the house. Or the pet could inadvertently pass feces when he uses his abdominal muscles to go from a lying position to a standing position, or when he jumps up on the couch, or in similar situations requiring use of the abdominal muscles.
Your dog or cat may also poop while walking without knowing she's doing it. It can also happen during sleep. Excessive gas and swelling of the abdomen are common in cases of fecal incontinence.
It's important to find the underlying cause of your pet's fecal incontinence. Your vet will want to do a complete blood profile – including a chemistry profile, CBC, urinalysis, and a fecal analysis – to check for the presence of an infection or parasites. Sometimes, additional diagnostics such as X-rays may be required to check for spinal arthritis or a bone tumor.
Both chiropractic and acupuncture – I use electroacupuncture in my practice – can be very helpful in these cases. Aligning the vertebral bodies and stimulating the nerve fibers that communicate between the colon and the brain can help reduce incidences of fecal incontinence.