Loss of bladder control in dogs

Most cases of incontinence can be resolved with medicines or surgery. Causes range from local dysfunction to underlying medical conditions like:

• Urinary tract infection: Urinary tract infections (UTIs) are especially common in older female dogs. These can occur for a number of reasons. Most commonly, debris or faeces accumulate near the urethral opening and create opportunities for E. coli bacteria to travel up into the urinary tract. A UTI can cause abnormal and more frequent urination in dogs.
• Weak bladder sphincter: As dogs age, their overall muscle tone deteriorates. This is true of the bladder sphincter as well: it simply lacks its previous strength to hold urine in the bladder. This means that there may be a constant, involuntary trickle.
• Blockage of the urethra: A stone blocking the urethra (the tube that carries urine out of the body from the bladder) or a tumour pressing down on it will also impede urination. When your dog can’t pee properly, the excess pressure from the bladder may constrict the tubes and cause urine to seep out. Alternatively, the blockage caused by the stones may mean that urine leaks out unpredictably as it goes around the abnormal growth (the kidney stones).
• Vestibulovaginal stenosis: This is a rare condition in female dogs wherein the part of the urethra close to the vagina is narrowed. Urine gets trapped in this space and can leak out when the dog gets up from a lying position.
• Brain or spinal cord disease: Spinal cord disease may compromise the dog's muscle control. There is a host of complications associated with these disorders and incontinence is amongst them.
• Ectopic ureters: This is a congenital defect involving the ureter. The ureter connects the kidneys to the bladder. Dogs born with this defect, however, have ureters that are connected to another endpoint; usually the urethra or genitals. This means that urine routinely seeps out involuntarily. Surgery may be required to correct this problem.
• Drinking too much water: Drinking a larger volume of water can cause dogs to urinate more frequently, and in dogs predisposed to incontinence, this could mean that some of this peeing is involuntary. However, in some cases, your dog will desire more water because of underlying health conditions. These include:

  • Diabetes: Diabetes in dogs is linked with being overweight, and the excess weight may push down on the bladder and cause complications. The high blood sugar causes excessive thirst and adds to the pressure on the bladder. Overall weakened immunity also increases the likelihood of incontinence.

  • Cushing’s syndrome: Cushing’s is caused by an overproduction of the stress hormone, cortisol. This can be due to a lesion in the pituitary or adrenal gland. Excessive thirst and panting are some of the symptoms of Cushing’s, which can lead to incontinence.

• Kidney infection: Inflammation of the kidneys (nephritis) can be acute (it can occur without any previous kidney problems), or usually in older dogs, caused by underlying conditions. Often one of the symptoms is incontinence.
• Trauma: Blunt force trauma can cause internal injuries and damage the integrity of the urinary tract. This is another common reason for incontinence in dogs.
• Hormonal imbalances: Testosterone in male dogs and estrogen in female dogs are important to maintain muscle tone. An imbalance in these hormones can cause incontinence.

Studies have shown that spayed females may develop incontinence up to three years after surgery. This is attributed to changes in hormone levels; estrogen is known to strengthen the walls of the bladder.

• Drugs: Certain medications are also known to induce incontinence. Drugs taken to combat diabetes and epilepsy are examples.
• Prostate disorders: A common feature of prostate disease such as prostate cancer in dogs is the swelling up of the prostate. When this occurs, the urethra may get squeezed and the dog will not have full control over urination.
• Bladder disorders: Disorders like urachal remnants - in which a cord that removes waste from foetal puppies before birth doesn’t close properly after delivery, multiple urethras and
• Hypospadias in male dogs: A birth defect in which the urethra opening is somewhere other than the tip of the penis can also lead to incontinence in dogs.
• Holding pee: Your dog may be holding their pee because of stress or fear. When the pressure on their bladder exceeds their capacity to hold the pee in, they may dribble involuntarily.

Read more: Obesity in dogs

Given that there can be many different causes of incontinence, the symptoms can vary in severity and type:

• Generalized lethargy: Infections will mean that your dog will have a fever and be more tired and inactive than usual. Hormonal issues, urinary stones, congenital defects can all lead to lethargy in dogs.
• Frequent squatting: Your dog may have the urge to urinate frequently without managing to clear his/her bladder fully. This is likely caused by some sort of blockage.
• Redness of the skin around the genitals: Constant urination may cause an infection near the genital area, especially if involuntary urination occurs in sleep or when the dog is lying down.
• Licking or nibbling at the genitals: A skin infection will irritate your dog and he/she may try relieving the itch by constantly licking the area.
• Excessive panting and overconsumption of water: Chronic conditions such as diabetes or Cushing’s will make your dog extremely thirsty and constantly lap up water.

If you notice a marked change in your dog’s behaviour and frequent uncontrolled urination, you should visit the vet immediately. 

Make sure that you tell your vet your dog’s entire medical history. Congenital issues and certain medication can also predispose your pet to incontinence. Following this, your vet will likely conduct a thorough physical examination of your dog.

• If your dog has a fever, that would suggest some sort of inflammation or infection.
• Neurological issues may be diagnosed by studying the responsiveness and behaviour of the dog.
• If it is a case of trauma, emergency surgery or intervention may be required.
• Urinalysis and urine culture are crucial when it comes to understanding UTIs. Urinalysis will explain the composition of the urine and can detect infections or hormonal issues. Culture will determine the type of bacteria or infection.
• Imaging tests, like contrast X-ray or ultrasound scan, may also be ordered if your doctor suspects an issue with one of the glands.
• If symptoms suggest a malignant tumour, a biopsy may be conducted as well.

Owners have the tendency to think that incontinence is a grim, irreversible sign of ageing and fear the worse. However, if the cause, such as an infection, is caught in time it can usually be contained. Often, incontinence is treated quite easily with medication.

• If the urine culture reveals an infection, an antibiotic will most likely be prescribed. The regimen usually lasts a couple of weeks and a urine culture test may be done again to gauge the effectiveness of the treatment. 
• Estrogen treatment might be administered to those dogs who have lost muscle tone in the bladder. Estrogen, along with ephedrine, is known to increase muscle tone in the area.
• Surgery may be required for anatomical issues such as ectopic ureters, urethral hypoplasia (underdeveloped urethra) and bladder abnormalities like urachal remnants - in which a special cord that removes waste from the bladder of the foetus before birth does not close or does not close properly after birth.
• If there are kidney stones or tumours, they will need to be surgically removed as well.
• Medication can also be targeted to neurotransmitters that instruct the bladder to release or retain fluids.
• Medications that strengthen bladder muscle fibre are also known to work well. 
• Hormone replacement therapy may be required for dogs with chronic hormonal issues. For diabetic dogs, treatment for incontinence may be based on insulin therapy. 
• Additionally, your vet may recommend behavioural treatment if your pet is urinating indoors due to fear, stress or abnormal behavioural patterns.

Loss of bladder control can happen to any dog, at any time. However, there are some conditions that increase the risk of incontinence in dogs:

• Old age
• Getting spayed: Incontinence has been noted in dogs after spaying. This may be because of hormone imbalance caused by the surgery. Levels of estrogen may go down; estrogen is associated with the muscle tone of bladders in female dogs. Estrogen treatment is usually administered to counter this issue.
• Breed: Incontinence or loss of control over the bladder can happen to any dog. However, globally, some breeds like Dobermans, Old English Sheepdogs, Cocker Spaniels and German Shepherd Dogs seem to present with this condition more often than other breeds.

There are a number of steps you can take to help your pet while they heal. Sometimes, of course, medications won’t work and you may have to manage incontinence in your dog for life. Here are some simple things you can do at home:

• Dog diapers are available in the market and will make it easier to manage spills.
• Waterproof sheets and extra padding in your pet’s sleeping area will make clean up easier and may assist in preventing infections.
• Longer, more frequent walks might help your pet relieve himself/herself fully.
• Make sure to keep a tab on your dog’s behaviour since incontinence can lead to an infection which will require medication and veterinary attention.
• Keep the area around your dog’s genitals dry as moist conditions are ideal for infections to fester.