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Questions for Dr. Shawn - Urinary Incontinence

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"Dear Dr. Shawn:
"My female sheltie Joeie has developed urinary incontinence. Her problem is worse when she sleeps: upon waking up, her bedding is always wet. Her veterinarian has checked her for bladder infections, stones, and tumors, but has not found any problems. He says she simply has incontinence. He wants to treat her with a drug called phenylpropanolamine. Is this safe? Are there other natural therapies that might work better? Will she have this problem the rest of her life?"

Answer:
"Urinary incontinence is a common problem that can affect male and female dogs of any age, although most of the pets that are affected with the condition are older pets. We usually can’t cure the condition, but rather manage it to minimize incontinence. As you mentioned, a number of conditions can cause signs of incontinence, including bladder or kidney infections, bladder stones, bladder tumors, and conditions that cause dogs to urinate large volumes of urine such as kidney disease, adrenal gland disease, and diabetes. Therefore, prior to making a diagnosis of incontinence, it’s important to make sure these other problems do not exist. Testing such as a urinalysis, urine culture, abdominal radiographs (X-rays) and ultrasound, and blood testing are needed before a diagnosis of incontinence is made. If a cause can be found, the incontinence usually resolves when the inciting cause is properly treated.

We don’t really know what causes incontinence. However, since the condition does often respond to hormonal therapy, decreased levels of sex hormones play a role. Also, pets with cognitive disorder often develop incontinence that responds to treatment for cognitive disorder. It appears that decreased levels of neurotransmitter chemicals like acetylcholine also contribute to incontinence in some pets.

Treatment for the disorder can involve medications or natural therapies. Conventional medications include hormones like estrogen or testosterone and drugs that strengthen the urinary sphincter like phenylpropanolamine. Hormones, while effective, can contribute to side effects such as bone marrow suppression, cancers, and aggression. Phenylpropanolamine is safe, very effective, and side effects (such as high blood pressure and aggravation of glaucoma) are extremely rare when used at the doses typically prescribed for pets. I recommend 12.5-25 mg per pet 1- 3 times daily as needed to control incontinence.

Natural therapies are obviously my first choice due to few if any side effects. I have found the following therapies quite effective. First, the choline supplement Cholodin by MVP Laboratories is effective in many pets, especially if the cause of incontinence is linked to cognitive disorder. Natural hormonal supplements that I like include Total Male and Total Female by Nutriwest. Ingredients in these 2 products that help incontinence. When needed, any of these products can be used with phenylpropanolamine.

In conclusion, urinary incontinence is a commonly seen problem in many pets, particularly older pets. The cause is not usually determined, although a cause that can be easily treated should always be sought. In those cases where a cause is not found, therapy with medications such as phenylpropanolamine can be tried. Alternatively, natural therapies using natural hormones, herbs, homeopathics, and choline are often effective."


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"Dear Dr. Shawn:
"I recently took my 4 year old Sheltie to her doctor as she has started leaking urine. She has always been immaculate with her behavior in the house and still asks to go out when she needs to. The urine seems to leak suddenly. My veterinarian's diagnosis is that she has incontinence due to being spayed. He has sent me home with a drug called phenylpropanolamine (PPA.) I am just a little concerned about starting this without any testing to see if there is an underlying conditiion (she did have a course of antibiotics to see if it was a urinary infection). My question is, should I start the medication or would it be wise to seek another opinion first?"

Answer:
”Urinary incontinence is a common problem in (usually) older pets. Urinary incontinence means that the pet cannot totally control its ability to urinate. Typically, urinary incontinence causes a "leaky bladder." Clinical signs often seen include finding "wet spots" under the pet where it sleeps, and dribbling urine as the pet moves about. The exact cause is unknown, although hormonal factors, hypothyroidism, and rarely bladder tumors can lead to urinary incontinence. Once the primary disease is controlled, the incontinence resolves. For example, dogs with hypothyroidism can improve with thyroid supplementation. Pets that urinate frequently, urinate large amounts of urine, strain to urinate, or have bloody urine are usually not incontinent but may have bladder infections, lower urinary tract disease (FLUTD) in cats, or bladder tumors.

In general, most pets with incontinence have idiopathic disease, meaning we don’t know or can’t identify the cause. These pets respond well to treatment with either conventional therapies (like PPA) or complementary therapies. If I need to use PPA, I start at a very low dose and always use supplements as well. In my practice, many pets respond to choline supplementation (using a product called Cholodin) or natural hormones. The good news is that unless the incontinence is caused by a bladder tumor, the condition is not fatal and often easily controlled with little or no need for conventional medications."


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"Dear Dr. Shawn:
"I enjoy reading your column each week and wanted to ask a question about my dog. She is a large lab-doberman female approximately 8 years old. I don't know her actual age because I picked her up in a parking lot as a stray. She has turned out to be a very beautiful, loving, graceful and intelligent dog. Unfortunately she is incontinent. My veterinarian put her on phenylpropanalymine for about two years now and it works some but not all of the time. I love this dog and do not want to give her up and so I am looking for any cure, remedy, therapy, or anything that will help us."

Answer:
”Phenylpropanolomine can be used safely for incontinence and it is safe in most pets. Some doctors have success with estrogen, but I try to avoid synthetic hormones due to side effects that can occur. Other therapies that may be helpful include choline, natural hormones, various herbs or homeopathics, and sometimes thyroid hormone (make sure you’ve had her thyroid values checked.) Surgery can be helpful in some cases.

However, before pursuing other therapies I would recommend a complete diagnostic evaluation. This should include a urinalysis, urine culture, blood profile, and abdominal radiographs (X-rays) and ultrasound. These tests will rule out other causes of incontinence including kidney disease, bladder infections, bladder stones, and bladder tumors. In most cases, a combination of therapies has worked best in my practice if no obvious cause of the incontinence can be found. Interestingly, I do see quite a bit of incontinence in labs and Dobermans."

 

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