Last summer, Brooke Frautschy noticed something odd about Delta, the Greyhound she brought into her home about two years ago.
Although housetrained and fastidious, Delta had started having accidents inside, often on her own bed. Even odder, these incidents seemed to happen when the dog was fast asleep.
"If she had an accident, she'd clearly get upset," says Frautschy. She'd jump up and start licking, or make a "mopey" face. "Sometimes she'd run into the other room," she says.Luckily for Delta, Frautschy was a veterinary student. So she neither panicked nor jumped to the conclusion that her dog had forgotten her training. Instead, she brought Delta to school, the University of Illinois College of Veterinary Medicine, to figure out what was wrong.It turned out that Delta was suffering from canine urinary incontinence. It's a relatively common condition; most veterinarians have treated at least a few cases. But it's also a condition that can be misunderstood by owners.
"It is a very frustrating problem for a lot of people, and it does lead to people giving their dogs up," says Julie Byron, DVM, MS, clinical assistant professor at the College of Veterinary Medicine, University of Illinois.
"People will tolerate a lot of different things, but they really don't want to deal with dogs who are wet all the time," adds Mary Lahato, DVM, clinical professor at the Cummings School of Veterinary Medicine at Tufts University.
Incontinence can be the result of injury, neurological disorders, or diseases like Cushing's (see sidebar), and affects both males and females, neutered or intact.
Most often, however, it occurs apart from any disease process-many dogs with the condition are perfectly healthy - and is most often seen in one group of dogs.
"It affects about 20 percent of spayed females," Byron says. Among large breeds, studies have suggested that the incidence may be as high as 30 percent. It may occur in the first few years after spaying, but is most commonly seen in middle-aged and elderly bitches.
"Most of these dogs will start to leak about three or four years after they've been spayed," says Byron, who specializes in urological diseases. Scientists are not sure exactly why these dogs start to leak, but most theories point to the role of one vital hormone-estrogen.
A lack of estrogen, which occurs when the ovaries are removed, can cause changes in pelvic structures designed to hold urine in the bladder. Byron notes that the same kinds of problems are seen in humans. "Just like women who undergo menopause, when the estrogen goes away there is some atrophy of those tissues, the tissues get thinner, the blood vessel numbers may drop, there may be a change in the type or content of the collagen, which may make tissues a little stiffer."
But estrogen is not the whole story, since not all spayed dogs become incontinent. A dog who starts to leak probably has a physical predisposition to the condition, such as weak pelvic muscles or ligaments, or a bladder positioned in a way that makes dribbling inevitable.
The good news is that, for the majority of patients, incontinence can he kept under control with drug therapy.
The most commonly used medication is phenylpropanolmine (PPA). It belongs to a class of drugs known as alpha-agonists. They bind to receptors on smooth muscle cells, which causes the muscles to contract. "That's my first choice," says Byron, noting that the drug works for 70 to 90 percent of incontinence patients.
In some dogs, side effects rule out the use of this drug. These can include restlessness and loss of appetite, and in the most serious cases, high blood pressure. Byron always checks blood pressure before suggesting PPA.
If PPA can't he used, another option is estrogen supplementation, which is thought to reverse some of the changes that occur due to depletion of the hormone. Byron says this approach works in roughly 60 percent of patients.
Veterinarians sometimes prescribe both estrogen and PPA for dogs who are not helped by either drug alone. In a patient who experiences mild side effects to PPA, it may he possible to reduce the dose and add estrogen. "There may actually he a synergistic effect," Byron says.
"One thing that's frustrating is that sometimes dogs will respond very nicely to the drug for a year or two, and eventually, there's a decrease in response," Byron says. "We don't understand why that happens. But just because a drug stops working doesn't mean that all is lost."
There are a few other drugs, similar to PPA, that can help if the more commonly used treatments stop working. There are also a couple of surgical fixes. In some cases, an operation known as a colposuspension can reposition the bladder to reduce dribbling.A relatively new procedure is collagen injection, in which the same material that plumps up starlets' lips is used to narrow the diameter of the urethra. Byron says this helps about 70 percent of the time, but there's no way to predict how long it will remain effective. For some dogs, it could last for years; in others, the collagen breaks down in a matter of months.
Labato says in addition to these methods there are experimental techniques, such as artificial sphincter devices, that might work in severe cases. She notes that there is also research underway in humans exploring the use of stem cells to improve pelvic muscle tone. Labato's laboratory is planning to explore the role obesity may play in incontinence, because many dogs who have the problem are also overweight.
Matter of Degree
As veterinarians at large university hospitals, Byron and Labato generally see the the most committed owners, and the more complicated cases. These are the ones that may require more than one kind of treatment, and the results may not be 100 percent.
Often, however, owners are happy with small changes. "If you have a dog that leaks every night, and you drop it down to once a week, that's an enormous improvement", Byron says.
That's the situation for Delta the Greyhound. PPA worked well for her, but she developed high blood pressure and had to stop treatment. Estrogen did not help, but another drug imipramine, an antidepressant that is also used for separation anxiety-has reduced Delta's leaking to about once a week. "That's a level I can deal with," says Frautschs. In the future, she intends to explore other options. These may include surgery as well as dietary and herbal approaches that, according to anecdotal reports, have met with some success.
While Byron recognizes that incontinence often lands dogs in shelters, she's also been impressed by the commitment of the owners of dogs she treats. In one case, a male Dachshund, the owners tried PPA. It did not help. Testosterone treatment, which often works in males as estrogen does in females, only prompted him to start marking in the house. Collagen injections worked, but only for a short time. Their solution?
"They're living with it," says Byron. "They love this little guy." He spends most of his time in non-carpeted areas of the house, and he's taken outside frequently. Sometimes, he wears a diaper designed for dogs with this problem. "He still plays and runs around the yard, and goes on walks," she says. "He's a very happy, healthy dog."
If All Else Fails
There are several products on the market that can help make the best of an imperfect situation.
- Doggy diapers, some with frills and fancy designs, are available from several manufacturers. Some companies, like Bloomingtails Dog Boutique and Diapers
for Dogs, will custom-fit them. Others make disposables and washable ones, like the SnuggEase. Tinkle Trousers (below) are designed to solve the
biggest problem with doggy diapers keeping them on an active dog.
- Specially designed bedding is also available for incontinent dogs. The SleePee Time Bed offers an elevated sleeping pad over a tray to catch urine. Several firms make products for bed-wetting children, such as waterproof mattress pads, that can ease the burden of cleaning up after an incontinent pet.
- Many of these products, as well as cleaning solutions that neutralize the smell of urine, are available online, direct from the manufacturer, at pet stores, and at web sites that focus on caring for senior and handicapped pets, such as handicappedpets.com.
When a Puppy Dribbles
Sometimes, when incontinence develops in a puppy, the cause may be a congenital abnormality of the urinary tract, known as an ectopic ureter. Normally, urine is produced in the kidneys and transported to the bladder through a tube known as the ureter. Sometimes the ureter bypasses the bladder and empties directly into the vagina or the urethra, the tube that transports urine out of the body.
Ectopic ureters will be evident in a very young puppy. They can be treated with surgery to put the opening of the ureter in the right place.