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Urinary Incontinence: Dealing With the "Leaky" Pet

A common problem in (usually) older dogs (and sometimes cats) is a condition called urinary incontinence. 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.

As mentioned, urinary incontinence can be seen in young pets including puppies and kittens, but is usually seen in middle-age to older pets. The exact cause is unknown, although since incontinence often responds to estrogen or testosterone supplementation following spaying and neutering, hormonal factors obviously play a factor in maintaining the tone of the urethra and preventing leakage of urine. Other hormonal imbalances such as hypothyroidism, and rarely bladder tumors (bladder tumors usually also cause include increased frequency of urination, painful urination or a burning sensation during urination, excess licking at the genitals, and occasionally blood in the urine) also 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 or complementary therapies.

 

Conventional Therapies
Conventional therapies work well for pets with urinary incontinence. Two types of therapy may be used: hormones or phenylpropanolamine (PPA.) Hormones such as estrogen or testosterone can be used effectively to treat idiopathic incontinence. Due to the chance of severe side effects including genital cancers and bone marrow suppression, treatment with these hormones is not usually the first choice. However, natural hormones given at low doses can be tried and may be associated with a decreased chance of side effects.

Phenylpropanolamine (PPA) strengthens and tonifies the bladder sphincter; a leaky sphincter causes incontinence. In women, it has recently been associated with strokes. This is a very rare side effect and to my knowledge has not been seen in dogs or cats. Side effects in pets are rare with PPA but can include hyperexcitability or worsening of glaucoma or heart disease or hypertension. To minimize the chances of side effects, the lowest effective dose is used and pets with certain preexisting conditions (glaucoma, prostate disease, uncontrolled hypertension) are not treated with this drug. In my practice, I usually combine PPA with complementary therapies. Doing so allows me to use very small doses of PPA, and so far I’ve never seen any side effects when using this medication. If your pet is already taking PPA for incontinence I would suggest working with your veterinarian to slowly lower the dose. Most pets I see can have their dosages cut by up to 75% and still remain continent (no longer leaky.)

 

Complementary Therapies
There are several complementary therapies that may help reduce incontinence. Each doctor has his own favorite supplements, but here are some that have worked well for me.

Choline supplementation (often combined with formulas containing natural hormones and herbs) is my main therapy for urinary incontinence. Choline is a precursor to the nerve transmitter acetylcholine. As pets age they may experience reduced levels of nerve transmitters or reduced sensitivity to them at nerve terminals. Providing extra nerve transmitters can help with several conditions, including incontinence and cognitive disorder (and in fact incontinence may be seen in some pets with cognitive disorder.) Choline supplementation appears to be most effective when started early in the course of incontinence. The only side effect I’ve seen with choline supplementation is hyperactivity, and this is extremely rare. If your pet develops this side effect reducing the dose of choline should eliminate the hyperactivity.

Additionally, effectiveness has been reported with other therapies such as various herbal formulas such as Rehmannia 6 or 8 (ingredients include rehmannia, cornus, dioscorea, moutan, hoelen, alisma (Rehmannia 6 and Rehmannia 8) and cinnamon bark and aconite (Rehmannia 8.) The herbs regulate water balance in the body.

Other herbs such as ginkgo biloba, mullein, and shiitake mushrooms may be helpful. Various homeopathics can also be tried.

Products that may be helpful include Vim & Vigor by PetCentrx and Bladder Strength by VetriScience.

 

Here’s my suggestion if your pet becomes incontinent:
First, a thorough physical examination plus urine and blood testing is needed. Other causes of urinary problems, such as bladder infections and diabetes, must be ruled-out. If all testing is normal, it is most likely that idiopathic incontinence is the culprit of your pet’s leaky bladder. A trial dose with any of the recommended supplements can be tried for 2-4 weeks. If ineffective, low doses of PPA plus the complementary therapies will usually solve the incontinence.

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