Treating Your Dog's Urinary Incontinence

This article provides information on the common causes and treatments for incontinence in dogs. If you have noticed that your dog is having more accidents in the house or you find wet spots on the floor or bedding where they sleep, your dog may be experiencing urinary incontinence.

Fortunately, canine urinary incontinence can usually be managed with lifestyle changes, medication, surgery, or a combination of treatments.

While cleaning up after your dog can be frustrating, remember that urinary incontinence is an unintentional or “accidental” action. Your dog isn’t misbehaving or forgetting its “house training;” it has a medical condition that requires treatment.

The type of treatment for incontinence depends on its underlying cause. Obtaining an accurate diagnosis from your veterinarian is essential to treat it successfully.

Urinary (or urethral) incontinence is a broad term used to describe the passive, involuntary leakage of urine. Any dog can be affected, but it is more common in middle-aged to senior dogs and spayed female dogs. Some medium to large-breed dogs are more susceptible to incontinence.

The severity can range from small drops of urine on the fur while walking or after it urinates to the complete unintentional voiding of a large amount of urine. The most common symptom of incontinence is a spot of urine underneath your dog after sleeping or relaxing.

Canine urinary incontinence falls into three general categories: Stress, urge, and mixed urinary incontinence.

1. Stress Incontinence: Also known as Overflow Incontinence or Urine Retention. This is when the bladder is so full that the normal physical mechanisms cannot prevent leakage. It often happens because a dog will not urinate because of stress, fear, or a behavioral issue.
    

2. Urge Incontinence: Certain medical conditions can stimulate an increased frequency of urination (polyuria). These include urinary tract infections or irritations (UTI), inflammation of the bladder, prostate gland, or vagina, and masses such as bladder stones (uroliths), cysts, tumors, and polyps.
    

3. Mixed Urinary Incontinence: This is when a combination of multiple factors affects normal urination. Combinations of urethral and bladder storage dysfunction and anatomic and functional disorders are most likely to occur.

1. Anatomical Abnormalities: Abnormal development of the urinary tract can cause urine leakage. The most common form is the incorrect placement of the ureters (ectopic ureter) caused by a birth defect. The ureters are the small tubes that carry urine from the kidneys into the bladder. Ectopic ureters usually open further down the urinary tract than normal, often resulting in urinary incontinence.
    

2. Urethral Sphincter Mechanism Incompetence (USMI): Approximately 80% of older dogs with urinary incontinence are diagnosed with Urethral Sphincter Mechanism Incompetence (USMI). USMI is the term used when the cause of the incontinence appears to be a failure of the “valve” of the bladder neck and urethra to prevent urine leakage. USMI can be congenital or acquired and often occurs along with ectopic ureters. 
   *Ectopic ureters are present from birth but can sometimes cause problems later in life as the valve mechanism also gradually fails. It is often associated with prostatic disease in male dogs and changes in vaginal support structures and tissues (vestibulovaginal anomaly) in females. 
    

3. Hormone Responsive Urinary Incontinence: This condition is related to Urethral Disorders. The female hormone estrogen decreases after a female dog is spayed. In these cases, the decrease in estrogen over time results in a female dog’s inability to close their urinary sphincter fully, which causes leaking. This is also known as urethral incompetence.
    

4. Neurological Causes: These are a disruption of the nerves controlling the bladder caused by brain diseases or lesions. Urethral Dysfunction most often involves inadequate urethral closure pressure. Common disorders that exhibit urethral dysfunction include urethral sphincter incompetence in older female dogs, intervertebral disc disease, degenerative myelopathy, and other spinal and neurological disorders.
    

5. Bladder Storage Dysfunction: This is when the bladder contracts too frequently (bladder hypercontractility) and pushes out small amounts of urine. 

Along with a medical history and physical exam, veterinarians will perform some or all of the following diagnostic tests to form their diagnosis:

• Blood Tests: To test kidney function, blood glucose, hormonal imbalances, and electrolyte abnormalities. 

• Urine Culture: Bladder infections are common in dogs with urinary incontinence. Urinary tract infections (UTIs) not only contribute to urine leakage but can cause complications if they are not diagnosed and treated. UTIs are easily identified in a urine sample.  

• Ultrasound: Used to examine the kidneys and bladder for abnormalities and see where the ureters enter the bladder. 

• Diagnostic Imaging:

  • Intravenous Urogram (IVU): A dye that shows up on X-rays is injected into the bloodstream and followed into the kidneys and further down the ureters and the bladder. Use to detect abnormalities of the ureters, including ectopic ureters.

  • Double Contrast Cystogram: Air and dye are injected up the urethra into the bladder to examine the position of the bladder neck. It is also used to find bladder wall abnormalities and bladder stones.

  • Retrograde Studies: Dye is injected into the vagina, the urethra, and the bladder to examine the anatomy of the vagina and possibly reveal ectopic ureters not seen in the IVU.

  • Cystoscopy: A small camera is placed in the bladder neck through the urethra. This procedure is usually reserved for medium and large breed dogs. It is very useful in ruling out ectopic ureters.

Once your veterinarian diagnoses the source of your dog’s urinary leakage, they can recommend a specific treatment plan. Most dogs respond well to medications, but surgery is sometimes necessary. Some common treatments include:

• Urinary Tract Infections (UTI): UTIs in dogs are commonly treated with antibiotics such as amoxicillin, sulfamethoxazole, and tetracycline. Also, UTIs can be painful, so veterinarians often prescribe pain medications.

• Bladder Stones: Diet and medications like allopurinol can help with some bladder stones. Some cases of urinary bladder stones require surgical intervention. Your veterinarian will discuss the best course of action based on your dog’s condition.

• Diabetes and Cushing’s Disease: Abnormal urination caused by diabetes and Cushing’s Disease can improve when treated. Diabetes is typically controlled by a combination of a therapeutic diet high in protein and fiber and low in fats and carbs, glucose-lowering drugs, and insulin. Cushing’s Disease is treated with either medication or surgery. Once these conditions are managed, your dog’s urinary incontinence should be better controlled.

• Ectopic Ureters: Treatment of ectopic ureters requires surgery to relocate the abnormal ureter to a more normal location. Your veterinarian will determine the appropriate surgical option for your dog.

• Weak Bladder: Some dogs respond well to hormone replacement medications or to drugs like phenylpropanolamine. Dogs that don’t respond to medication may require surgery. Surgical options include colposuspension, injection of bulking agents such as collagen into the urethra, or stem cell therapy in certain cases.

• Estrogen-Responsive Urinary Incontinence: Estrogen decreases after a female dog is spayed and as intact (unspayed) dogs age. Decreased estrogen levels affect the urinary sphincter, causing leakage. Medications such as diethylstilbestrol (DES) mimic the effects of the natural estrogen, improving the function of the nerves and muscles of the urinary sphincter.

1. A Change in Diet
   Diabetes is controlled by a diet high in protein and fiber, low in fats and carbs, and glucose-lowering drugs or insulin injections. There are also dog foods available specifically for dogs with bladder issues. Ask your veterinarian for a recommendation for a therapeutic diet that is right for your dog and their condition.
    

2. Increase Water Intake
   Believe it or not, increasing your dog’s daily water intake can help with incontinence and other bladder problems once the initial cause is treated.
   Drinking more water dilutes urine, and diluted urine contains less concentrated minerals and other cells that contribute to the development of crystals, stones, mucus plugs, and inflammation. Pets drinking more water also need to urinate more frequently, and this increased urination flushes the bladder, therefore decreasing the chance of bladder crystal or stone development.

        Ways to Increase Water Intake

• Feed your dog canned, wet dog food. Canned food contains more liquid and moisture and helps increase water intake.

• Feed your dog more frequently. Dogs fed several times daily often drink more than pets fed only one meal a day.

• Add warm water or broth to dry food. If you are concerned about switching from dry to wet food, add warm water or broth to their dry food. Be sure to ask your veterinarian which type of broth is best for your dog, as many may contain high levels of salt or other minerals.

• Frozen treats. Some dogs love ice cubes. If they don’t like “plain” ice, freeze slices of cucumber, carrots, apples, blueberries, or broth in ice cube trays. If your dog is a “cruncher” or aggressive chewer, you may want to skip offering ice cubes to reduce the risk of tooth fracture or injury. 

1. Other Natural Remedies
   Some natural remedies that are used to help with dog incontinence are:

• Phytoestrogens: Phytoestrogens are estrogen-like compounds derived from plants that can help with spay incontinence.

• Corn Silk: Corn silk contains mucilage, which has a thick gel-like texture that coats the inside of the bladder and soothes irritation from UTIs. It also functions as a mild diuretic and contains phytoestrogens.

• Saw Palmetto: For male dogs, saw palmetto is believed to reduce the size of a swollen prostate.

• Hands-on Therapy: Acupuncture and other Holistic or Alternative Veterinary Medical Treatments can be successful in resolving some forms of canine urinary incontinence.

Be sure to speak with your veterinarian before starting any supplemental therapy. Some herbs and other natural remedies may interact or interfere with your dog’s medications.

Some conditions seem like urinary incontinence but are a completely different issue. The following examples of inappropriate elimination are voluntary urination instead of “accidents” or involuntary urine leakage. That means the pet is aware they are urinating where they shouldn’t but have lost control of their bladder.

• Polydipsia: This is the medical term for an increased water intake. Excessive drinking of water leads to more frequent urination. Some underlying medical conditions can cause increased thirst, such as diabetes, Cushing’s disease, and kidney or liver disease. Your veterinarian will run tests to rule out other medical causes before diagnosing your dog with involuntary urinary incontinence.

• Urinary Tract Infection (UTI): Technically, a UTI is not incontinence because the dog knows they are urinating. However, a bladder infection can cause a strong urge to urinate, often referred to as an overactive bladder. It is common for veterinarians to test incontinent pets for a bladder infection.

  • Submissive or Excitement Urination: This is a voluntary urination that has a behavioral component. Submissive urination often involves a small amount of urine leakage and only happens when your dog is near a person or excited about an event.

  • Bad Habits and Lack of Proper House-Training: Some dogs have not been properly trained not to urinate in the house. This condition tends to happen near a door or somewhere away from where your dog eats, sleeps, and plays. It is usually characterized by a complete emptying of the bladder.

  • Cognitive Decline: Older pets can experience cognitive changes similar to dementia that alter their ability to recognize appropriate places to urinate. In these cases, you will typically find a normal amount of urine in any place throughout the house.

  • Pain: Pain can also lead to inappropriate elimination, as some pets find it difficult to squat or move to the correct location. This can look like your dog is dripping urine as they try to make their way outside.

There are many reasons why your dog may be incontinent, leaky, or peeing in the wrong place. Some causes are a product of age or lack of hormones and are easily corrected with medication. Other causes are symptomatic of another, sometimes serious, underlying medical condition.

Your observations, a thorough physical examination, and diagnostic tests can help your veterinarian pinpoint the specific cause of your companion’s incontinence. In most cases, your dog’s urinary incontinence can be managed with lifestyle changes, drug therapy, a surgical procedure, or a combination of all of them.

Can urinary incontinence in dogs be cured?

How your dog’s urinary incontinence is treated depends on its specific cause. In some cases, urinary incontinence resolves as an underlying condition is treated. Other causes cannot be cured but can be successfully managed with medication. While other dysfunctions can only be fixed through surgery.

What do you do when an old dog is incontinent?

Talk to your veterinarian if you're concerned that your older or senior dog is developing an incontinence problem. They'll perform a full health check and identify whether any underlying conditions are aggravating the problem, such as a urinary tract infection.

Why is my dog peeing while lying down?

Dogs sometimes leak urine when they are sleeping or lying down because they become so relaxed that the muscles in the urinary tract loosen and leak. The evidence is commonly a wet spot or wet patches where they were sleeping. This is usually a sign of losing urethral muscle tone due to age or hormonal problems. But it could also be from diabetes, UTIs, or other medical conditions. Schedule an appointment with your veterinarian to check for causes.

How do you tell if a dog has a UTI?

Frequent urination, straining to pee, and/or painful urination are common symptoms of a UTI. Other signs of a UTI are blood in the urine, dripping or leaking urine, and frequent licking of the genitals.

Are certain dog breeds prone to urinary incontinence?

Any dog may develop urinary incontinence, but some breeds appear more prone:

• German Shepherds
• Rottweilers
• English Springer Spaniels
• Doberman Pinschers
• Weimaraners
• Old English Sheepdogs
• Dalmatians
• Bearded Collies and Collies
• Boxers
• Siberian Huskies

Are older, spayed, female dogs more prone to incontinence?

Yes. Estrogen decreases after a female dog is spayed and as they age. Over time, it can result in the inability to close their urinary sphincter fully. This is also called urethral incompetence. Older, non-spayed female dogs sometimes experience urinary incontinence related to lower estrogen, too.

What are the signs of kidney failure in dogs?

Symptoms of kidney failure in dogs include:

• Weight loss
• Nausea and vomiting
• Pale gums
• Loss of balance or stumbling
• Chemical smell to the breath
• Significant loss of appetite

Are there natural remedies for dog incontinence?

Natural Incontinence Remedies include:

• Phytoestrogens. There are plant-derived estrogens used to treat spay-related incontinence.
• Corn Silk. Some people use corn silk as a supportive treatment and remedy.
• Saw Palmetto. This herb works as an anti-inflammatory.
• Sang Piao Xiao San. This is a Chinese remedy made from praying mantis egg cases.
• Acupuncture.

Are doggy diapers really a thing?

Diapers help reduce how much you need to clean around your house. They are especially helpful to senior dogs that know they have to go but can’t reach the door in time. Absorbent bedding is also helpful. It’s hygienic, easier to clean (just throw them away), and pulls urine away from your dog’s skin, reducing irritation and “diaper rash.” It also might help to keep a pee pad near the door when they are not wearing a diaper.

This article is meant to provide general and not medical advice. We strongly recommend that a veterinarian be consulted for the specific medical needs of your animal.

PetMD
North Downs Specialists
VCA Animal Hospitals