Leaky Dogs: A Primer on Urinary Incontinence

Photo Credit: © Susannah Kay

Does your dog awake from her sleep in a puddle of urine? Does she dribble urine when she stands up or is walking about? If so, she has involuntary urine leakage, known as urinary incontinence. Not only can this be bothersome and even embarrassing (dare I anthropomorphize) for the dog, it is truly a huge cleanup nightmare for the humans who live with a leaky dog. Urinary incontinence often results in frustrated attempts to use diapers, many loads of laundry, and irrational reprimands for the poor dog who has no control over the situation. Worst-case scenario, the dog who normally sleeps beside her master’s bed, is banished to the backyard.

The good news is, for most dogs, the leaking can be stopped or markedly diminished with appropriate therapy. The cause of the incontinence must first be established with appropriate diagnostic testing performed by a veterinarian.

Normal urination

When urine travels from the bladder (its holding reservoir) to the outside world it passes through a rather narrow tubular channel called the urethra. A muscular sphincter is present right at the point where the urethra connects with the bladder. It is this urethral sphincter that prevents urine leakage by remaining tightly closed. When the brain sends a signal that it is time to urinate, the bladder contracts at the same time the sphincter relaxes thus allowing urine to flow.

Hormone responsive urinary incontinence

Far and away the most common cause of canine incontinence is referred to as  “hormone-responsive incontinence” or “acquired urinary incontinence.”   It is a disease of neutered dogs- most commonly middle aged and older females, but occasionally occurs in males and younger females. Various studies report an incontinence incidence rate of 5-20% in spayed female dogs. There is evidence that neutering before three months of age substantially increases the risk of future incontinence.

Other factors that may be associated with increased risk for hormone responsive urinary incontinence include:

Breed: Old English Sheepdogs, Doberman Pinchers, German Shepherds, Boxers, Weimaraners, Rottweilers, and Irish Setters are at increased risk.

Size: Large and giant breeds have increased risk and small breed dogs have decreased risk.

Tail docking: This surgical procedure performed on puppies of certain breeds is suspected to increase the risk of incontinence.

The diagnosis of hormone responsive urinary incontinence is made based on ruling out other potential causes and/or response to medication. Most dogs with this form of incontinence respond favorably to medication. The standard two that are tried alone or in combination are diethylstilbestrol (an estrogen product) and phenylpropanolamine (PPA). For dogs that are nonresponsive to medication, treatment options include collagen injections or placement of a constricting ring at the site of the urethral sphincter.

Incontinence caused by increased thirst

Dogs who drink more water produce more urine. This translates into a bladder that becomes maximally distended, particularly during the night when a dog spends many hours in a state of sound sleep. This bladder distention can override the urethral sphincter, resulting in urine leakage. The key here is to hone in on the cause of the increased thirst. Correct this issue and the urine leakage typically resolves. Common causes of increased thirst include kidney disease, liver disease, urinary tract infection, and hormonal imbalances including diabetes mellitus, diabetes insipidus, Cushing’s disease, and Addison’s disease. Increased thirst can also be caused by some medications (diuretics, corticosteroids, antiseizure medications) and changes in diet.

Urethral sphincter abnormalities

Defects at the level of the urethral sphincter can interfere with its normal function. Such abnormalities can include bladder/urethral stones, prostate gland disease, tumors, and inflammation caused by infection. Resolution of the incontinence is dependent on successful treatment of the underlying disease.

Neurological disease

Normal urine retention and voiding is dependent on a complex set of neurological signals involving the brain, spinal cord, and nerves leading to the bladder and urethral sphincter. Disease within this circuitry can result in urinary incontinence, typically accompanied by other neurological symptoms such as hind leg disuse or weakness and an inability to pass bowel movements normally. Therapy is dependent on the underlying neurological disease.

Plumbing problems

The most common cause of urinary incontinence in puppies is a birth defect called an ectopic ureter. Ureters are the narrow conduits that transport urine from the kidneys to the bladder. The term “ectopic” means in an abnormal place or position. An ectopic ureter transports and empties urine into the urethra rather than the bladder. The diagnosis of this plumbing defect is made visually either by passing an endoscope (a telescope-like device) into the urethra and bladder, or by performing an imaging study (CT scan X-rays) following the administration of contrast material. Incontinence caused by ectopic ureters can often be corrected surgically or with laser therapy.

What your vet will want to know

If you have a leaky dog, be prepared to answer the following questions. Your veterinarian will be able to use this information to help diagnose the cause of your dog’s incontinence.

  • When did the incontinence begin?
  • When is the leakage typically observed- during sleep or with activity, before or after urinating outside?
  • Is your dog drinking more water than normal? Ideally measure how much water she drinks during a 24-hour time period. Normal water intake during 24 hours should be no more than one ounce per pound of body weight per day.
  • Does the act of urination appear normal in terms of time spent squatting, strength of urine stream, and appearance and odor of urine?
  • Are there any other observed symptoms such as difficulty passing a bowel movement or hind end weakness?
  • Has there been a recent change in diet or addition of medications or supplements?

Have you ever lived with a leaky dog? What was the diagnosis and what was the outcome?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

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9 Responses to “Leaky Dogs: A Primer on Urinary Incontinence”

  1. Gracie says:

    I rescued a 3-year old chocolate Lab with bladder incontinence. At the time of adoption, she was on Proin – 1 pill 2x/day with each feeding. That worked for a few months, but after having to twice up the dosage to stave off the dribbling and wet bedding, my vet suggested DES. We discussed the side effects and made the decision to proceed with the treatment. She now takes DES once every 15 days and, at age 11, is problem free.

  2. Cathy Allred says:

    I have an 8yo mixed breed who began experiencing incontinence at the age of 5. We used DES for two weeks while also starting her on Chinese herbs. The double dosing was so we could get enough herbs in her system to take over the work of the DES. She did great on the herbs until last summer when she developed an itching problem. Itching from this particular herb was a common side effect so we had to go back to DES. Purely by accident; I forgot to give the DES. She was only taking it once a week so I decided to wait and see what happened. She was leak free for six months but recently diagnosed with a UTI that took two courses of antibiotics to clear. I still have never seen her leaking but after some research it seems it is possible that she just dribbles and that could be contributing to the UTI. She is back on the DES. She was spayed at 4 months of age. I simply didn’t know any better. I’m glad to see this subject out in the dog world so often these days.

  3. Laurie says:

    Oh Ellen, that is so sad. We have terrible decisions to make sometimes.

    I think incontinence is really hard on dogs because they know they’re not suppose to pee in the house and they feel wrong about it even if it’s not their fault. Not exactly embarrassed, but a kind of “oh no, how did that happen?” feeling. It’s good that there are more and more treatment options now.

    Carolyn, that is fascinating about parsley. I know it has a diuretic effect on humans if you eat a lot or drink the tea. The same is true of dandelion. I wonder if that has the same effect on dogs.

  4. Miriam Yarden, B.Sc.,MS,APDT says:

    Here is a problem: we have been using DES and phenylpropanolamine for incontinence for years when indicated. However, 90% of veterinarians do not have it now, do not recommend it now and it is almost impossible to get in a regular pharmacy even if the vet gives a prescription. True, they do have some side effects (is there anything that does not?) but they were extremely useful when they were available. Any comments, Dr. Kay?

  5. Carolyn M M says:

    Years ago, Maggie developed incontinence. I researched everything I could, took her to the vet and we just couldn’t get to the bottom of it.

    Maggie was on a homemade diet since there were no good commercial food sources available in the developing country where we lived at that time.

    I had been tracking in a spreadsheet, the homemade diet I was feeding (yes, I’m nerdy that way). By chance, I read somewhere that parsley can trigger the bladder. And in fact, for some home prepared meals, I was using my homegrown windowsill parsley as one of the greens in her diet. When I stopped the parsley, she was never bothered by incontinence again.

    Do hope this tip about parsley may be helpful to someone somewhere. The other take home message is to never underestimate the importance of keeping written records! These allowed me to make the connection about parsley and Maggie’s incontinence in the first place.

  6. Jane says:

    I have a mini poodle who started waking up wet around 5 years old. The vet first gave her hormone shots. After 2 years and 5 shots (one every 5 or 6 months) I thought: Hormones are what gave me cancer so I changed vets and the next one suggested Proin. She took a pill a day for 2 years and did well. I changed vets again because of a kidney problem at 10 years of age. She is a holistic vet and we started weaning Emily off the Proin. After 9 months all I do is rub wheat germ oil on her tummy once a week and she is leak free. I would not have believed it if someone told me this could be. I am not a holistic person, but I am a believer now. Emily has been leak free with just wheat germ for 4 months.

  7. rm says:

    Dr. Kay,

    One of my vets mentioned that the age of spaying will affect what is prescribed to an incontinent female. When I was growing up, most female dogs were spayed around 6-9 months. However, a lot of dogs (puppies) in animal shelters are being spayed at 8 weeks.

    The difference is that the dogs spayed at 6-9 months have been exposed to some estrogen during development. Not so for the 8 week spays. How important is it to know when your dog was spayed when talking to the vet about this issue. I know first hand, sometimes when adopting a dog from an animal shelter the medical records can be incomplete. I got my dog at 1.5 yr old and she was spayed, but no indication as to when. I got her in 2006, and there isn’t any evidence (i.e. mammary glands or medical information) of her ever being a mom, and right now I’m under the assumption that she was a traditional 6-9 month spay.

    Could you elaborate on spay date and treatment for incontinence?

    Thanks.

  8. Nita says:

    I’d love to know more about docking tails leading to an increase in incontinence. Are there studies that show this? I haven’t heard of this, so would love to know where to get more info. I do have a docked, spayed bitch with incontinence.

  9. Ellen says:

    Yes, my 11 year old Weim developed urinary incontinence and excessive thirst after anesthesia for removal of benign cysts. What we didn’t know at the start was that she was riddled with cancer with the primary in her lung with mets to the abdomen. Her post op incontinence was controlled by meds. She was never “herself” after the surgery and despite multiple trips to 3 specialty vets, a myriad of tests, no one diagnosed her cancer until I demanded a chest x ray for subtle coughing when prone. Her pleural effusion was massive with malignant cells confirmed by pathologist. Mets to abdomen. Heartwrenching decision to euthanize that day. Haven’t gotten over her death yet.