Urinary incontinence is the involuntary voiding of urine.
It is primarily a common problem in spayed female dogs as they age. It isn’t, however, always directly related by spay. Don’t fail to identify the actual cause.
Other potential causes behind urinary incontinence in dogs include:
- an ectopic ureter
- urinary tract infections
- urinary stones
- neurological problems
- kidney disease
- other diseases that cause increased drinking
- cognitive dysfunction
- cancer
When the above potential causes are ruled out, your dog will receive a diagnosis of a weak sphincter linked to early spay. Is that what is happening with Cookie?
How it started
The first time I found a puddle where Cookie was resting was about two weeks after her bout of pancreatitis. She has never leaked before that; not even a little bit.
Cookie was lying on the couch a licking her vulva a lot. She made a wet spot. At first, I thought it was from all the licking. Further inspection revealed that the spot seemed much wetter than licking could make it.
Her vulva seemed to look normal, and there was no smell to it nor the wet spot Cookie made on the sheet. But as I was examining Cookie, I saw a little teardrop of clear liquid come out. So perhaps she was licking so hard because it was dripping? Or was she just licking because of irritation, and the drip was secondary to that?
Talking to a vet
In the morning I reported it to our vet.
Here is the thing: estrogen-dependent urinary incontinence usually appears in the morning; the dog wakes up in a puddle of pee as the sphincter relaxes while asleep. Cookie leaked the evening and she was not sleeping. As well as it didn’t look or smell like urine, and the wet spot didn’t even stain.
Cookie’s vulva didn’t look red or irritated, and the discharge was clear. The veterinarian advised to prevent her from licking it so much, and see.
The next evening, Cookie was not licking herself but made puddles again. This time the area was quite soaked. The whole thing lasted for about two hours, and that was that.
What is happening?
There was no color and no smell to the fluid. It was cold outside, and Cookie was bouncing through deep snow. I was wondering whether that might have irritated her and cause the drips? I know that my nose gets very runny in cold weather. And it’s always happened after she spent some time outside.
Either way, we decided to take her to the vet the next day.
He checked Cookie’s urine, there was no infection. He found some low-grade vaginitis and figured it could be because of a virus she caught. Her resistance would be reduced after pancreatitis. Another possibility were changes in the flora of the vagina after antibiotic therapy. The veterinarian figured it should be self-limiting and we agreed on letting her body deal with it on its own.
The leaks stop
And just like that, it stopped.
Everything was just fine for a couple of weeks. Then the leaking returned. In the same pattern, sometime after her day at the horse farm. Again, it lasted for about a couple of hours and stopped. As Cookie was resting, I actually saw it squirt when she moved.
To me, it still wasn’t clear whether it was indeed urine or some other fluid.
And if her bladder was full, why wouldn’t she know she needed to pee?
After it started again, I decided to invite her to go outside and pee. The first day it seemed to have stopped the leakage. The second day it seemed to have stopped the leakage. The third day it did not. Hm …
Anatomical issue?
Were we looking at some kind of a plumbing problem after all?
If it was, why it would not appear until now? An ectopic ureter is a developmental defect. Cookie was 2 years old; how would she never had any problems?
Further reading on ectopic ureters.
And after three evenings it went away again. Went away to return another couple weeks later. What kind of strange cycle is this?
I found that very confusing. If it was incontinence, why would it come and go like that? Cookie goes out for walks or days at the farm every day. She eats a bunch of snow every day. She runs and plays every day. Everything is consistent and yet for the third time, she had a couple of evenings of leakage.
A potential theory?
Just when I thought things couldn’t get any more strange, our vet mentioned that he had people mention that some treats/chew sticks, such as rawhide, caused increased urine production as well as pumpkin causing bladder leakage.
Cookie’s diet had been consistent, didn’t contain any pumpkin but she did munch on a rawhide a tiny little bit. Not each time this happened, though.
And why does it last only an hour or two?
Another vet visit
We had Cookie examined again. The vulva was normal, the area near urethra was still a little red. Urine was normal. No signs of infection and urine culture didn’t grow anything.
And again, after the three days, the problem went away for months.
Half a year later
There were no puddles until summer. This time, they weren’t really leaks, but rather squirts.
The first day, Cookie was leaking a bit in the evening. We took her to pee, she did but leaked some more after. Stayed dry for the night, though.
The next day she was actually at the vet for her rabies shot. They checked her out thoroughly and examined her pee region as well. She did squirt at the vet a little. But nothing unusual was found, and we thought it was going to go away as in the past. Which it seemed to have happened.
There were no leaks for a few days. But then Cookie leaked a lot; a huge puddle. That was unexpected and unwelcome.
We had to pull out puppy pee pads.
Since then it’s been off and on. Not like in the past when she’d leak for a bit and then remain dry for a long time. So what has changed?
Another vet visit
We made an appointment for another exam, urinalysis, and culture.
Until now, the vet gelt that the incontinence was a result of Cookie being spayed very early. We don’t know when but there was an indication it was really early. That part would fit hormone-responsive incontinence.
Things that can cause urinary incontinence are
- Hormonal imbalance
- Weak bladder sphincter
- Urinary tract infection
- Urinary stones
- Spinal injury or degeneration
- Protruding intervertebral disc
- Presence of other diseases that cause excessive water consumption, such as diabetes, kidney disease, hyperadrenocorticism
- Congenital abnormalities
- Anatomic disorders
- Certain medications
Checking out the urine and overall health is a starting point. Cookie does not have any other symptoms of a problem. She drinks, pees, eats and acts normally and happy.
I feel it’s something else
Some of the things about this do make me feel that there is something else to it than garden variety incontinence.
It doesn’t happen when Cookie sleeps soundly; it doesn’t happen unless she moves. The urine doesn’t dribble but squirts out with movement. Last night Cookie remained perfectly dry. When she was getting up to face a new day of adventures, she dribbled some.
Getting her to empty her bladder doesn’t seem to have any effect on this. If she’s going to leak, she’s going to leak before or after going to pee. No difference whatsoever.
Cookie was in the office, awake, watching stuff outside the window. Then JD had found something and she was getting up to see what he’s got. As she moved, that’s when it squirted.
Vaginal pooling?
I managed to video tape it. After seeing it, our vet from Kitchener feels that it fits better vaginal pooling rather than incontinence.
Based on my description of events, Dr. Kay also says she’d wonder about some sort of structural anomaly that is retaining a small puddle of urine; perhaps in the vaginal vault. Particularly since there were several times when Cookie was also leaking mucus during a walk.
The timing also doesn’t quite fit. It is also possible that there is a component of infection involved. Hence the urinalysis and culture and all that to start with.
To Dr. Dan, it also looks like a structural problem with a pocket of urine pooling. To Dr. Patrick, it looks like a typical hormone-related incontinence. It makes sense to him that muscular control of the sphincters nor being as strong as they should due to her lack of exposure to female hormones like estrogen. Dr. Roxane feels that Cookie might have tweaked her lower back/pelvis. Wouldn’t be surprising the way Cookie is flying through the tall grass.
Whatever it is, we need to get to the bottom of it.
Further testing
If the initial work-up doesn’t reveal anything, we need to look into ultrasound or vaginoscopy or both.
When and how it happens does confuse me. To me, it doesn’t fit with typical incontinence. To some of my veterinary friends it does, though.
- it does not necessarily happen during the night or when she’s sleeping (she might be awake and try to lick herself clean so clearly not sleeping
- full bladder is not [a sole] cause because taking her out to pee does not put a stop to it
- it does seem to happen primarily when she moves (e.g. I was sitting there, watching with a flashlight; everything was nice and dry and then she moved and urine squirted out) though sometimes it might dribble a bit on its own. Generally, though, it squirts out with movement.
It almost seems to me the urine might be pooling someplace. That’s why going to pee doesn’t make much difference and that’s why it squirts out with movement…?
Looking at the urine
With a leaking dog, the proper procedure is to start by checking the dog and the urine.
Cookie has been checked for the third time in the last couple of weeks with no unusual findings. The vet only found minimal entrapment and no evidence of inflammation, urine retention or staining, just a bit moist. Cookie decided not to squirt on her this time. There was no evidence of pain.
Urine didn’t reveal anything useful to solving the problem.
Our local vet is fully convinced that Cookie’s problem indeed is estrogen responsive incontinence.
She put Cookie on estrogen replacement to see how it works. She was dosed with one pill every 24 hours for four days and twice a week thereon until all medication is used up.
The vet office called yesterday to check and Cookie’s leaks indeed seemed to have gone away.
I was happy to report that though I emphasized that in the past they’d go away on their own too so we cannot really be sure whether the medication helped or whether they just stopped.
Come and go
And this morning Cookie dribbled again.
She into her twice a week dose and is to get a pill Wednesday evening. She didn’t make a big puddle; though that might be because I was watching like a hawk and took her out to pee. Which she did and then stayed outside so it’s hard to assess things then.
Meanwhile, her specific gravity was kind of low. The vet isn’t concerned, I kind of am because Cookie seems to have notoriously lower specific gravity than I feel she should. However, this could due to the fact that so far she never had first-morning urine checked.
It just never worked out that way because we were more concerned about it being fresh than being the first pee.
It was important to test the first-morning pee to get a better picture of Cookie’s ability to concentrate urine. She doesn’t look or act sick, though.
Cookie can concentrate urine properly
We collected Cookie’s first-morning pee and it was concentrated the way it should be. Together with blood work not indicating any kidney issues, kidneys were ruled out.
The estrogen treatment didn’t make much of a difference. The leaks got reduced but haven’t gone away.
The first time Cookie started with the leaks was right after her bout of pancreatitis. Then they went away for several months only to return. What has changed?
It would stand to reason that something would be different then and now.
Diet change?
One thing would have been some change in diet. Treating her pancreatitis, Cookie was on prescription food and off her “bone meal” stuff. After we moved to Jasmine’s ranch, I didn’t have a way of cooking it up for her so she was off it as well.
However, once things got sorted out a bit I started making it again … and didn’t seem to have made any difference.
So the food likely was not it.
Chiropractic care?
Then it occurred to me. Pretty much ever since we got her she was getting regular chiropractic adjustments. The initial reason was that she’s been very lame because of the fragment of the porcupine quill in her foot. I felt that the compensation must have taken a toll on her and made her first appointment.
It turned out that her pelvis was a mess and we started doing monthly treatments. After we moved, we left her chiropractor behind and haven’t found a new one.
And here is the kicker. When she had pancreatitis, her chiropractor felt she didn’t want to burden the body and we didn’t do any chiropractic until Cookie was all well again.
Certainly a common thread.
Sore back connection?
Sometimes leaking becomes worse if the low back is sore or there are some pelvic issues. When the right nerve gets pinched, such as the nerve that works the neck of the bladder, this could lead to leaks.
It made sense to me so we made an appointment with a local chiropractor and got Cookie adjusted.
She needed adjustments to right sacroiliac joint (SI), right sacral apex, Left L4, L2 posterior.
Could that have been behind the leaks? Perhaps … She’s had no leaks since. Coincidence? Perhaps. But the adjustment certainly didn’t hurt anything.
For a time it looks like the chiropractic care was working.
Back to square one?
Estrogen therapy had mixed results and so did the chiropractic. Ultrasound ruled out anatomical abnormality. There was no infection and no kidney problem.
Cookie can go without leaks for months.
Is exercise involved? I imagine that Cookie being more tired could contribute. As well as more exercise increases water intake, making the bladder fuller?
Sometimes can dribble and sometimes she can end up in a pool of urine. But whether she leaks during sleep or wake state, it never happens during the night.
She can hold a full bladder
Cookie is perfectly able to remain dry through the night in spite of getting up with a full bladder. And she is perfectly able to leave a puddle right after she peed outside, with bladder presumably mostly voided.
So how come the sphincter can hold large volume one day and not a small amount the next? That remains my question.
It’s a process
More than one thing might be involved. It could be that a drop in estrogen is a contributing factor because the therapy makes moderate difference. The amount and type of exercise might be involved, whether because of increased tiredness or some neurological aspect of it.
We keep observing, thinking, and investigating.
Don’t laugh but the latest working theory is a bouncy bladder.
Related articles:
Urinary Incontinence in Dogs: Living with an Incontinent Dog
Potty Accidents in Dogs: Incontinence versus UTIs
Further reading:
How to Identify and Treat Urinary Incontinence in Female Dogs