Urinary Incontinence

Overview:

Urinary or urethral incontinence (UI) is the loss of voluntary control of urination. This involuntary urination is most often seen in spayed, female, large breed dogs that are middle-aged to elderly. However, in Greater Swiss Mountain Dogs (GSMD), UI is a common affliction in young growing female GSMDs and is a frequent problem in all ages of spayed GSMD females. It is also known to occur in male GSMDs, but this is not a common occurrence.

A wide range of factors can cause urinary incontinence, which include:

Urethral Sphincter Mechanism Incompetence (USMI)
Urinary tract infections (UTI)
Anatomic abnormalities, such as ectopic ureter(s)
Neurological disease or injury
Behavioral issues such as submissive urination

The most common cause of urinary incontinence in GSMDs is urethral sphincter mechanism incompetence, sometimes called weak bladder sphincter.

USMI occurs when the muscles that close the urethra (tube from the bladder) fail to tightly contract, allowing urine leakage. This disease can be congenital or acquired; the congenital form is relatively common in female GSMD puppies when compared to other breeds of dogs. A majority of these puppies with USMI will become continent after their first heat cycle, but not all. However, acquired USMI (also commonly referred to as spay incontinence or hormone-responsive incontinence) is often seen following spaying, so unfortunately it is quite common for adult female GSMDs to experience urinary incontinence starting within months to years after spaying.

The propensity of USMI in female GSMDs, also contributes to an increased number of UTIs in females as infection causing bacteria can more easily accesses the urinary tract and bladder through the loosely contracted urinary sphincter. Additionally incontinent dogs are more likely to frequently lick their genital area which can introduce more bacteria into the urinary tract.

Warning Signs/Symptoms:

The most common sign of UI is a spotting or pooling of urine underneath your sleeping dog. Your dog may also dribble urine when walking or after urination. The dog seems unaware of this occurrence. Your dog may have wet hair on the lower abdomen or between the legs and may frequently lick around the genital area. If additional symptoms such as frequent urination, blood in the urine, urine has a strong smell or frequent attempts at urinating occur, then a urinary tract infection may be likely.

What to do:

While urinary incontinence is not usually a life threatening condition taking your GSMD to the veterinarian for examination promptly is recommended. UI is at best uncomfortable for your dog and can progress to a more serious condition if not treated promptly. If UI is a new occurrence with your GSMD or they are displaying possible symptoms of a UTI, consider collecting a urine sample from your dog to take with you to your dog’s veterinary appointment.

What to expect at the vet:

Your veterinarian will take a complete medical history, perform a thorough physical examination and will order a urinalysis and a complete blood count (CBC). If more serious conditions are suspected x-rays or an ultrasound might be performed.

Treatment:

Treatment is based on your dog’s specific diagnosis:

If the UI is being caused by an uncomplicated UTI, your dog will most likely be treated with an antibiotic that has been selected based upon a urine culture and sensitivity test by a veterinary laboratory. In GSMDs it is not uncommon for an extended period of 2-4 weeks of antibiotic use to be required to completely clear the urinary infection.

For USMI, medications that increase urethral sphincter tone such as Proin (phenylpropanolamine) and imipramine, or hormone replacement therapies such as Incurin (estriol) or diethylstilbestrol (DES) can be used alone or in combination. Once on the appropriate medication, your dog should stop leaking within a few days to a week. The majority of USMI cases respond well to medical therapy. However, for those few urinary incontinence cases which are not responsive to medicine, there are some possible surgical treatments available.

Some GSMD owners have also seen success in treating urinary incontinence in their dogs with natural treatment options, such as herbals (corn silk, traditional Chinese medicines, etc), homeopathic remedies and/or alternative treatments with chiropractic adjustments and acupuncture.

Your veterinarian will be the best suited to determine which treatment is appropriate for urinary incontinence in your dog.

Prevention:

To help prevent recurrent UTIs, daily supplementation to your GSMDs diet with a cranberry extract, such as D-Mannose is thought to help prevent bacteria from latching on to urinary tract cells and causing infection. Also ensure that your GSMD drinks adequate water and has opportunity to empty their bladder on a frequent basis.

At this time there does not appear to be prevention for congenital USMI commonly seen in female puppies prior to their first heat cycle. However, as mentioned previously a majority of GSMD females will be continent after their first heat cycle and only develop acquired USMI after spaying. Many GSMD breeders have long advised owners to wait until after sexual maturity before spaying/neutering their dog to avoid or lessen possible negative long-term health impacts, such as UI. Additionally in recent years, there have been published health research studies that have found an association between early altering and early-onset urinary incontinence. To determine whether, when and how your GSMD should be spayed/neutered, an owner should carefully research and fully discuss all options with your dog’s breeder and veterinarian to ascertain the best fit for your dog’s health and well being.

References:
My Dog IS Leaking, By Stanley Rubin, DVM, MS, DACVIM
Urinary Incontinence. Washington State University College of Veterinary Medicine.
Urinary Incontinence (Urethral Incontinence) in Dogs, By Tammy Hunter, DVM; Ernest Ward, DVM
What to Do About Lack of Bladder Control in Dogs, By Evan Ware, DVM
Incontinence: Urethral Sphincter Mechanism Incompetence, By Michael Kraun, DVM
Study Finds Early Neutering of Bitches Increases Incontinence Risk, Royal Veterinary College News