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PetDr, Veterinarian
Category: Veterinary
Satisfied Customers: 68
Experience:  PetDr has been a veterinarian for 13 years and working as a medical director in one of the best hospitals in NJ.
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We have an 11 year old, female mixed breed (dachshund + terrier),

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We have an 11 year old, female mixed breed (dachshund + terrier), 21 pounds, spayed. She has been incontinent since January, and is on Paxon and Prion. Along with the above, the vet has treated her for a urinary tract infection and she seemed to get a little better. A urinalysis has showed a little blood and elevated protein levels in he urine. She is incontinent when she sleeps or just sitting there. If she is nervous, she is worse. We have spent about $1500 on her since January. They did the expensive blood tests to check her hormones and it did not seem to show any abnormalities. They do not find any lumps when they examine her manually. She has never had puppies and she does not seem to be in pain. The Vet is competent, but seems to be out of ideas that we can afford. Any ideas?

I'm sorry to hear Ginger has not feeling good.

There are several important causes of incontinence and most of these are ruled in or out with a urinalysis and urine culture. The urinalysis reveals cell types and biochemical elements in the patient's urine while the culture isolates the bacteria growing in the urine. The bacterial species grown are identified and tested for their sensitivity towards different antibiotics, the end result being confirmation of the presence of infection and a list of appropriate antibiotics. Since Ginger was treated for urinary tract infectin and got a little bit better maybe it just cured the infection part of her bladder problem.

Most Cases of incontinence are due to:

  1. Infection of the urinary tract (usually bladder infection)
  2. Excessive consumption of water
  3. Weak bladder sphincter (especially common in female dogs)
  4. Spinal cord disease.

Aging, obesity, reduced sensitivity of neurologic receptors in the sphincter and possibly other factors all contribute to this condition which is especially common (up to one in five affected) in female dogs. Once other more serious conditions have been ruled out, the weak sphincter may be treated symptomatically with one of several medications.

It is not entirely clear how estrogens are helpful in this treatment. Originally, estrogens were given to post-menopausal women with urinary incontinence and the treatment was simply extrapolated to dogs. It is possible that estrogens are important in the maintenance of neuroreceptors in the bladder sphincter and without estrogens the receptors become unresponsive to the transmission of the storage message from higher neurologic centers. (In other words, the message from the brain to hold the urine does not get through to the bladder.) In dogs, diethylstilbestrol (DES) is the most common estrogen used, though it is now only available through compounding pharmacies. Other estrogens that have been used include estriol (Incurin®) and conjugated estrogens such as Premarin®. Regardless of which product is used, the basic process is the same. A higher dose is utilized to begin therapy and, if it is effective, the dose is tapered to the lowest dose needed to maintain effect. For DES, dosing every couple of days is typical while with estriol most dogs end up dosed once daily.

In male dogs, testosterones seem to be more effective than estrogens, possibly through action on the prostate which sits at the neck of the bladder and incorporates the sphincter.

Alpha-Adrenergic Agonists:
These medications act by enhancing release of the neurotransmitter chemicals that act on the receptors of bladder sphincter. Effectively, they turn up the volume dial on the "hold it" message from the high neurologic areas. The usual medication for canine use is phenylpropanolamine, currently available in liquid and chewable tablets and is typically given two or three times daily. Ephedrine and pseudoephedrine, common decongestants, are sometimes recommended alternatively. Side effects can include irritability, appetite suppression (phenylpropanolamine was the active ingredient in many human diet pills until recently), and blood pressure changes. Most dogs, male and female alike, tolerate phenylpropanolamine uneventfully. For especially resistant cases of incontinence, estrogens and alpha-adrenergic agonists can be used together.

Anticholinergic drugs are medications that work, not on the sphincter of the bladder, but on the rest of the bladder where urine is stored, relaxing the muscle fibers thus facilitating storage. An example of such drug would be imipramine, an anti-anxiety medication commonly used in humans. It has anticholinergic properties and can be used in combination with phenylpropanolamine in the treatment of animal incontinence. While phenylpropanolamine and DES are commonly used medications for this condition, imipramine is not but it does represent another option when a patient does not respond to the first two medications combined. Other anticholinergic drugs that might be used included oxybutynin or flavoxate.

Gonadotropin-Releasing Hormone (GnRH)
Several studies have been performed using analogs of this hormone (such as leuprolide) in incontinent dogs for which DES and phenylpropanolamine have failed. More than half of the dogs tested regained complete continence while still more achieved improvement.

I hope my answers were satisfactory, please let me know if I can further guide you on this matter.

PetDr and 2 other Veterinary Specialists are ready to help you

I'm just following up on our conversation about Ginger. How is everything going?

Dr. N. Ezik