Canis ISSN: 2398-2942

Urinary incontinence

Contributor(s): Melissa Wallace

Introduction

  • Lack of voluntary control over flow of urine.
  • Needs to be differentiated from dysuria, polyuria, abnormal elimination behavior.
  • Cause: neurogenic disease, anatomic abnormality, acquired urinary tract disease.
  • Signs: urine soiling or wetting in house.
  • Diagnosis: involuntary flow of urine.
  • Treatment: increase urethral tone, surgical correction of cause.
  • Prognosis: good if cause treated.

    Print off the owner factsheet Urinary incontinence Urinary incontinence to give to your client.Follow the diagnostic trees for Canine Urinary Incontinence and Congenital canine urinary incontinence.

Pathogenesis

Etiology


Neurogenic disease
  • Upper motor neuron disease (spastic neuropathic bladder).
  • Lower motor neuron disease.
Anatomic abnormality Acquired urinary tract disease

Predisposing factors

General
  • Breed.
  • Ovariohysterectomy.
  • Obesity.
  • Old age.
  • Tail docking.
  • Intrapelvic position of bladder.

Pathophysiology

  • Normal urethral function is a combination of normal urethral elasticity, a normal smooth muscle in the proximal urethra, normal skeletal muscle further distally and an intra-abdominal bladder neck (increased intra-abdominal pressure is transmitted to the proximal urethral and the urine remains in the bladder).
Increased urethral pressure
  • Structural abnormalitycausing (partial) obstruction, such as prostatic disease, inflammatory or infiltrative disease, urethral plug, urolith, neoplasia, stricture, polyp or a periurethral mass → incontinence when intravesical pressure exceeds urethra pressure → increased residual urine volume (>0.5 ml/kg).
  • Functional abnormality(reflex dyssynergia): sympathetic or somatic neurological abnormality → inability of urethra to relax → incontinence when intravesical pressure exceeeds urethral pressure.
Decreased urethral pressure
  • Acquired urethral sphincter mechanism incompetence.
  • Congenital urethral sphincter mechanism incompetence.
  • Prostatic disease or surgery.
  • Complication of perineal urethrostomy.
  • Inflammatory or infiltrative disease of the urethra.
  • Lower motor neuron disease (L1-L4 sympathetic innervation of smooth muscle in proximal urethra; L7-S3 innervation of urethral skeletal muscle in distal half of urethral in females and post-prostatic urethra in male dogs).
  • Cauda equina syndrome Cauda equina neuritis.
  • Dysautonomia Dysautonomia.

Timecourse

  • Days to weeks before presentation.
  • In some cases months.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Scott L, Leddy M, Bernay F and Davot J L (2002) Evaluation of phenylpropanolamine in the treatment of urethral sphincter mechanism incompetence in the bitch. JSAP 43 (11), 493-496 PubMed.
  • Gregory S P, Holt P E, Parkinson T J & Wathes C M (1999) Vaginal position and length in the bitch - relationship to spaying and urinary incontinence. JSAP 40 (4), 180-184 PubMed.
  • Nickel R F, Vink-Noteboom M & van den Brom W E (1999) Clinical and radiographic findings compared with urodynamic findings in neutered female dogs with refractory urinary incontinence. Vet Rec 145 (1), 11-15 PubMed.
  • Thrusfield M V, Holt P E & Muirhead R H (1998) Acquired urinary incontinence in bitches - its incidence and relationship to neutering practices. JSAP 39 (12), 559-566 PubMed.
  • Holt P E & Moore A H (1995) Canine ureteral ectopia - an analysis of 175 cases and comparison of surgical treatment. Vet Rec 136 (14), 345-349 PubMed.


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