Dog Pod - Episode 3
Dog Incontinence with VET Dr. Kevin
Learn about the myths and truths surrounding dogs with incontinence issues.
Listen in as Dr. Kevin Cruickshank explains:
- the potential problems such as infections
- how to know if your dog wets
- how bad they can get
- the simple fixes
- why mobility is so important
- how dehydration happens and why this makes it worse
- how clean teeth can help (yep! it's a truth you won't believe)
- and many more insights!
Listen to episode Here
Podcast Transcript
Scott: All right. Welcome back to another Dog Pod Podcast and we are sitting here with Dr. Kevin Cruickshank, again, on another fine day, here on the Gold Coast and welcome back, Kevin.
Kevin: Thanks Scott, good to be with you.
Scott: So what I thought what we might do today is have a bit of a chat about incontinence and some of the things that sort of probably flow on from what we spoke about in the last episode which was around joint pain, arthritis. I have kind of heard that it is a bit of a myth. I have heard some other vets and other people talk about this and my understanding is it is a bit of a myth that, what they said was that dogs don't really suffer incontinence. What they are struggling with is getting up off the bed and my understanding is that it's not really quite true. Obviously as dog's age, they do have difficulty getting up and that sort of stuff. So do you want to give us the truth around what is actually going on here?
Kevin: I think, you know, the truth is a combination of things actually. So it certainly isn't a myth that dogs have true urinary incontinence. So when they are leaking without realizing that they are. So we are not talking about dogs that are urinating more frequently than normal, but actually a dog who just does not realize that there are some urine dripping out and very often it can be a very small quantity. It is just a little bit of a dribble and so you might not even find a wet puddle. The dog might just be licking more around.. often is more commonly female dogs, so around the sort of vulva area or you might just find some bedding that is more smelly than normal or bit damp or wet, or it can be much more obvious and actual puddle that you finding and it does not necessarily mean that it is every night or every time they resting or sleeping.
Scott: Right. Okay. So when they-- is it under, I guess, there must be multiple reasons is when they are under pressure getting up, is when they are more relaxed.
Kevin: Typically when they are more relaxed, and so I think this is where the multifactorial part comes in. Is if they, so the bladder is closed by a muscle that keeps it closed and stops you leaking and that is the part that for various medical reasons and quite often that actually is a hormonal reason. That muscle is not as strong as it used to be, but then, if you have got a reason that the dog is not able to go to the toilet as common, as frequently as normal, then that bladder can be under a bit more pressure. So that is where the idea of a dog with arthritis and struggling to get up, might be one that then is more prone to actually manifest the incontinence. So because their joints hurt to get up, they don't necessarily go as frequently to the toilet as they might need to and then when they are lying, sleeping they have got a full bladder and therefore it leaks a bit more easily because it is a pressure issue. If the bladder is only half full or only a tiny bit full it is probably not going to leak, but if it is actually been able to get quite full because they have not gone to the toilet say just before going to bed or something like that, then they are more likely to leak.
Scott: Right. That that muscle which can only take so much is under more pressure and the...
Kevin: Exactly, right.
Scott: Yes. Okay.
Kevin: So that muscle is under hormonal control and that is why it is often female dogs that have more incontinence. It is often an age related thing, similar to humans as well as we age, it is unfortunately one of the muscles that starts to give way in the body. It is often a point that people are worried to actually not desex dogs because they say every female dog who's been desexed is going to be incontinent. Well, that is a bit of a myth. It is not as common as that, but also if your dog does have incontinence, it is not a really rare or unexpected thing. It happens, perhaps maybe in about ten percent of female dogs, so...
Scott: Okay. It is not overly high.
Kevin: No, it is not overly high but it is not weird and unusual.
Scott: Yes.
Kevin: You know, one in ten dogs and really that is just, really off the top of my head.
Scott: Yes, sure.
Kevin: The fortunate thing is it is very, very manageable. Both from if we can do things that help with their mobility and typically something like arthritis, that can help, but there are also medications that have virtually no side effects, but that can really help improve the strength of that muscle in that working and go expectation can be with the right medication, that incontinence can be completely controlled. So that really improves that dog’s quality of life because they know they should not be wetting. They do not like it, they're often quite embarrassed, they feel a bit wet and that is often why they licking a lot more at themselves. It also makes them prone to urinary tract infections, leaking as well.
Scott: Okay, right. So I was going to say like because often times, dogs if they are that relaxed, it is probably happening during the night. I would imagine while they are sleep.
Kevin: Very typically, yes.
Scott: Dog owners might not be able to identify that easily because four hours later they have still been asleep, they get to morning it is probably dried on the bed. What else do they look for, I guess does the dog owner sort of look for?
Kevin: Certainly, if they starting to get a bit of a skin infection or they constantly wet or smelly around the rear end. That is a very strong suggestion that they may be having incontinence. Just being aware of what is on your dog's bedding and that is it smells fishy, if it is more smelly and that so thing or sometimes you take the cover off to wash it and you actually see on the more different colored material underneath that. Oh, gee. There is actually probably been some leaking happening here and you might not have noticed it on the top layer.
Scott: How much leaking are we talking about? Is it a lot? Is it just a little bit? What are we...
Kevin: Typically it is quite a little bit, like it might be three tablespoonfuls or less sometimes. Sometimes it is just a few drops that leak out, but it can be the size of a coffee mug of water, if that sort of volume as well. You might find a complete puddle but it is actually less common that you find such a large volume. It is often small but, you know.
Scott: When a dog's really getting a lot older and they are starting to get, I guess, having a lot more difficulty with mobility and stuff. How serious can it get or is it more a... process sort of managing a little bit like the arthritis as you go through or is it get to a point where because it like, I know, you were there put when Jazz sadly got-- had to get put down and I know she got really bad towards the end and it was a big warning sign for me. As a dog owner, I think we are obviously a lot more ignorant than vets are because you are a lot more educated than we are as dog owners, but what does a dog owner need to look for when things are getting really bad or when there are still things that can be done.
Kevin: Yes.
Scott: As they age.
Kevin: The frequency that you might have problems with incontinence can increase from it being a, once a week type of event to being in every single night type of problem, but then also in terms of their mobility and quality of life there is if they are spending more time just sleeping and lying around than they are getting up. Typically they may have been a dog that used to follow you everywhere. Now, they just lie there sleeping. If they are stumbling more commonly that can be a sign of problems.
Scott: Yes.
Kevin: Even if it progresses on from them actually not having control of their bladder to also not having control of their bowels. That is a different process, but also can if they are... you know I often liken it if we had to go to the toilet without having a seat to sit on and your hips were all arthritic and you have to try and squat. Then also pass a motion, you know, you hold off until the very last minute and so dogs do that too.
Scott: Okay.
Kevin: Then when they are really full, sometimes it is just too hard to get up and they will go to the toilet in on where they're just lying. So that is perhaps a sign also that their quality of life is not so good.
Scott: So we do not typically see a lot of incontinence in the male dogs, and I was just going to sort of, I guess, bring up the way male dogs and female dogs go to the toilet differently because males cock their legs.
Kevin: Indeed.
Scott: So I guess different postural things with the female dogs the way they squat and things like that, that would be something else to look for. It is a common thing that you see in dogs as they start to struggle, with their joints.
Kevin: Yes, if they not squatting completely and so they might soil themselves a bit more. Male dogs that maybe used to always cook their legs and then they starting to actually toilet more like a female that could be a sign that yes, their legs are not feeling strong enough or too sore to balance on the one leg, certainly can be an indicator. Then being either on just a different surface or quite typically suddenly needing to go up some stairs. They might be fine on level surfaces and then you see that they really battle with their mobility if they have got to try and even just go up a few little steps.
Scott: Right.
Kevin: It can be quite a sign that it looked like they were coping and now suddenly they were not coping on the stairs.
Scott: Okay. Yes, and that change can be quite quick can't it. I mean it can be-- it certainly matter.
Kevin: It certainly can because they cope and compensate. They don't want to look like they are struggling and we often see it around this time of year. When you suddenly get a bit of a cold spell, the arthritis has been there all the time. It is been there for months and they have been coping, been coping maybe they have actually gone and overdone something and they get a bit of an injury on top of arthritis and you get a dog that seemingly was doing quite okay. The owners are just thought it looks like his just getting older. One morning, they literally cannot stand up. They can't get out of bed.
Scott: Right.
Kevin: They might try and they legs splay a lot. That is also a common one that either the front or the back legs are just splaying.
Scott: Yes.
Kevin: So yes, it can seem that it has come on very suddenly, but then when we look at the subtle signs, it might have been slowly progressing for a while.
Scott: Okay. All right. I guess what-- because to me probably with my limited knowledge is I am searching for questions to ask around this. So I guess as a vet, I am probably reaching out to you saying, what else should I be asking you about incontinence that dog owners need to know. I mean that there are certain things that you see in come through the vet and I guess what else should they be looking for? What else can they do to help them?
Kevin: Yes. Well, that is the thing. It is often hidden and they are not aware of incontinence happening. You might notice that the dog is suddenly a fair bit more thirsty than normal and actually just toileting, urinating more frequently and that might be the signs that they have actually picked up a Urinary Tract Infection because the sphincter that's the muscle that keeps the bladder close. It has two purposes to keep you from leaking urine, but it also is keeping infection out. So it is like a security gate basically and you have control to go to the toilet. You open the gate, you let it out, but when you stop urinating, you're also stopping ascending infections and this again is where females are bit more prone than male dogs because there is a shorter pathway to the outside and it is a wider opening. So it is much easier for an infection to get from the outside into the bladder. Where as in a male, it is got to travel all the way up around the penis and in fact, so the penis is actually vet. When we think about it is located in the middle of the abdomen underneath them and the pathway is it goes all the way to the back behind the tail and turns in and goes inside the pelvis and gets to the bladder there. So it is a very long organ, actually, most of it is hidden to us. So that is difficult for infection to travel all that way up and into the bladder.
Scott: Right. So female dogs much more prone...
Kevin: Much more prone to getting UTI’s or Urinary Tract Infections and the symptoms of those is frequent urination, doing small volume pees really, so squatting and maybe squeezing for quite a bit of effort and pushing and only a very little bit of urine, quite often with a UTI that urine might be blood-tinged. So just a little bit pink, it might not look like frank blood but little bit of redness in the urine is blood.
Scott: That is time to get to the vet...
Kevin: Absolutely, yes and then it is normal process. If you are, if you do have concerns that your dog may have either Urinary Tract Infection or incontinence, one of the ways you can save yourself some time and really help your vet is when you make an appointment for that to actually take a fresh urine sample with you because one of the first questions they are going to ask you for is to get a urine sample. However, catching that is not always easy and people don't have to fret about if they cannot manage to get it. We normally able to actually get that in that the clinic as well for them. A urine analysis is one of the simplest, it is not a very invasive thing to do, it is not a very costly thing.
Scott: Yes.
Kevin: That will help us to assess because also a syndrome that we see is that a dog that hasn't been leaking out of the blue starts to leak and that is very commonly if they have got a bit of a weak sphincter, but it is not so weak that they leaking all the time. If they have then got a UTI, it just is the straw that breaks the camel's back and they suddenly start leaking so it doesn't necessarily mean that every dog that has a bit of incontinence is now going to need to be on medication for that incontinence for the rest of its life. Because in those situations quite often just clearing up the Urinary Tract Infection and the incontinence will stop again. The sphincters then got back enough control to stop them from leaking.
Scott: Is it just a case of antibiotics, course of antibiotics or what is...?
Kevin: Normally is for a Urinary Tract Infection, depending on what type of infection it looks like. The very best way to approach it is the vet would actually send that urine sample off to the laboratory for a culture because that then allows us to test which antibiotic is the most targeted to the infection that they have got.
Scott: Okay.
Kevin: It doesn't have to necessarily be done like that. We can sometimes just have an educated guess and put them on the appropriate antibiotic. Then if the incontinence resolved, then the issues sorted. It may be that they, in the future are going to have the need for medication for that incontinence or it may just not be an issue in the future. If we have cleared up the infection and they're still leaking then that is the time that we look at some medication and there is a few options both in terms of how they actually work. One is more hormonal based and the other one is a drug that actually helps improve the strength of that sphincter. Then also, options in a tablet form versus a syrup because some dogs are easy enough to give tablets to and obviously that can be a big struggle. If you have got to give that for the rest of the dog's life, but the syrup is very, very practical. I have had my own dog with incontinence and having her on the syrup form was really easy. We just stored it next to her food bowl. Every time we served up her meal, we just put the right of dose of the medication and that really controlled it very well. On that medication, the expectation is that they shouldn't leak at all.
Scott: Right. Okay.
Kevin: So it is really can make a dramatic difference both to the animal’s quality of life and to the owner because none of us like to be constantly washing dirty dog bedding and having leaking on the floor and that sort of thing.
Scott: So let us talk about, I guess, the severity of untreated when they do get an infection just how bad can things get. I think it is important for dog owners to understand obviously what left untreated can also look like.
Kevin: Yes. Because it is also, it is not just about the convenience. Medically it...
Scott: Smell the dog bed and just...
Kevin: For sure. Those are day to day consideration...
Scott: Health issue.
Kevin: Yes from the medical point of view, an untreated Urinary Tract Infection can become a much more resistant, UTI that then really causes quite a severe inflammation in the bladder, causes a lot of bleeding, lot of discomfort to the dog and that infection can ascend further from not just staying in the bladder but going up an ending up in the kidneys. Then you have got a much more difficult problem. Worst case scenario, it can result in kidney failure.
Scott: Okay, wow.
Kevin: From the kidneys it can also spread into the rest of the body.
Scott: Yes.
Kevin: We see it actually happening also the other way around. Infections from elsewhere in the body can transfer and end up in the bladder or in through the kidneys because all of the blood in the body is filtered through the kidneys. Ultimately that is their main job of the kidneys is to filter the blood of the body and get the waste products out. The most common process is if you have got an infection in the mouth, which is actually very common from having bad teeth, then you get it...
Scott: The lack of teeth brushing we talked about.
Kevin: Yes, absolutely. Then you get gingivitis and that gingivitis then spreads in the bloodstream, the bacterial infection gets filtered out by the kidneys, but then passes down and ends up in the bladder. Ultimately the bladders just the reservoir of where the urine is stored before it is expelled from the body.
Scott: Yes makes sense.
Kevin: That infection from the teeth leads to Urinary Tract Infection.
Scott: So interesting.
Kevin: We had see that more older dogs have dental problems. So these things are all very intertwined and definitely also coming back to the link with arthritis and incontinence. If a dog holds on to its urine for a bit longer and there is a bit of bacteria in that urine, it is more likely to become established as a Urinary Tract Infection. Whereas if we are going to, us or an animal is going to the toilet more frequently, they're flushing that out. It does not have time to establish as a fixed infection. So we sometimes see it in other animals that say suddenly do not want to go outdoors because it is rainy or cold weather or something and they holding on to their urine for longer and they get a Urinary Tract Infection, but certainly in arthritic dogs for that same reason either that they not going or unfortunately if they not able to stand up long enough while they're toileting and female dog, again, maybe accidentally flopping down or falling where she is just urinated and on to the ground and getting infection in that way from being arthritic, so...
Scott: Yeah right. It is so interesting how much of this comes back to their mobility and the youthfulness and their ability be able to get up and stay mobile and I find that quite fascinating. I am obviously because it is what we do but, I mean, it is really interesting that sort of just step by step, you can see these deteriorations, but just how far they can sort of an...
Kevin: That is exactly right and that is why if you can do things that help with their mobility, then you are actually impacting so many other parts of their health in their body as well. It is one of the core aspects of quality of life. If a dog has mobility, we have got so many mobility aides, scooters, all those sorts of things.
Scott: For humans.
Kevin: For humans, but it is not there for animals. So if they are not mobile, it limits their ability to go to the toilet, it limits the ability to just get up and have a drink of water, something as simple as that. If you're crippled with arthritis, you have got to think twice how desperate am I for that drink of water.
Scott: Right.
Kevin: Actually, if we look at that one. Not drinking as much, again, coming back to Urinary Tract Infections, you are not going to have that flushing effect there.
Scott: Got you.
Kevin: So yes, it manifests in quite a few ways. So if we can improve their mobility, we help not only their quality of life but also other health issues, in terms of the rest of their body.
Scott: Are dog owners, would you say typically good at the prevention side of things where I think society as a whole of become a lot more health conscious over the last probably two-- maybe probably three decades, perhaps 20, 30 years.
Kevin: For sure. Yes.
Scott: We have got a lot more knowledge, we have got the internet, everyone is more educated and we will do another podcast on this sometime about the Google vet patients.
Kevin: That will be a very good chapter.
Scott: With the dog owners becoming so educated. I think that would be an interesting topic that makes, actually makes your life a little bit harder, but they pre-diagnose everything, all that stuff. Are dog owners, because they have become more educated, are they getting better at prevention? I know my attitude with dogs 20 years ago is very different to what it is now.
Kevin: Absolutely. I think people are so aware of what they can be doing and preventative health care and what they need to be doing. It really is good to see and I think we're seeing the results in dogs living longer and not just living longer but having a good quality of life in that time and that ranges across health issues, dental diseases we're talking about but behavioral things, mental stimulation, so that they-- you know, and that links in also with them being part of, a member of the family. Family pet but not just a dog out in the backyard.
Scott: That's something you have seen dramatically change in your 22 years in veterinary...
Kevin: Very noticeable. Yes. I know they are very much considered as they should be I think. I see our pets are part of the family and so people care for them just as much, it is really is nice to see.
Scott: Yes, awesome. Well, Dr. Kevin Cruickshank, thank you very much for being with us on another Dog Pod Podcast. We will do a bit of a shout out too, if anyone wants to leave questions on our Facebook page or something like that to ask Doctor Kevin. Feel free to go ahead and we look forward to your company on the next one. We might do the Google chat.
Kevin: Sounds very good. Absolutely. No, it's been a pleasure to have a chat again Scott. Thanks.
Scott: Thanks for being with us. Cheers.
Kevin: Take care.
[End]
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