This page was last updated: November 26, 2008
INCONTINENCE IN YOUR DOODLE
Goldendoodles, like all other mammals, store urine in their bladder. Normal nerve and muscle control of the bladder allows a doodle to hold urine when needed and release the urine at appropriate times. If a Goldendoodle loses voluntary control of its bladder and urine leaks from the bladder without the dog's consent or knowledge, the condition is termed urinary incontinence. This leaking creates problems both for the dog and the owner. Obviously, owners are unhappy to find wet spots whenever their Goldendoodle gets up from a nap. Less obvious may be the fact that a leaking bladder creates problems for the dog, as well. Dogs that leak urine often end up sitting or lying in it, which can lead to urine scalding of the skin, irritation, infections, and discomfort. In addition to the wet spots, owners may notice that their pets are constantly licking the soiled areas of their body. Most dogs leak when they are resting because their body and muscles relax. A few dogs will be so incontinent that they actually leak urine while they are awake and walking.
Whether asleep or awake, dogs with urinary incontinence are unaware that they are dribbling urine and cannot control the problem.
Any problem that impacts the muscles or nerves that control the bladder opening can lead to urinary incontinence. So a dog with degeneration of the nerves to the bladder may leak urine. Additionally, there are
other causes of incontinence, including a congenital malformation called ectopic ureters. This is a condition seen in young dogs where the
tubes that drain urine from the kidneys (ureters) do not enter the bladder in the correct place. These misplaced ureters will allow urine to leak. Finally, dogs with a bladder that is obstructed by a tumor or stones may leak urine because the bladder cannot empty correctly. In this case the bladder overfills and urine leaks out.
Do not confuse urinary incontinence with a bladder infection. Dogs with bladder infections do not really suffer from urinary incontinence. Many times owners of a dog with a bladder infection will believe that their dog has suddenly become incontinent because the dog `leaks' a few drops of urine every few minutes. It is true that dogs with severe urinary tract infections are too painful to hold their urine and will appear incontinent as they void urine very frequently. However, these animals are aware of their situation and just cannot wait any longer to pass the urine out of their painful bladder. They are actively urinating. The dribbling stops as soon as the bladder infection is appropriately treated.
The most common type of urinary incontinence identified in dogs is called hormone-responsive incontinence. Dogs with this type of urinary incontinence will get better when placed on hormones, so the problem is correctly termed `hormone-responsive'. The sex hormones, estrogen and testosterone, help to increase the muscle tone of the sphincter that holds the bladder closed. Estrogen is found in female dogs, while testosterone is a male hormone. If either of these hormones is decreased, the result is a decrease in the tone of the sphincter and the possibility of urinary incontinence. Estrogen and testosterone decrease with age and are significantly reduced with spaying and neutering. Although the dog's body does continue to produce some estrogen or testosterone after spaying or neutering, most of the hormone is removed. Interestingly, although many dogs are spayed at a very
early age, most cases of urinary incontinence are reported in dogs over ten years old.
Hormone-responsive urinary incontinence usually bothers older, spayed female dogs. Often the dog was spayed under a year of age and much later, in its golden years, starts to leak urine. There are no other problems found and the dog responds to treatment designed specifically to help this problem. This condition is much less common in male dogs
of any age. Occasionally, young female dogs become incontinent soon after they are spayed.
If your Goldendoodle dribbles urine or leaves a puddle behind after sleeping, the dog may be suffering from urinary incontinence. If this is the case, treatment is available. However, it is critical to have the dog properly diagnosed before starting therapy. The medications that are used to treat hormone-responsive urinary incontinence are not going to help a dog with any other type of bladder or urinary tract problem. Not every dog that suddenly leaves puddles in the house or loses its `house-training' is urinary incontinent and not every dog that becomes incontinent suffers from hormone-responsive urinary incontinence. It is up to the veterinarian to identify the cause of the problem before any treatment
is started.
The veterinarian will talk about the dog's history, give the dog a thorough physical examination, and run tests to help identify the cause of the doodle's frequent or uncontrolled urination. The veterinarian cannot run one, specific test to look for hormone-responsive urinary incontinence, but can rule out other causes that may be mistaken for this problem. Additionally, the veterinarian can make sure this is a medical, not behavioral issue, and that other physical problems are not contributing to the leaking.
Your veterinarian will most likely request a urinalysis, urine culture, radiographs, and blood work. The urine tests will help to rule out bladder infections and bladder stones. The radiographs will help identify problems such as bladder stones, tumors in the bladder, ectopic ureters, and even a bladder that sits too far back in the abdomen. The blood work will help identify any dog suffering from diseases such as diabetes or kidney disease. These problems can cause the dog to produce too much urine and therefore have to urinate frequently. This can be mistaken for urinary incontinence in a dog that is left alone for long periods. The dog produces large volumes of urine, but cannot get outside to urinate because the owner is not home. The owner returns home to find a puddle and assumes the dog leaked while it slept. The dog then urinates normally when taken outside. This dog appears to be incontinent, but is not. Instead, it is urinating in the house when the
owner is away because its bladder is over-filled and the dog cannot wait until the owner returns.
The physical exam and x-rays can also identify physical problems that can contribute to urinary incontinence. For example, an older dog with severe hip dysplasia and arthritis may actually not be incontinent, but simply too sore to get up every time `nature calls.' Finally, the dog's age and reproductive status will help the veterinarian make the correct diagnosis. A four month old puppy that leaks urine is far more likely to have an anatomical problem that requires surgery than a 14 year old spayed female dog. She is far more likely to have hormone-responsive urinary incontinence. Behavior problems must also be identified and corrected before making the final diagnosis. The dog that most likely suffers from urinary
incontinence and does not have behavior problems has a history of acting fine when awake and maintaining house training, but tends to leave wet spots when napping or sleeping. In comparison, a puppy that squats and eliminates when you greet her is most likely showing submissive urination, not incontinence. Additionally, an intact male dog is more likely to be `marking' the refrigerator than suffering from incontinence. Finally, an elderly dog that loses its house training and suddenly simply squats in the house is more likely to have a cognitive deficit than a true incontinence.
Therapy for urinary incontinence depends on the cause. Anatomical problems, such as ectopic ureters, are corrected surgically. Treatments for bladder obstructions depend on the cause of the problem and may include surgery, chemotherapy, dietary changes, and medications. If hormone-responsive urinary incontinence is identified and other conditions are ruled out, therapy is very straight forward. Hormones, such as estrogen, can be used. However, they are not the first choice of medication because they can have severe adverse effects. The first treatment of choice is a medication called phenylpropanolamine (PPA).
This drug helps to increase bladder sphincter tone and solves the problem for many dogs. It is often given twice per day and has minimal side effects, which include restlessness. If this drug is not helpful, other similar drugs can be substituted.
Some female dogs that do not respond to PPA may need to have their estrogen levels increased with a drug called diethylstilbestrol . Dogs on this drug should be closely monitored for adverse effects, including bone marrow suppression and anemia. Alternately, some male dogs respond to testosterone, typically given by injection. In all cases, PPA is the treatment of choice and should be tried first. Finally, some veterinarians have had success with dogs that do not respond to medications alone by performing a surgery that pulls the dog's bladder a little farther forward in the abdomen. After surgery, the dog is
treated with phenylpropanolamine.
The majority of dogs do well on PPA. They do need to be kept on the drug for the rest of their lives because bladder sphincter tone will relax and the incontinence will recur if the medication is stopped. For those that do occasionally leak despite medication, it is important to remember that this is not the dog's fault. A few changes in routine can help reduce the impact of the urine leaking. Obviously, these dogs should always be taken out to urinate before naps or nighttime sleeping. If needed, they can wear baby diapers or special dog diapers. The dogs can even sleep on special dog beds with perforated pads. The dogs rest comfortably on top of the pad, while urine drips through to a catch-pan situated below it. Additionally, remaining in contact with your
veterinarian may help identify other problems contributing to the leaking and will allow changes in medication, if needed.
Do not panic if your dog wakes up and leaves a wet spot behind. It is not the end of the world, but the beginning of a small mystery. If you can identify the mysterious leaking as hormone-responsive urinary incontinence, you can treat appropriately and decrease the leaking. You will have solved the mystery and helped your older pet feel more
comfortable and healthier. Your pet and your rugs will thank you.
Dr. Jane Leon
