How to outwit refractory incontinence in dogs

"I remain hopeful ..." (Shutterstock.com)In a review of the leaky predicament of urethral incontinence in female dogs based a recent session from Fetch dvm360 conference speaker India Lane, DVM, MS, EdD, DACVIM, we found out the whys and the what to dos about it. But perhaps the solution you tried isn't quite working? The frustration continues for the client as does the discomfort for the poor pet. In her session, Dr. Lane reviewed the possible causes of refractory cases of incontinence. Work your way through this list if your ideas have dried up but your patients haven't.

Cause or complicating factor

Possible solutions

Inadequate dosage or frequency of administration of medication

• Check dosage and increase the dosage within the recommended range

• If using estrogen, increase the frequency (up to every two days) as tolerated

• Change the product type (formulation or supplier)

Desensitization of alpha receptors

• Consider a washout period and restart the alpha agonist at once-a-day administration

Inappropriate medication

• Consider changing from estrogen to alpha agonist administration

• Consider adding estrogen to alpha agonist administration

Poor owner compliance

• Consider switching to a long-acting alpha agonist or to estrogens to improve compliance (or vice versa)

Underlying urinary tract infection

• Monitor for a urinary tract infection and treat appropriately

Underlying polyuria

• Evaluate for common, treatable polyuric disorders (e.g. hyperadrenocorticism, diabetes mellitus)

Mixed disorder of micturition

• Check bladder size for urine retention and overflow incontinence

• Consider the addition of or a trial treatment with an anticholinergic agent

Underlying anatomic abnormality or urine pooling

• Recheck external genitalia and conformation

• Investigate anatomy further with contrast radiography and/or cystoscopy

• Consider endoscopic management of an ectopic ureter or a vaginal abnormality

Underlying neurologic lesion

Investigate for a subtle lumbosacral disorder with a neurologic examination and imaging studies

Behavioral component or senility

Consider treatments for behavioral disorders or cognitive dysfunction

Refractory urethral incompetence

Consider bulking agents to enhance medical management; consider an artificial sphincter in severe, refractory cases