Incontinence: A Messy Problem
Incontinence (leakage), whether fecal or urinary, is a reason many older pets end up in shelters. It can be an extremely frustrating issue for a pet owner to deal with, especially because there can be many underlying causes and the required work up and treatment can be extensive. Some examples include arthritic pain making it difficult to posture or get into a litterbox, degenerative neurologic changes, infectious causes, stress related to household changes, endocrine disorders like diabetes or Cushing’s, or even cognitive dysfunction (senility). I recommend a workup with your primary veterinarian to try to get a diagnosis and the most effective treatment plan. This post will discuss possible parts of what a workup might entail, as well as briefly cover medications/treatments and management that may be beneficial.
EXAM & DIAGNOSTICS (WORK UP)
A physical exam is an important part of working up differentials (potential causes) for incontinence. A veterinarian may look for evidence of scalding or staining, feel your pet’s bladder to determine size and check for abnormalities (note that not all can be felt), and perform a rectal exam to check anal tone, the prostate in males, and further examine the bladder and urethra.
Your vet may also want to run blood work to check for things like renal or liver abnormalities and/or a urinalysis to look for evidence of a urinary tract infection, insufficient concentration, or high glucose content in the urine (which can be indicative of diabetes). In cases of fecal incontinence, a fecal exam can help rule out causes like parasites and some bacterial overgrowths. Diagnostic imaging such as radiographs (Xrays) or ultrasound can give better information on presence of bladder stones (which often require surgery to treat), bladder wall abnormalities, prostrate abnormalities, and urinary retention. Your vet may also need to perform further tests such as blood pressure readings, or culture and sensitivity on the urine.
MEDICATION & TREATMENT
If your vet finds evidence of urinary tract infection on the urinalysis or suspects it based on the history and their physical exam, they will need to prescribe the appropriate antibiotic regimen. If urinary accidents are secondary to a disease like diabetes or Cushing’s, you will need to work closely with your veterinarian to get your pet appropriately regulated.
If the suspected cause is urethral sphincter incompetence (the valve used to retain urine in the bladder is faulty, which can be an age- or hormonal- related change), your vet may prescribe hormone replacement therapy with diethylstilbesterol (DES) or a medication such as phenylpropanolamine, which increases the tone of the sphincter. It is important to discuss potential side or adverse effect to watch for on these medications.
When the suspected cause of incontinence is that it is secondary to pain, getting your pet on an effective pain management regimen can make a huge difference. You can see a brief review on treating pain in older pet’s in one of my previous blog posts. Even physically assisting your pet to posture using a special harness or a towel can be helpful. If your older cat is having a difficult time getting into their litterbox, you may need to find one with lower sides or cut an entrance so that they do not have to step over a ledge. A future blog post will focus on several tips for litterbox issues, so stay tuned for that!
Cognitive dysfunction (senility) can also play a role in incontinence in older pets. In another future blog post I will cover this topic and give you more information. Sometimes treating the cognitive problems will help decrease your pet’s incontinence issues as well.
There is some evidence that acupuncture can be beneficial in treating fecal and urinary incontinence. If you are interested in this therapy, I encourage you to reach out to veterinarians trained in this treatment modality. At this time I am not trained or extremely knowledgeable in this field (I am hoping to achieve this in the future).
MANAGEMENT, DIET, & SUPPLEMENTS
Management is an essential aspect of caring for a pet with incontinence. Keeping your pet and their bedding clean and dry is important to prevent scalding and secondary skin infections. Gentle shampoos such as Zymox, Dermalyte, or baby shampoo can be used for bathing the affected area(s). A prescription medicated cream like silver sulfadiazine (SSD) can be used to treat infected areas. For unresponsive cases of incontinence, belly bands or doggy diapers may be necessary to protect the home, the pet’s bedding, etc. The following are some sources to find pet diapers:
Dietary changes may cause improvement in some cases of fecal incontinence. Lower fiber diets create less fecal volume so your pet may have more time to get outside before having an accident. A couple of diets veterinarians have found helpful include gastrointestinal formulations such as Hill’s i/d or Purina EN.
Some people have found supplements to be helpful with their pets, but please remember that supplements are not regulated by the FDA and it is difficult to assess their quality and/or effectiveness. Vet Classics Bladder Support and Vetriscience’s Vetri-Bladder are two supplements currently on the market that have favorable reviews.
The most important thing to keep in mind is that while your pet’s incontinence can be frustrating, there is a multitude of possible causes and many of those are treatable. There are also several ways to help manage this problem. I urge you to visit with your primary veterinarian to find what works best for your pet.