Urinary- Incontinence in Dogs

Prion

There is a veterinary phenylpropanolamine product available called Proin (Rx), for the treatment of incontinence in dogs. This is not a new drug but was previously a human drug now removed from the market . The side effects phenylpropanolamine like high blood pressure problems reported in humans that caused the human product recall have not been shown to occur in pets. Phenylpropanolamine has been used for many years to successfully treat incontinence in dogs. There were several years that it was not available when the FDA removed the human drug and it had to be reconsidered as a veterinary drug. Other treatments options were and are available and are sometimes still used - you will see below.

Incontinence treatments in male dogs

Question: Dear Doctor,

I've been a subscriber since February. My question involves our 19 month old neutered Labrador Retriever. We have recently noticed that he is leaking urine....it does not happen on a regular basis and does not seem to necessarily coincide with excitement or a full bladder. We noticed his bedding was damp at times and just thought that it was from his licking himself. He does not urinate more frequently than normal. I read the information on incontinence you have in the alphabetical index and obtained a urine specimen from him this morning which I will take to my vet for analysis. I am curious about the testosterone injections that were mentioned and want to know if there are any side effects with them as with bone marrow suppression with DES injections for females. Thanks for any information you can give.

Sincerely, Phyllis

Answer: Phyllis-

The use of testosterone for incontinence that occurs after neutering does not have the risk of bone marrow suppression that the use of estrogens in females can have. It is not without the risk of side effects, though. Dogs supplemented with testosterone may exhibit an increase in urine marking and aggressive tendencies. While urine marking may be viewed as an inconvenience by some owners rather than a serious problem (although many owners will find this a serious side effect), an increase in aggressive tendencies can be life threatening to the pet. I am not aware of an oral testosterone product, usually testosterone cypionate is given by injection once a month.

Phenylpropanolamine works for many male dogs and there is a veterinary phenylpropanolamine product available, Proin (Rx), even though the human products are all gone from the market at this time. To the best of my knowledge the high blood pressure problems reported in humans have not been shown to occur in pets and we have used this medication for a long time without significant side effects, as well.

It would be a good idea to try to rule out neurologic causes for the urine leakage, especially if there are any other signs of neurologic problems, such as weakness in one or both rear legs, improper foot placement or a drooping tail. In addition, making sure that a urinary tract infection or disorder is not present is also a good idea. The odds probably favor a decrease in urine sphincter tone (the form of incontinence associated with decreases in the reproductive hormones) but it is still a good idea to be careful not to miss another cause.

Good luck with this.

Mike Richards, DVM 8/30/2001

Incontinence

Question: I'm not up on medical lingo, so bear with me. my black lab mix Abbey has had a problem with leaking urine. It literally drips out of her at this point. It started out as an intermittent problem. We have taken to the vet several times for this. He has put her twice on medicine(it's the one that was in cold medicines for humans until it was recalled). He also suggested it might be a bahavioral problem. Her urine was tested , and came back negative, although it was somewhat diluted. The other option I was given was to put her on hormones, but I really don't want to start a 1& 1/2 year-old dog on a lifetime of hormones, and their side-effects. We are really at our wit's end here--is there such a thing as a doggy urologist? We live in upper New York, are close to Connecticut, but are willing to travel to solve this problem for our dog( she is just miserable). Where could we find a top-notch animal hospital, or specialist? In addition, Abbey was diagnosed with hip dysplasia around her first birthday. Unfortunately, she was too old for the surgery that can correct this problem at that age( it's not hip replacement, but the newer option) She has been on Cosequin, with great results. She runs, jumps, and behaves perfectly normal. I only mention this because I wonder if the two could possibly be related? Any suggestions you can give me are greatly appreciated. I use your site often for information. Thank you, Dagmar

Answer: Dagmar-

Incontinence can occur for a number of reasons. In a young dog, it is helpful to try to be sure that there isn't a cause for the incontinence that can be cured, prior to treating it symptomatically. Your vet may already have made an effort to do this, or it may be necessary to seek the help of a specialist.

Incontinence can occur because there is an increased urge to urinate that the dog can't control, when there is a decrease in the ability to resist urine flow for hormonal, neurologic or anatomical reasons and occasionally as a behavioral problem. Of these, hormonally responsive incontinence is the most common cause.

If the phenylpropanolamine (PPA) was effective when you were using it but the incontinence returned, hormonally responsive incontinence is the most likely problem. If it did not help at all, the failure doesn't rule out hormonally induced incontinence, though. Some dogs do require estrogen replacement therapy. Usually it is possible to use low enough dosages that adverse side effects are unlikely. I really can't remember having a serious problem from the use of diethylstilbestrol (DES) for incontinence, but we have had some problems with other estrogens, so there is some reason for concern when using estrogens. Phenylpropanolamine is available under the brand name "Proin" as a medication for dogs.

If the PPA was not effective, it would probably be a good idea to see a specialist to try to get a complete work-up to rule out non-hormonal causes of incontinence such as misplaced ureters, bladder stones, chronic lower urinary tract infections and neurologic problems. It may take dye contrast X-rays of the urinary tract to establish that the system is anatomically correct and functional, culture and sensitivity testing of urine extracted directly from the bladder, X-rays for bladder stones and a general work-up to rule out other systemic problems in order to feel comfortable going ahead and using hormonal therapy.

Unfortunately, I am not able to tell you who does this sort of workup in your area but the veterinary schools (Cornell, Tufts) are usually a good choice and there seem to be several referral centers in the New York area (the Animal Medical Center in Manhattan, for example). Your vet can help you find a specialist and most are happy to do this.

I couldn't find any information that suggests Cosequin (tm) or other glucosamine/chondroitin products lead to incontinence. We have seen several dogs with severe hip dysplasia who we think would urinate where they were laying because getting up was too painful. We believe this to be the case because pain relief or hip replacement therapy ended the problem in these dogs.

Good luck with this. Don't rule out using estrogens entirely. We have found them to be useful and not very likely to cause problems, so far. Checking to be sure estrogen therapy is necessary is a very good idea, though.

Mike Richards, DVM 6/16/2001

Treating incontinence in dogs

Question: Dear Dr; I have a dog with spayed female incontinence. For over a year I have treated her with ppa (acutrim) with total success. Unfortunately, this drug is now unavailable. Hormonal tx is out of the question since she has liver disease. My vet has no answer for me, and I am at my wit's end. Any suggestions? Thanks in advance Annette

Answer: Annette-

I am sorry for the delay in replying to your question. There are several medications that are currently being used to treat incontinence in dogs in an effort to find one that replaces phenylpropanolamine (PPA). They are:

1) Diethylstilbestrol (DES), which is a synthetic form of estrogen. There is some fear of bone marrow suppression when using DES but I do no recall ever experiencing this problem in practice, so I presume it is rare. I know of no reason that DES can not be used when there are changes in liver function, but your vet may know something that I do not. DES is currently only available from compounding pharmacies but all the ones that we deal with have it, so it is readily available.

2) Imipramine (Tofranil Rx), a tricyclic antidepressant, causes urine retention in some patients treated with it, so it is being used in the hopes this effect will occur in patients with incontinence. Initial reports are encouraging, but that is often the case when people are looking for a substitute for a medication and want to have good results.

3) Pseudoephedrine (Sudafed tm) causes similar effects to phenylpropanolamine but has not been used extensively. The dosage is 30mg for small dogs and 60mg for big dogs. I have been using 30 lbs. of bodyweight as the dividing line between large and small. I have not had enough reports back from owners yet to know if this is working at all.

4) Some compounding pharmacies still have phenylpropanolamine powder and can custom make capsules with the appropriate dose for a patient who needs this medication. It is worth calling around to the various compounding pharmacies (or checking online for veterinary compounding pharmacies) to see if one of them has this medication. Your vet should know of some of these, as well. There are several that advertise nationally.

Good luck with this. I hope that one of these suggestions is helpful if you have not already found a solution to the problem.

Mike Richards, DVM 1/8/2001

Phenylpropanolamine's alternatives

Question: Hi, Dr. Mike -

I'm sure I won't be the first, nor the last, of your clients/correspondees to ask just what you will recommend to take the place of the now-defunct phenylpropanolamine. I am just sick that I can no longer obtain Dexatrim, or other OTC meds, to control BOTH Trudi's and her Boxer-sister-Fanci's (Fanci's is the typical spayed-female-leakage, brought on by advancing years) incontinence.

A brief note on our CRF gal, Trudi. Twenty-two months after the original diagnosis of chronic CRF was handed down, she is still doing remarkably well. The herbal iron tonic I discovered about 4 mos. ago has really created a huge improvement in her looks, stamina, eating patterns, demeanor. We continue to have small episodes of pancreatitis, which (so far) can be controlled by removing all food for 24 hrs. Strangely, although she LOOKS so great, her blood chem values have changed little; outwardly, the only sign that she's a CRF gal is her constant-and-profuse shedding.

Dr. Mike, I sure hope you'll be able to give us a tip as to what (either OTC or Rx) we can use to control the incontinence from now on. Thanks in advance.........your advice has always been valuable to us!

Regards, Rozanne

Answer: Rozanne-

Phenylpropanolamine is still available from some compounding pharmacies. I know of at least two in our area that still have the powder to make this medication and I believe that it may remain available through compounding pharmacies.

There are alternatives to phenylpropanolamine. The one currently being talked about the most on the Veterinary Information Network (www.vin.com, a service for veterinarians only) bulletin boards is impramine (Tofranil Rx), 1 to 2mg/kg of body weight every 12 hours, up to 15mg twice a day. I have not used this medication because we have had good success using diethylstilbestrol (DES) and have been able to obtain this medication from our local compounding pharmacy. We usually use 0.5mg per day for 5 days for small dogs, or 1mg per day for large dogs. We then try to lengthen the interval, usually reaching a once weekly or twice weekly dosage in most female patients. We usually try testosterone in male dogs but generally have to combine this with something else, such as phenylpropanolamine, so when our supply of this runs out, we will have to consider other options for our male patients, probably. I am hoping that when we run out of phenylpropanolamine the compounding pharmacies will still be able to get the medication.

Mike Richards, DVM 12/4/2000

Leaking urine and accidents - medication related in Samoyed

Question: Help! My samoyed has suddenly forgotten what it means to be house trained. She is currently on medication for myositis, predinose 30mg every other day, and when she started to leak urine, she was put on phenylpropanolamine (now down to 25mg on the days she gets her prednisone). In the last week, she has started to have accidents in the house, even after she is brought in after being out for a while. I let her out several times during the night and still she slips. Is this related to the medication? Thanks. P.A.

Answer: P.A.-

It is very likely that there is a relationship to the medication with the sudden change in urinary habits. Sometimes prednisone can make it easy for bladder infections to occur, so it would be worth having her checked by your vet for this. Bringing a urine sample that is less than 4 hours old can be helpful, just in case it isn't possible to get a urine sample at the vet's office. Prednisone can also sometimes push a dog with a tendency towards diabetes into exhibiting signs of that disease and the urine will help to rule that out.

If the urination problems are not related to cystitis there is still a chance that the prednisone is contributing, since it does make dogs drink more and urinate more. In that case, it may be necessary to try to find a lower dose that will control the myositis but not induce excessive urination. Sometimes it isn't possible to do that but it is worth trying.

Sometimes when dogs start to have accidents in the house for medical reasons the behavior becomes self supporting since dogs like to urinate where they have urinated before. Cleaning the area carefully with an enzymatic cleaner and working hard to catch her urinating so that you can reinforce that it is not acceptable behavior with a loud "NO" can help to restore her old and better habits.

Good luck with this.

Mike Richards, DVM 12/21/99

Incontinence in older Ibizan Hound

Q: Dear Dr. Mike,

I have a ten year old female ibezan hound who was spayed three years ago. This morning she was lying on the couch, and I was petting her. When she got up, there was a small puddle of urine. She is totally housebroken, and had just been walked, so I was very surprised and concerned to see this. To my knowledge this has never happened before, and we were recently at the vet who gave her a clean bill of health. Your input on this matter would be greatly appeciated. Thank You A. K.

A: A.K.

Incontinence is not unusual in older female dogs. It is probably occurs at a slightly younger age in spayed females and may be a little more common in them. The history is typically exactly what you have seen, urine leakage while laying down or while asleep. It is best to rule out bladder infections and causes of increased urination such as diabetes and Cushing's disease as contributing factors. Your vet may feel that this was accomplished during the recent exam but it would be best to check with him or her on this. Incontinence responds well to treatment in most cases. Usually the first medication tried is phenylpropanolamine but estrogen supplementation is sometimes also used first. Whichever medication is used, the other one is available if there is treatment failure. In many instances we find that treatment for a couple of months will often stop the problem for some time and that going on and off of medications doesn't seem to make them less effective when it is necessary to use them again. Let your vet know this is happening and I think you'll find that treatment works well.

Mike Richards, DVM 9/21/99

Incontinence - possible causes in Golden

Q: Dr. Richards I was reading the letter from Maggie about her 2 year old Golden Ret. who has been suffering with incontinence. Our 6 yr old JR terrier had the same problem as a 3 yr old and we pursued the same suggested treatment as Maggie's vet prescribed, with no results. We decided that we would have to live with the 'leaking' and proceeded to 'waterproof' the house as much as possible. However, after a few years of other medical problems, we recently found that Charlotte suffers with liver shunt and hydrocephalus. But during our exploration of her liver problems, the surgeon discovered a kidney stone blocking one of her ureters. The stone was removed during exploratory surgery, and since that time there has been no more urine 'leakage'. I am confident that the stone may have played some part in that problem. Is it possible that stones can be transient enough to sometimes cause this situation? We treated Charlotte at various times for what we suspected as urinary tract infections, on the basis of urinalysis results. Can existing stones be a cause of the positive test results? Thanks for your expertise. Maureen

A: Dear Maureen-

There are a number of possible causes of incontinence. Small stones in the ureters, bladder or urethra can definitely cause signs of incontinence. It is conceivable that there could be recurrent episodes of incontinence associated with stones from metabolic causes, such as urate stones. These tend to be formed in larger numbers than struvite stones and it is not uncommon to find hundreds of small stones when these are present.

Incontinence is commonly encountered in veterinary practice. The majority of cases are probably estrogen responsive incontinence. In a spayed female dog in which incontinence shows up after the surgery it is very tempting to ignore other possible causes and treat for this one. Especially since it can be pretty expensive to test for all possible causes. In a dog in which incontinence is not responsive to therapy or when there are reasons to suspect other causes may be present it is important to know what else can lead to incontinence and to eliminate as many of them as possible through appropriate testing.

It is important to consider several different things when dealing with incontinence. As a first step it is important to establish that the problem really is incontinence and not just an increase in the need to urinate causing the dog to urinate in the house because it has to. Disorders that increase the amount of urine produced and therefore the need to urinate include diabetes mellitus, hyperadrenocorticism (Cushing's disease), diabetes insipidus, uterine infections, kidney failure, administration of corticosteroids and some other medications and other more infrequent causes. It is important to let your vet know if your dog is drinking more than normally and urinating larger volumes than normal. There are also diseases and disorders that increase the urge or need to urinate without an increase in actual urine volume. These include cystitis, bladder stones or stones elsewhere in the urinary tract, cancer in the urinary tract and prostate disease in males.

There are also a number of disorders that are considered to be forms of incontinence that are not related to estrogen levels. Neurologic disorders affecting the nerve supply to the bladder can lead to incontinence. There are several classes of these disorders. In general the bladder is large and distended due to the loss of nerve function. This is a hint that there may be neurologic causes. Many practitioners do not feel confident in their ability to diagnose neurogenic bladder disorders and if they are suspected it may be necessary for a neurologist to help in the diagnostic process. Large bladders can also be a sign of an obstruction to urine flow beyond the level of the bladder, such as a urolith (stone) in the urethra, especially in a male dog and cat.

Some dogs are born with their ureters, the tubes that connect the kidneys to the bladder, misplaced. When this happens it may lead to continuous urine leakage, especially if they miss the bladder entirely and implant directly into the urethra.

There are also dogs with behavioral incontinence. Stress or excitement can lead to urine leakage. Another behavioral condition some dog owners confuse with incontinence is submissive urination. This is a form of voluntary urination, so not truly incontinence, that occurs when a dog is very submissive. These dogs usually roll over when approached, show their undersides and urinate a little or sometimes a lot.

This isn't really about incontinence, but urate stones are fairly common in dogs with portosystemic vascular shunts. It is probably a good idea to consider the possibility of these stones in any dog with liver shunts. Any bladder stone can cause or make it seem like cystitis or incontinence is present, both by mechanically obstructing the urinary tract and by irritating it and creating a better environment for bacterial infection.

I am glad you thought to write about this. It is good to be reminded to think about all the possible problems that can lead to any particular sign or syndrome sometimes.

Mike Richards, DVM

Urine leaking in Golden

Q: Hello, I have a problem with my 2 years old female golden retriever (spayed around 6 months of age). I notice when she is asleep that she is leaking urine. It started while she was on antibiotics Apo-Sulfatrim 480mg due to an ear infection (I though it was a side effect). There is no bladder infection. My vet is convinced that this is incontinence and suggested the use of ESTROGEN SUPPLEMENTATION. I heard that this medication can cause serious side effects. I'm looking for a homeopathic treatment. I would like to know if you have any suggestions. Thank you

Maggie

A: Maggie-

I am sorry, but I have no experience at all with homeopathic treatment.

The two most frequently recommended treatments for incontinence in female dogs are estrogen supplementation and phenylpropanolamine (Propagest TM, Dexatrim TM).

The most successful estrogen supplement was diethylstilbestrol (DES), which is currently hard to find. Estrogens do not cause side effects with great frequency but the side effects can be very serious, including suppression of the bone marrow's ability to produce red blood cells that may not respond to withdrawal of the medication. We never experienced this side effect in our practice but it was worrisome enough that we preferred to attempt treatment with phenylpropanolamine first whenever possible. We have not had much success with alternative estrogen products that have been suggested since DES has become harder to find.

Phenylpropanolamine is a decongestant and is the active ingredient in Dexatrim (TM), the product used for appetite suppression in humans. As far as I can tell there is no appetite suppressive effect in pets. It does not seem to have serious side effects but it often has to be given three times a day to be effective and that is a drawback for many pet owners. Sometimes it works for the majority of incontinence when it is given at bedtime since many dogs are only incontinent when they are sleeping.

There may be herbal or homeopathic treatments for this problem. If you have an interest in them, there are veterinarians who use these treatment methods in their practices.

Mike Richards, DVM

Incontinence after neuter

Q: I am in search of solutions to two problems that I am having with my 10 month old male pug "Pepper Boy". He is having a urine leak from his penis since approx. 1 month after he was neutered at 8 months. My local Vet. gave him a 2 week supply of antibiotics but this did not clear up the problem. The second problem is a bald spot that has developed on his shoulder. We have tried various creams but these have not helped. The Vet. thinks it is a fungus but can not rid him of it. Any help you could provide in solving these problems would be greatly appreciated.

A: I guess I would be suspicious of hormonally based incontinence in a dog that developed urine leakage after neutering. Usually this will not occur this quickly and it isn't a common problem in male dogs but it just seems like a reasonable possibility once infection seems unlikely (the reason for the antibiotic treatment first). It is usually responsive to treatment with testosterone replacement and sometimes only a couple of injections are necessary to stave off the problem for long periods. It might be a good idea to take bladder X-rays to rule out bladder stones and consider a general chemistry panel to rule out causes of increased urination before attempting incontinence treatments.

If your vet has taken skin scrapings from the sore and not found parasites then I have no other good suggestions for diagnosing this problem other than considering a skin biopsy if it won't clear up. They can be very helpful in difficult cases of skin disease.

Mike Richards, DVM

Urinary Incontinence in Rottie

Q: Dear Dr mike, My female Rott is a year old and she is house broken, and when she sleeps now we see on her bed it is wet so i have been watching her and she didn't do this before, what could be wrong with her, could she have a cold ?She dont have any thing else. thanks

A: Your dog probably has urinary incontinence. This is an inability to hold urine in the bladder. When dogs urinate where they are sleeping or particularly if they urinate when laying down and awake, this is the best possibility. It is important to rule out a bladder infection, bladder stones and diseases that cause increased production of urine, such as diabetes before deciding that incontinence is the cause of urine leakage. In addition, there are several causes of incontinence, which respond to different treatments. In almost all cases, it can be controlled, though. Your vet can help with this problem, almost for sure.

Dimetapp tablets for incontinence

Q: Dr. Mike, In the case of urinary incontinence, what do you think of the use of Dimetapp extentabs (twice daily if necessary 12 hours apart). ????

A: Dimetapp tablets contain phenylpropanolamine and a second ingredient (brompheniramine) which probably isn't necessary to administer but also probably isn't harmful. It is usually less expensive to use phenylpropanolamine (generic of Propagest Rx) by prescription just because of marketing/packaging costs but if it is more convenient to use this formulation and the antihistamine doesn't cause drowsiness or other side effects I see no reason not to.

Mike Richards, DVM

Leaking urine

Q: Hello, Having a problem with my female German Shepherd - she is a little over 7 years, been spayed around 6 months. I notice when she is asleep that she is leaking urine, she also urinates quite a bit outside especially before I start throwing her toy for her. She was overweight so I have had her on a diet and she has lost a few pounds and at least has a waist now. She drinks a lot of water and is always warm (panting). I was wondering if the spaying could have damaged the muscle that controls her bladder. We have noticed quite a few wet spots where she lays and it seems to happen only when she is relaxed and asleep. She has a normal appetite, looks healthy and is energetic. I would appreciate your comments. Thank you

A: Spaying does not damage the urinary sphincter muscles, to the best of my knowledge. It does cut down on the estrogen levels in the female dog's body, though. This can lead to a loss of muscle tone and possibly mucosal thickness in the bladder, which does often lead to incontinence. Most dogs with this condition will respond to estrogen supplementation, usually using diethylstilbestrol (DES). Many vets prefer to try phenylpropanolamine (Propagest Rx, Dexatrim Rx) first, though. This medication is less likely to cause side effects than estrogen supplementation. Some dogs require both medications.

The most serious side effect of DES is bone marrow suppression. I think this must be pretty rare because we have used this medication in our practice for eighteen years now and have not seen this in any of our patients. We have seen it using other estrogen products and feel that it has to be considered as a risk due to those experiences, though.

I do not know the percentage of spayed females with this trait and it does occur naturally in older female dogs who have not been spayed. It does appear to happen more commonly in spayed females, though.

There are a also a number of neurologic causes of incontinence. It is important not to overlook any evidence of neurologic disease in an incontinent dog. Also, it is important not to overlook causes of increased urine production that may be contributing to an incontinence problem. Diseases like diabetes, hyperadrenocorticism and kidney failure can all cause an increase in drinking and urine production which can show up as incontinence in a dog that previously did not have problems with urine retention.

Hope this helps.

Mike Richards, DVM

Incontinence in a 7 year old Pug:

Q: Dear Dr. Mike: We have a 7 year old male pug that has developed incontinence recently. Our vet has been treating for bladder and kidney infections with various medications for several weeks but the problem continues. The vet seems to be stumped by this and we would like to know if you have any suggestions. Thanks.

A: It sometimes takes a little while for a vet to become convinced that incontinence really is incontinence, especially in a young or middle-aged dog. Usually we try to rule out bladder infections, bladder stones, neurologic disorders, hormonal disorders that increase urine output and all other possible causes of urinary problems that we can eliminate before giving up and accepting that incontinence is present. I can't fault this approach because most of the time I do the same thing. Often, we will try antibiotics to make sure that cystitis isn't present, then suggest X-rays of the bladder and a general lab panel to try to rule out obvious hormonal disease like diabetes. Bladder stones seem to be a relatively common cause of incontinence in male dogs in our practice. Sometimes the history is so strongly supportive of incontinence that we go right to exploring the possible causes of it first - neurologic and hormonal disorders being the most common causes of incontinence in dogs.

Once your vet is convinced that this is incontinence and not something else, he will probably try hormonal therapy if no obvious neurologic disorder is present. In male dogs, this is usually testosterone by injection since a convenient oral form of the hormone isn't available as far as I know. Most of the time the injections can be spaced around a month apart. If neurologic signs are present, they will be treated based on exactly what your vet finds. Good luck with this.

Mike Richards, DVM

Continued:

Q: Dr. Mike: Thank you for your response and advice about our pug's incontinence. I have some more information that might be helpful in discovering what is wrong with Wally. You will recall that he is a 7 year old, male pug. The doctor has been treating him for three weeks with no success. She says that he has blood in his urine as well as protein. This would lead me to believe he has a bladder infection, but why doesn't medication help? She x-rayed him and found nothing. Blood tests showed that his white blood cell count why slightly elevated but nothing extreme. Any more suggestions? Thanks!

A: I would be more worried about bladder stones and bladder cancer in a dog that continued to have blood in the urine after three weeks of antibiotic therapy. It is difficult for bacteria to resist antibiotics in the bladder because the concentrations of antibiotics in the urine are often many times the concentration of the antibiotics in the blood, since they are often filtered intact through the kidneys, which results in them being in urine in high concentrations.

The non-surgical approach is to consider either contrast X-rays (air or a contrast solution can be injected into the bladder to help outline stones that don't show on X-rays or a bladder tumor) or ultrasound exam. The other approach is to consider exploratory surgery to see if a cause of the problem can be determined. In our practice, which is pretty rural, clients often elect to have exploratory surgery rather than traveling to a specialist for ultrasound exam or paying for contrast X-rays when there is a strong chance surgery may be necessary later. Avoiding surgery is important to other clients and they opt for the more advanced testing procedures.

I hope you find a reason for all of this soon.

Mike Richards, DVM

Incontinence in Akita

Q: My one year-old Akita has developed frequent urination and a mild cough. Her urination is in small amounts and coincides with coughing..This started when we came home from a hike in the woods. She has not had any health problems and is spayed. Thanks.

A: I'm sorry, but this is a problem that you're going to have to get your vet to resolve. It is possible that your Akita is experiencing incontinence and some dogs do have more problems with urinary incontinence after exercise or excitement. It makes some sense that coughing might exacerbate a problem with incontinence but one is young for the problem and it would be a good idea to have the cough checked out if it continues, anyway. If incontinence is the problem it is usually possible to treat it with estrogens or phenylpropanolamine, so your vet should be able to help out.

Mike Richards, DVM