🚻 Vet Guide 2025: Urinary Incontinence in Dogs and Cats – Causes, Medications & Surgery Options 🐶🐱💧

By Dr Duncan Houston, BVSc

💡 What Is Urinary Incontinence?

Urinary incontinence is the involuntary leakage of urine. Unlike behavioral issues like marking or housetraining lapses, true incontinence is a medical condition—often easy to treat. Unfortunately, some pets are misdiagnosed, ignored, or even euthanized for something that may be resolved with medication or minor surgery. 🚫🩺

🧪 Common Causes of Incontinence

1. 🔬 Bladder Infection (UTI)

Very common in female dogs and senior cats. Diagnosed via urinalysis and culture. Most resolve quickly with the right antibiotic. 🦠

2. 💧 Excessive Water Intake

Diseases like:

• 🍬 Diabetes
• 🧬 Cushing’s syndrome
• 😺 Hyperthyroidism (cats)
• 💊 Side effects of steroids, diuretics, or other drugs

...can lead to “overflow” incontinence.

3. 🐕 Weak Bladder Sphincter (USMI)

Extremely common in spayed female dogs. Known as urethral sphincter mechanism incompetence (USMI), this condition occurs in up to 20% of spayed females. 🐾

4. 🧠 Neurologic Disease or Spinal Injury

Can disrupt the nerves controlling the bladder. Requires advanced testing like spinal imaging or neurologic exams.

5. 🧬 Rare Causes

• 🚼 Ectopic ureters (congenital issue)
• 🎗️ Tumors or polyps in urinary tract
• 🦴 Spinal trauma or slipped discs

🩺 Diagnosis

Your vet will perform:

• 🔬 Urinalysis + culture
• 🧪 Bloodwork for endocrine disorders
• 🩻 Imaging (X-rays or ultrasound)
• 📈 Urine specific gravity to assess dilution

💊 Treatment Options

1. 🌸 Estrogen-Based Medications

• DES (diethylstilbestrol): compounded estrogen, dosed every few days
• Estriol (Incurin®): newer option, typically dosed daily

2. 🧠 Alpha-Adrenergic Agonists

• Phenylpropanolamine (PPA): boosts “hold” signal to sphincter
• Side effects: excitement, appetite suppression, blood pressure rise

3. 🧘 Anticholinergic Drugs

• Imipramine: anti-anxiety med with bladder-relaxing effects
• Oxybutynin or flavoxate: additional bladder support drugs

4. 💉 GnRH Hormone Therapy

Leuprolide and other hormone analogs can help difficult cases that don’t respond to estrogen or PPA. ⏳

5. 🧬 Combination Therapy

Many dogs require both estrogen and PPA. Work with your vet to find the most effective combo. 🐶🧪

🔧 Surgical Solutions

1. 🩺 Colposuspension (Females Only)

Tacks the vaginal tissue to the body wall, compressing the urethra. 53% fully resolved; another 25% improve with added medication. 🐕♀️

2. 🧷 Cystourethropexy

Can be done in males or females. Attaches urethral structures to limit leakage. Can cause increased urination or straining. ⛔

3. ➕ Urethral Lengthening

Used in dogs with a very short urethra. Offers a surgical fix when others won’t work. 💡

4. 💉 Collagen Injections

Cosmetic-style urethral bulking. 27/40 dogs in one study gained full continence. 10 more became continent when oral meds were added. 👌

🛡️ What to Do When Nothing Works

• 🧷 Diapers (washable or disposable)
• 🧽 Waterproof bedding or pet pads
• 💧 Extra cleaning around the genitals to prevent rash or infection

🧪 Special Considerations in Cats

Incontinence is rare in cats but can be due to:

• 🦠 Infection (esp. in older cats)
• 🧠 Trauma or neurologic issues
• 🧬 Congenital abnormalities

🩺 Final Thoughts from Dr Duncan Houston

Urinary incontinence is not a “normal part of aging” and should never be a reason to give up on your pet. With simple medications or advanced interventions, many dogs (and even some cats) regain full or near-full continence. Seek help early. Don’t let stigma or assumptions keep you from finding relief for your pet. 🐶🐱💙

📲 Need Help With Incontinence? Ask A Vet Now

If your dog or cat is leaking urine or having accidents, let’s find the real cause. Download the Ask A Vet app and chat live with Dr Duncan Houston for personalized recommendations, medications, or referrals. 🐾💬