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Incontinence, Fecal 537

• Reward dogs for eliminating outside with Client Education concerns saves lives. Clients are unlikely to
play, freedom, exercise, praise, interaction • Client education is key to preventing and talk about behavioral concerns and questions
VetBooks.ir Technician Tips tices should have handouts (see Additional SUGGESTED READING Diseases and Disorders
resolving these problems. All veterinary prac-
with other dogs, and time to smell their
unless prompted to do so.
canine world.
Suggested Readings for other sources) that
et al, editors: BSAVA manual of canine and feline
staff member should be responsible for
Ask about housebreaking or litter box training explain how to housetrain dogs. A designated Houpt KA: Housesoiling by dogs. In Horwitz D,
at every puppy/kitten visit. When taking rectal explaining and following up on training behavioral medicine, Gloucester, UK, 2009, British
temperatures, watch for perineal staining; it with clients. Small Animal Veterinary Association.
may point to abnormal stool consistency that • Quick screening at each veterinary visit for AUTHOR: Soraya V. Juarbe-Diaz, DVM, DACVB
the owners do not report. elimination complaints and other behavioral EDITOR: Karen L. Overall, VMD, MA, PhD, DACVB

Incontinence, Fecal Client Education
Sheet

BASIC INFORMATION ○ Excessive licking of perineal region iatrogenic (e.g., anal sacculectomy or rectal
○ Tail chasing pull-through surgery) trauma
Definition ○ Scooting • Neurogenic FI results from impaired
Involuntary loss of bowel control character- • Neurogenic incontinence: often unaware sensation or reduced neurologic control of
ized by the inability to retain bowel contents, of the need to defecate. Often, there are defecation.
including flatus and fecal material other signs of neurologic disease (e.g., gait ○ Includes peripheral neuropathies (e.g.,
deficits, dysuria/urinary incontinence, spinal diabetes mellitus), junctionopathies (e.g.,
Epidemiology pain). myasthenia gravis), spinal cord disease or
SPECIES, AGE, SEX trauma (e.g., subarachnoid cysts, fibro-
Any species, age, breed, or sex PHYSICAL EXAM FINDINGS cartilaginous embolism), intervertebral
Depends on the cause: disc disease, constrictive myelopathy
GENETICS, BREED PREDISPOSITION • Visual inspection may reveal (e.g., articular process malformation,
• German shepherd dogs: lumbosacral stenosis ○ Erythema, ulceration of perineum, anus lumbosacral stenosis), dysautonomia, or
• Manx cats, English bulldogs, pugs: spinal ○ Anal mass/swelling age-related cognitive dysfunction
malformations ○ Aberrant tail movement/carriage
• Digital rectal exam DIAGNOSIS
RISK FACTORS ○ Absent anal sphincter tone
• Spinal cord/pelvic trauma ○ Thickened rectal mucosa Diagnostic Overview
• Colorectal neoplasia ○ Abnormal stool consistency/composition History and physical exam findings should aid
• Colorectal/perineal surgery • Orthopedic exam classification of structural versus neurogenic
• Diffuse polymyoneuropathies/polyneuropa- ○ Pain when lifting tail causes.
thies ○ Evidence of pelvic or vertebral fracture
• Neurologic exam Differential Diagnosis
ASSOCIATED DISORDERS ○ Intracranial disease: altered mentation • Incontinence must be distinguished from
May be associated with paraparesis, tetra- ○ T3-L3 myelopathy: paraparesis with intact behavioral issue resulting in inappropriate
paresis, or urinary incontinence in animals pelvic limb reflexes (upper motor neuron) defecation.
with neurologic causes of fecal incontinence ○ L4-S3 myelopathy: paraparesis and • Severe diarrhea may result in some degree
(FI) decreased to absent pelvic limb reflexes of fecal incontinence.
and anal tone; large, flaccid bladder ± lack
Clinical Presentation of tail movement (lower motor neuron) Initial Database
DISEASE FORMS/SUBTYPES ○ Dysautonomia: lack of anal tone; large, Depends on categorization as a structural or
Try to discern whether the animal senses flaccid bladder; fixed mid-range pupils; neurogenic cause
and postures to defecate or defecation occurs ocular/nasal discharge; weight loss; lack
without the animal’s awareness. The former of heart rate increase with stress/exercise Advanced or Confirmatory Testing
suggests a problem with fecal storage (storage Additional testing depends on suspicion of the
or sphincter incontinence), and the latter sug- Etiology and Pathophysiology cause (structural vs. neurogenic) of FI.
gests loss of neurogenic control (neurogenic Fecal incontinence can be classified according Structural:
incontinence). to structural and neurogenic causes: • Abdominal imaging (abdominal radiographs
• Structural (storage/sphincter) FI results from and ultrasound)
HISTORY, CHIEF COMPLAINT inability to store feces because of colorectal ○ Thickened colonic wall (inflammation,
• Storage/sphincter incontinence: animal is disease or inability to form a seal around the infection, neoplasia)
aware of need to defecate but unable to feces because of disruption of the normal ○ Generalized or focal dilation of colon
control defecation as a result of colorectal anal sphincter anatomy. ○ Lesions suggesting infection or neoplasia
or anal disease. Other signs may include ○ Includes anatomic and inflammatory con- (lymphadenopathy, masses)
○ Tenesmus ditions in the prostate, colon, rectum, or ○ Ultrasound-guided transabdominal cyto-
○ Hematochezia anus such as colorectal neoplasia, proctitis, logic sampling of abnormalities identified
○ Small and/or frequent bowel movements colitis, anal fistulas, chronic constipation, on ultrasound (e.g., masses, lymph-
○ Malodorous stools or discharge and pelvic (e.g., whelping, vehicular) or adenopathy)

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