Page 1084 - Cote clinical veterinary advisor dogs and cats 4th

538 Incontinence, Urinary

• Thoracic imaging: if neoplastic or infectious Acute General Treatment PEARLS & CONSIDERATIONS
causes suspected • Opioids may slow colonic transit time, but Comments
VetBooks.ir Giardia, and Tritrichomonas foetus (cats only); • Keep perineal area clean to prevent dermatitis. • A careful assessment of the history and
this rarely helps to resolve incontinence.
• Centrifugation fecal flotation: helminths,
physical exam is needed to differentiate true
sensitivity is moderate to low, especially for
Chronic Treatment
FI from a behavioral condition.
identification of cestodes with single fecal
sample testing. Empirical anthelmintic • For animals with incontinence as a result of • Fecal incontinence may develop before
therapy is recommended if clinical suspicion external anal sphincter abnormalities, surgical other neurologic deficits in animals with
exists. options (e.g., silicone elastomer sling, muscle neurogenic FI.
• Colonoscopy/proctoscopy with biopsies of transfer flap) may be available.
affected areas may be indicated for inflam- • Some neurologic causes may be addressed Prevention
matory or neoplastic conditions. surgically (e.g., intervertebral disease). Use a cautious approach to perineal and
• Rectal scrape if thickened mucosa (p. 1157) colorectal surgery.
Neurogenic: Nutrition/Diet
• Advanced imaging (e.g., CT, MRI, myelog- Highly digestible, low-fiber diets may decrease Technician Tips
raphy) to evaluate spinal cord lesion stool volume. If highly digestible diets worsen • Discuss risk of FI associated with perineal
• Cerebrospinal fluid analysis incontinence, addition of insoluble fiber to or colorectal surgery.
• Electromyography and nerve conduction stimulate colonic contractions and improve • Address perineal hygiene, and emphasize
studies fecal consistency may improve signs in animals importance to owner.
• Specific infectious disease testing (e.g., with colitis-induced FI.
distemper, Neospora, Toxoplasma), depending Client Education
on history, exam findings, initial diagnostic Possible Complications Take animal outside immediately after feeding.
tests, and the prevalence of infectious diseases • Perineal dermatitis
in area • Urinary tract infections, especially in female SUGGESTED READING
• Pilocarpine response test dogs Cave N: Fecal incontinence. In Washabau R, et al,
editors: Canine & feline gastroenterology, St. Louis,
TREATMENT PROGNOSIS & OUTCOME 2013, Saunders, pp 118-123.
AUTHOR: M. Katherine Tolbert, DVM, PhD, DACVIM
Treatment Overview Depends on ability to resolve underlying cause EDITOR: Leah A. Cohn, DVM, PhD DACVIM
Successful treatment depends on the ability to
identify and resolve cause.

Incontinence, Urinary Client Education
Sheet

BASIC INFORMATION PHYSICAL EXAM FINDINGS DIAGNOSIS
• Urine staining or scalding in perineum
Definition • Urine dribbling from vulva or penis between Diagnostic Overview
Lack of voluntary control over the passage of urinations Any patient with a chief complaint of urinary
urine • Neurologic deficits (if neurogenic cause) incontinence should have a complete review
• Bladder should be palpated before and after of the medical history (notably to assess the
Epidemiology urination. possibility of behavioral causes and determine
SPECIES, AGE, SEX • Bladder expression whether polyuria or pollakiuria is present); a
• Dogs more often than cats ○ Easy: decreased outflow resistance physical exam, including abdominal palpation,
• With young animals, congenital disorders ○ Difficult: normal or increased outflow rectal palpation when feasible, neurologic exam,
are more likely. resistance and exam of the genitalia and reproductive
• Older, spayed females are prone to inconti- • Rectal exam tract; a urinalysis; and bacterial culture and
nence due to urethral sphincter mechanism ○ Urethral thickening (inflammation or susceptibility of urine.
incompetence (USMI [p. 1011]). infiltration)
○ Prostatomegaly (p. 824) Differential Diagnosis
GENETICS, BREED PREDISPOSITION ○ Bladder trigone abnormalities Incontinence must be distinguished from
• Ectopic ureter: Siberian Husky, miniature behavioral issues (pp. 533 and 535), pollaki-
and standard poodle, Labrador and golden Etiology and Pathophysiology uria (p. 802), or polyuria (p. 812). Causes of
retrievers, Newfoundlands, terriers Neurogenic: incontinence (p. 538) can be divided as follows:
• Manx cats: spinal cord malformation • Lower motor neuron (LMN) (lesion at • Neurogenic
S1-S3 spinal cord segment or peripheral ○ LMN disorders: S1-S3 segment or
Clinical Presentation nerve disorder) peripheral nerve disorders
HISTORY, CHIEF COMPLAINT • Upper motor neuron (UMN) (lesion cranial ○ UMN disorder: cranial to S1; usually
• Dribbling urine to sacral spinal cord segment S1) characterized by urine retention; overflow
• Trouble housebreaking: puppies Non-neurogenic: incontinence can occur
• Incontinence while sleeping: a hallmark of • Anatomic • Non-neurogenic
USMI in spayed female dogs and ectopic • Functional ○ USMI: most common cause in adult female
ureter(s) in puppies dogs

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