Page 2497 - Cote clinical veterinary advisor dogs and cats 4th

1246 Incontinence, Urinary

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VetBooks.ir Disorder Salient Feature
Large- to giant-breed dogs; acute-onset nonprogressive deficits; variable pain during examination
Fibrocartilaginous embolism
(often none); bilateral, asymmetrical neurologic deficits
Congenital (spina bifida, sacrococcygeal hypoplasia) Spina bifida: Manx cat and bulldog predispositions; neurologic signs only if concurrent spinal cord
malformation
Sacrococcygeal hypoplasia: common in Manx cats; increased risk of clinical signs if all coccygeal
vertebrae absent
Intracranial or spinal cord disease involving UMN Less common cause; UMN signs; abnormal cranial nerve exam, behavior or mentation indicative of
pathways cranial to L4 intracranial disease
Peripheral neuromuscular disease Usually diffuse involvement reflecting generalized weakness and LMN dysfunction
Autonomic dysfunction: dysautonomia Gastrointestinal (GI) signs common; pupillary light reflex may be absent despite normal vision; heart
rate may not increase after atropine administration
Reservoir Incontinence: Awareness of urge to defecate but conscious control to defecate is overwhelmed; patient postures to defecate every time (showing
awareness of passing feces); normal sphincter and neurologic exam
Inflammatory (proctitis, colitis), infectious or neoplastic Signs of GI disease (e.g., weight loss, anorexia, vomiting, tenesmus, and/or dyschezia); feces usually
colorectal disease abnormal (e.g., diarrhea, hematochezia); digital rectal exam may reveal pain, mucosal irregularities,
tumors
Diets or diseases causing diarrhea Overwhelming fecal volume; responds to a bland, limited-ingredient, or low-residue diet trial
Subtotal colectomy Medical history; decreased rectal capacity causing frequent, urgent defecation
Constipation (overflow incontinence) Radiographs to confirm; diarrhea passes around formed feces
Conditions affecting locomotion Observe gait, sitting/standing, and urination/defecation attempts; complete orthopedic examination
Behavioral Incontinence: Conscious defecation in inappropriate locations with normal posturing and frequency; physical exam usually unremarkable; rule out
medical conditions first
Inadequate/inappropriate housetraining Usually young or newly adopted pets
Separation anxiety Only occurs in the absence of the owner; usually associated with other destructive behaviors
Litter box aversions Inadequate privacy; inter-cat aggression; litter box, substrate, or location preferences; poor litter box
hygiene
Cognitive dysfunction Geriatric animal; changes in interactive or social behavior, and sleep cycles; anxiety or excessive/
repetitive locomotion

L, Left; L4, fourth lumbar vertebra; LMN, lower motor neuron; R, right; UMN, upper motor neuron; UTI, urinary tract infection.
Reproduced from the third edition in unabridged form.
THIRD EDITION AUTHOR: Julio Lopez, DVM, DACVIM

Incontinence, Urinary

Size of Bladder Immediately After Voiding Salient Features
Big Bladder (i.e., Urine Retention)
UMN disorders Often neurologic dysfunction obvious (e.g., paresis); bladder difficult to express
LMN disorders Often neurologic dysfunction obvious (e.g., paresis); pelvic trauma/disease may be recognized; bladder easily
expressed
Dysautonomia Additional signs typical (e.g., megaesophagus, fixed pupils, vomiting, dry eyes)
Bladder atony Follows any cause of urine retention; may be temporary or permanent
Detrusor-sphincter dyssynergia Typically adult large-breed dog; urine stream starts then quickly stops; repeated attempts at urination
Partial urethral obstruction Overflow dribbling of urine; obstruction/difficulty passing urinary catheter; imaging often identifies cause (e.g., prostatic
enlargement, urethral stone, mass effect)
Little Bladder (i.e., Complete Voiding)
USMI Very common in middle-aged to older spayed dogs; begins as puddle while sleeping; often responds to treatment trial
Ectopic ureters Congenital; may be mistaken for housebreaking issues; confirmed by contrast imaging or cystoscopy
Patent urachus Congenital; may be mistaken for housebreaking issues; wetness/dribbling from near umbilicus
Urge incontinence Associated with stranguria, pollakiuria; active urinary sediment typical; infection common but not consistent
Pelvic bladder Usually not a problem unless combined with other disorder (e.g., mild USMI, polyuria)
Vaginal diverticulum/stricture Relatively mild incontinence; digital vaginal examination and vaginoscopy can confirm
Feline leukemia virus Test all incontinent cats for retrovirus infection
Behavioral Rule out medical conditions; behavioral assessment

LMN, Lower motor neuron; UMN, upper motor neuron; USMI, urethral sphincter mechanism incompetence.
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