Incontinence Meds and Diabetics

Urinary incontinence is not uncommon in spayed dogs, and some conditions increase the chances of incontinence. Whenever a pet is producing larger volumes of urine, the urinary bladder is more often full. This increases the pressure on the urethra and increases the risk of leaking urine. The typical M.O. of an incontinent dog is dripping urine in the bed (or wherever) when she sleeps. Finding a pee spot on your nice comforter can downright ruin a good snuggle.

Probably the most common cause of increased urine production would be kidney disease. Diabetes and cushings disease are also reasons a pet may urinate large volumes. If a pet presents to my practice with the complaint that she is peeing the bed, you can bet I run a full blood profile along with a urinalysis to look for underlying causes. We also need to rule out a urinary tract infection as incontinent dogs are prone to urinary infections. Running labwork is an important step before starting medication! I have diagnosed more than one pet with kidney issues or urinary tract infections due to emerging incontinence. Even after diagnosis of incontinence we need to monitor these pets for urinary infections. I typically run a urinalysis on incontinent dogs at least twice a year to make sure I’m not missing an infection which can make the situation harder to control.

Now, if we do diagnose incontinence, we have several medication options. First however, let’s mention the obvious! It’s just common sense to take your incontinent sweetie outside before the family goes to bed. And if you happen to get up in the night yourself, let her out to potty then, too. Unless you rejoice in doing extra laundry, an empty bladder is your friend. For diabetics, good glucose regulation will make incontinence control much easier! If blood sugars don’t rise above the kidney threshold of glucose, sugar won’t spill over into the urine, pulling fluid with it, making voluminous pee. It’s simple as that.

Incurin. This drug is an estrogen. Estrogens increase muscle tone of the dog’s urethra. It has much replaced the compounded use of DES (a synthetic estrogen that we used in the past), and incurin is FDA approved for dogs. Incurin has the highest efficacy rate of controlling incontinence relative to DES or proin. We start pets at a dose and then taper the amount each week until we find the minimally effective dose. On the flip side, some pets may not respond initially and we may bump up the dose.

Tummy upset is the most common side effect of incurin, but mammary and vulvar swelling and increased thirst and a variety of other signs are possible at lower incidence. I have a 17-year old canine patient who happened to have heart disease and high blood pressure, so we changed her from proin (which she had been on for years) to incurin. She had vulvar swelling with the incurin but as we tapered down her dose (and her incontinence luckily didn’t recur) the swelling resolved. Estrogens at high doses could cause bone marrow suppression, but at the low doses typically needed to control incontinence it’s not a big concern. Again, always play with the dose to use the minimally effective amount of the drug to control the leaking.

Proin is the most common brand name for phenylpropanalamine (PPA). PPA was a human medication many years ago (nasal decongestant, diet aid/appetite suppressant), but went off the human market for rare side effects in humans. Then we vets had to get it compounded for a while until Proin came out, in a tasty liver flavored tablet no less. There is potential for Proin to theoretically affect blood glucose slightly, but if the dose is given consistently it should make no difference in overall glucose regulation. If a diabetic is started on proin, we may need to slightly adjust the insulin dose. Pharmacology books mention caution with diabetes, but it may just be that human diabetics are prone to high blood pressure. As I mentioned above, proin can increase blood pressure.

I have one Labrador on both Incurin and Proin together to control her urinary incontinence. Sometimes we need a 2nd agent to get the job done. Just as we sometimes need to use 2 medications, sometimes we can wean pets off medication altogether or have a pet on a very low dose. It’s worth the effort to taper the dose.

Finally, I will mention that there are vets using collagen injections around the urethra to help with urinary incontinence. This is something you will likely need to go to a specialty hospital or university teaching hospital to find.

I’m always happy to have ADWDiabetes readers send me questions. It is where many of these newsletter ideas come from! Keep those questions coming to [email protected].

NOTE: Consult your veterinarian to confirm that my recommendations are applicable for the health needs of your pet.