22 replies to this topic

[Rockstar]

Hi everyone, I'm hoping someone can elighten me on this subject.
Roxy has had 2 incidents in the past 2 nights where she has peed in her sleep. She knows how to wake me up, and it's not like she wakes up, pees on the carpet and goes back to sleep. She is peeing while she is sleeping on her bed, because she will lay in it and is all wet when she wakes up.

Is this a UTI? A bladder infection? Something else?

I do have an appt for tomorrow afternoon at the vet. Should I ask them to test for anything else? I'm worried about this. She is 2 1/2, fully housebroken, and I don't know what would be causing this. My poor thing.

[Laurae]

Poor Roxy! Peeing while sleeping is a classic sign of spay incontinence. But having symptoms for only two nights is nothing to be alarmed at just yet. It could just be a simple UTI--is she peeing more often while she's awake? Actually, this has happened to Sophie before. I rushed to the vet, and a UTI was not present, so she got PPA. Then, before I gave her any of the meds, she never did it again.

[Rockstar]

Well she pees quite a bit because she drinks a lot of water. We go to the park maybe 2 hours every night and she drinks water there while we're playing frisbee. I let her out right before bed to go, and then she's inside for about 7-8 hours, and I let her out again in the am.

She's actually done this once before a few months back, but I let it go because it never happened again. Do you think a vet check isn't necessary unless it keeps happening?

[Samantha J]

Is she drinking more now than she did Amy?

Like Laura put i wouldn't worry too much but i would still take her in to see your vet. Hopefully it is just a one of thing like Sophie or if she has a little infection some meds can clear it up.

Keep us posted.

[Laurae]

It's been really hot the past couple of nights. I bet she just drank too much water. Is she licking at herself? If not, maybe give it another day or two, and if she is still peeing in her sleep, then bring her in.

[Rockstar]

I didn't think she was drinking any more than usual, but it's possible that's all it is. (She's not licking at herself at all.) I just don't understand why it's not waking her up at night! She sleeps right through it, where normally she will wake me up if she has to go outside. I think that's the part that freaked me out. And remembering her doing it a few months back, I thought maybe I did not pay enough attention to it back then when I brushed it off.

[Laurae]

I remember it freaked me out with Sophie, too! Craig also leaks a little at seemingly random times, and I have not yet been able to find out why. I guess I have lost a little confidence in easy answers as to why incontinence happens if it is only occasional. But it might not be a bad idea to go to the vet sooner rather than later--at least it may rule out a UTI.

[Rockstar]

I'm glad I'm not the only one who doesn't think it's normal! The bf was like 'we'll just have to let her out more during the night.' (Which maybe in this case is true!) but I'd rather be safe than sorry. I think I will still go to the vet, it would be great to rule out a UTI for my own reassurance if anything!

Laura, what's PPA??

[Laurae]

PPA is a drug used to treat urinary incontinence. From the always-helpful online Merck Veterinary Manual:

Urinary incontinence is most commonly caused by urethral sphincter incompetence. It is most common in large breed, spayed female dogs (11-20% incidence) but may be seen in intact females, male dogs, and cats. Estradiol-17β concentrations decrease after ovariohysterectomy in bitches, resulting in deterioration of urethral closure within 3-6 mo. Currently, there are no approved drugs for the treatment of incontinence in animals, and most of the human products traditionally used have been removed from the market due to toxicity concerns. Some estrogen compounds and α-adrenergic drugs may still be available to veterinarians through compounding pharmacies (Table: Drugs Used to Treat Urinary Incontinence). Diethylstilbestrol (DES) is a nonsteroidal estrogen derivative that closely resembles the natural estrogen, estradiol. Because it is inexpensive and infrequently administered, it is the first choice for treating urinary incontinence in female dogs. It is orally bioavailable and in dogs reaches peak plasma concentrations in 1 hr; it has an elimination half-life of 24 hr due to enterohepatic recirculation. Estrogens sensitize the urethral sphincter to α-adrenergic stimulation; therefore DES therapy is synergistic with α-adrenergic drugs. DES is given as a daily loading dose for 7-10 days, and then reduced to once weekly dosing, if possible, to avoid toxicity. Treated dogs are extremely susceptible to bone marrow suppression from estrogen, typified by early thrombocytopenia and potentially fatal aplastic anemia. Hematopoietic toxicity is rarely seen in cats. Other adverse effects seen in dogs include alopecia, cystic ovaries, cystic endometrial hyperplasia, pyometra, prolonged estrus, and infertility. When used once weekly in spayed female dogs, adverse effects from DES are rare. α-Adrenergic agonists such as phenylpropanolamine (PPA), ephedrine, pseudoephedrine, and phenylephrine act directly on smooth muscle receptors to increase urethral tone and maximal urethral closure pressure. Although often more clinically effective than DES, their action is short lived, usually requiring dosing 2-3 times/day. Of this class of drugs, PPA is the most effective and produces fewer cardiovascular side effects. Previously available in over-the-counter cold medications and appetite suppressants, it has been withdrawn from the human market because of toxicity associated with overuse as a diet aid. It may still be available from some compounding pharmacies. Ephedrine, pseudoephedrine, or phenylephrine may be tried if PPA is unavailable. Adverse effects of α-adrenergic drugs include excitability, restlessness, hypertension, and anorexia. In male dogs, testosterone injections are used to treat urinary incontinence but are generally less effective than estrogen therapy in female dogs.


http://www.merckvetm...s...tm&word=PPA

[urge to herd]

If you can, get a clean catch, first pee in the morning urine specimen and drop it at the vet first thing in the morning. They can test for infection and let you know pretty quick. If you've never done this, it's actually pretty easy. I take the dog on leash out into the yard, with a clean shallow dish, like a cut down washed out microwave meal container. The minute she squats, slip the dish under her little bottom. You'll only need a tbs or so of urine, so if she stops mid stream and moves, you're ok. Pour the sample into a clean, sealable container, (I use a fresh small zip lock baggie), refrigerate and get to the vet quickly. I'll put the baggie in a plastic drink cup to make it easier to transport.

You can use a variety of things to catch the urine, the cut down plastic tray is what's easiest for me. Neither of my girls has ever even noticed, they're not picky that way.

She may not be incontinent or have an infection, she may just have had a lot of water and be sleeping deeply. But I'd check it out w/your vet.

Hope it's simple. Both my girls are on PPA, and Shoshone takes weekly DES as well.

Ruth n the BC3

[AK dog doc]

FWIW, IME DES works better than PPA. I've had a very small number of patients who fail on DES. I've had a lot more who fail on PPA. PPA IS available as a veterinary drug - we used to get a product called Proin; now we use one called Uriflex. The DES we have compounded by a pharmacy.

It's worth noting that the majority of the listed side effects for DES are of no concern in a spayed dog, since they no longer have uterus, ovaries or fertility to be concerned about. I have never seen any dog develop alopecia, hepatotoxicity or anything even remotely resembling a bone marrow supression in dogs who are appropriately dosed on DES. This is not to say it can't happen, just to say that *I* have never seen it happen. I've used that medication in practice for 15 years. My BF's dog (who I love like I love my own) has been on it for three years; as you can imagine, I would not have Rx'd it for her if I thought it was likely to cause a problem. Although it's true that any dog can have any reaction to any medication, I consider it to be a pretty safe medication when used as directed. Not every spayed female dog is responsive to it, but most are.

PPA has been (as noted) less effective IME. It's also less convenient for the owner, as it has to be dosed two to three times daily, rather than once to twice weekly. I have seen side effects with PPA... restlessness, irritability, and anorexia are the usual culprits. They don't happen often, but generally if they do they require withdrawal of the medication. There are no studies that indicate a stroke risk in dogs, but that was why it was withdrawn from the human market.

ONE IMPORTANT NOTE: I have occasionally had people call me and say "You know, that DES was working GREAT and then all of a sudden she started peeing in the house again. We upped her DES to every day for the last week and it STILL isn't helping!" NEVER DO THIS. Call your vet first. It turned out in nearly all such cases that the dog had developed a bladder infection and was suffering from urge incontinence, not true incontinence.

How to tell urge incontinence from true incontinence:
Urge incontinence occurs with bladder irritation from stones, infection, or inflammation. The (previously housebroken) dog squats and urinates inappropriately in the house. She KNOWS she's peeing in the house, but her bladder is just to irritated that she can't wait and she has to go RIGHT NOW. This is not her fault. Do not punish her. Take her to a vet and get her bladder worked up. (NOTE: occasionally you have an older dog who is developing senility. That is ALSO not her fault, but it's not the bladder's fault either, so other workup and treatment will have to be approached.) As a general rule, it's never bad to take a urine sample for just-in-case workup; uncontrolled urinary incontinence does increase the risk of a UTI.

True incontinence occurs without the dog's knowledge or control, and takes the form of leaking urine, usually when the dog is relaxed or asleep, and is most commonly seen when the dog is sitting or lying down. It may not occur every day and it may be affected by other things - for example, a dog who is verging on (but does not truly have) true incontinence may have a bout when she is over-tired, has an extra-full bladder, and/or has some irritation of the bladder or sphincter that is temporarily disrupting function just enough to kick her over the edge into urine leakage. Persistent incontinence is a reason to treat, to avoid other complications such as vaginitis or cyctitis or urine scald (not to mention carpet cleaning).

As always, see your local vet, who can see your dog and do a physical exam, a urinalysis and diagnose her (which I can not do over the internet). This has been strictly for informational purposes. We now return you to your regularly scheduled broadcast.

[Rockstar]

Thank you SO much for explaining how to get a sample. I was thinking 'How the heck am I going to do that?' as soon I read your first sentence! It sounds easy enough and she's pretty biddable. I'm sure she won't mind. I will do this first thing tomorrow morning (if she doesn't pee it all out tonight while she's sleeping that is!).

And luckily, I just happen to work in a lab and there is a sterile, clean urine cup available they said I could have!

[Rockstar]

Thank you for all that information AKdogdoc! So it won't be out of line if I do need a prescription for Roxy to ask for DES instead, if my vet suggests PPA?

[sweet_ceana]

True incontinence occurs without the dog's knowledge or control, and takes the form of leaking urine, usually when the dog is relaxed or asleep, and is most commonly seen when the dog is sitting or lying down. It may not occur every day and it may be affected by other things - for example, a dog who is verging on (but does not truly have) true incontinence may have a bout when she is over-tired, has an extra-full bladder, and/or has some irritation of the bladder or sphincter that is temporarily disrupting function just enough to kick her over the edge into urine leakage. Persistent incontinence is a reason to treat, to avoid other complications such as vaginitis or cyctitis or urine scald (not to mention carpet cleaning).

What age is this most recognized/ diagnosed? Twist was checked for a UTi when we were fixing her spay stiches because of her frequent "piddles," and she still has more accidents than a 4 month old puppy normally would. I am not sure if she is just a late bloomer in "knowing," she has to potty or if there is something else going on. She squats, but with no warning. Would squatting rule this out? (I really hope so, because that would not be a good diagnosis for most adopters to hear.) I am going to give her some more time to work on those little muscles because sometimes she holds it like a champ and other times she pees 4 times in 1 hour, but it would be good to know if this is something I may need to ask our vet about... and if I should take out stock in carpet cleaners lol.

[RaisingRiver]

River at age 2.5 (spayed at 7mos) was recently like 2-3 weeks ago diagnosed w/ incontinence (UTI was not found). She's on PPA and does take it twice a day, I just add the 1/2 tablet to her food. She was going in her sleep. But now all seems well.

I didn't know there were other options besides PPA but since it isn't all that much trouble right now (it's still new) and it's working... I'm not sure I'd want to ask to see if she can be switched to something like DES. But good to know there are better (for me at least) options.

[herdcentral]

My 7 month old pup has urinary sphincter incontinence. She is currently not spayed and I have been advised in her case to spay her after her first heat in the hope that it may resolve her incontinence. I have her on PPA as Propalin which works like a charm with no side effects that I can determine. If I forget to give her the PPA she will start to leak again in her sleep within a day. I give it twice a day iner food which is no problem as they get fed twice a day anyway.

My older spayed bitch has the occasional episode usually only after she has been over active and excited and drunk lots of water.

[PSmitty]

Lilly started leaking urine in her sleep a year or so ago. We took her to the vet, no UTI. He said he didn't want to put her on something unless it started happening more frequently. So, we're waiting. She does still have it happen occasionally, and I'm sure we'll have to put her on medication eventually. Thanks for the info, AKDD.

[Rockstar]

Well I thought it was getting better, she had been waking me up in the middle of night (for 2 nights anyway) but she is back to peeing in her sleep again. She has a vet appt on Tuesday morning and hopefully we can get her on some meds to help her. She is starting to seem more down lately too, maybe I'm imagining that, but she seems more droopy and less energetic. I guess we'll find out soon enough!

[urge to herd]

If she's droopy and seems off, she probably has a UTI. If there's any way you can get her in earlier, do it. UTI's are painful and can spread to the kidneys. I'd even take her to the emergency vet - 4 days is a long time to wait,and she'll only feel worse and worse. Take a urine sample if you can. If not, they'll get one w/a needle at the vet.

Hope you get this resolved soon, Amy, and that she feels better.

Ruth n the BC3

[Laurae]

Poor girlie! I hope you get some answers at the vet appointment!