Prevent Dog Urine Killing Grass

Ways to protect your law from dog pee include:

1. Promote good hydration. Make sure that your dog always has fresh water available, and consider adding some water to her food. Drinking more water leads to more dilute urine, which is less likely to harm your lawn. Note: You can’t force your dog to drink! Just make that water fresh and appealing to dilute the dog urine.
2. Enforce rotating pee spots. If you have multiple yards, switch up which one your dog goes in for elimination outings or use portable fences to give certain grass areas a rest from the dog urine. This helps to spread out the urine rather than all of it being concentrated in one spot. If you walk your dog on leash, mix up the route you take for walks.
3. Create a designated pee spot. Alternatively, you can sacrifice one part of your lawn and make it the designated urination zone. You can either accept that this area will have sad-looking grass or cover it with gravel or mulch.
4. Consider adding tougher grasses. Seed your lawn with more resilient plants, such as ryegrass, fescue, sedges, or even clover.
5. Rinse away the urine. Spray off areas where your dog pees to dilute the urine and spread it over a larger area.
6. Allow your lawn to grow taller between mowing. This allows the grass to be more resistant to pee stains.
7. Check your fertilizer. If you treat your lawn with fertilizer, use a low-nitrogen fertilizer so that it doesn’t double up on the nitrogen already deposited by your dog.

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Reasons your dog might be peeing in her sleep

Any condition that alters a dog’s ability to completely empty her bladder can cause her to urinate while she sleeps. These conditions include urinary tract infections, bladder stones, tumors of the bladder or urethra, and congenital malformations of the bladder.

Arthritis and senility in older dogs may cause urine leakage while sleeping. Dogs with arthritic hips and knees may find it difficult to maintain their urination posture long enough to completely empty their bladder. Canine senility may impair a dog’s ability to remember when to go outside and urinate. Both conditions can lead to a dog falling asleep with a bladder that isn’t empty and potentially cause urine to leak out while they sleep.

Any medical condition that causes increased thirst and urination may lead to nap time urine leakage. These conditions include (but are not limited to) diabetes, kidney disease, and hyperadrenocorticism (Cushing’s syndrome).

Spay incontinence (also known as urethral sphincter mechanism incompetence) is caused by decreased muscle tone of the urethral sphincter. The urethral sphincter is the muscular valve the keeps urine in the bladder until a dog is ready to pee. As the name suggests, this is a condition that affects primarily spayed female dogs (although a small percentage of neutered male dogs can also be affected).

What to do when your dog pees in her sleep

If your dog is peeing in her sleep, make an appointment with her veterinarian. (While you’re waiting for an appointment, you may want to order some dog diapers. There are disposable and washable/reusable products especially for female dogs available online.)

The vet may want to collect a sterile urine sample for urinalysis and a bacterial urine culture. Radiographs (X-rays) may be recommended to look for bladder stones or tumors and to screen the hips and knees for arthritis. Bloodwork may also be recommended to look for causes of increased thirst and urination. If no underlying problem is found, a medication trial for treating spay incontinence may be prescribed.

Don’t overreact to a wet spot! Stray urine isn’t normal, but if you work with your veterinarian to determine the cause, chances are strong that a solution will follow.

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The average dog’s bladder will begin to expand once it contains about 16 to 22 mL of urine per pound of body weight. When a bladder starts to expand, neurons in the bladder wall send signals to the brain that say, “Hey! I’m starting to fill up with urine! Tell the dog to go pee so I can be empty again.”

Ten-pound Fido will start to feel the urge to pee when his bladder contains between 160 and 220 mL of urine. If his body produces urine at the maximum rate of 40 mL per hour, he may want to pee in as few as four hours (when his bladder contains160 mL of urine). If, in contrast, he produces urine at the lowest average rate (2 mL per pound of body weight per hour), and he can withstand the urge to pee until his bladder is as full as possible (220 mL), he could go up to 11 hours before having the urge to urinate.

It’s important to note that every dog’s ability to withstand the discomfort of a full bladder is different!

HOW MUCH CAN A DOG’S BLADDER HOLD?

An average dog’s bladder can hold about 44 mL of urine per pound of body weight. For Fido, our 10-pound dog, this would be about 440 mL of urine. It would take between 11 and 22 hours for Fido to make that much urine. At this volume, Fido’s bladder would be stretched to the point of being painful. If he can’t go outside or use a pee pad, he is likely going to find a convenient place to relieve himself – like the living room rug! (And who would blame him?)

HOW LONG CAN A DOG GO WITHOUT PEEING?

The general rule of thumb for normal, healthy dogs is to let them outside to pee every 4 to 8 hours, except at night. Most dogs are able to sleep through the night without having to pee. Their urine production slows down overnight because they are sleeping and not consuming water.

Puppies and senior dogs will need to pee more often. Puppies make more urine in a shorter period of time than adult dogs. And senior dogs feel the urge to urinate more often than they did in their younger days.

Medical conditions that cause your dog to drink more water will result in your dog having to pee more often. This includes diabetes mellitus, hyperadrenocorticism (Cushing’s disease), bladder infections, and chronic kidney disease. Increases in activity level or the ambient temperature will also increase water consumption, resulting in more frequent urination.

If your dog has trouble “holding it” for less than the amount of time that his bladder should start to expand, it would be wise to schedule a checkup with his veterinarian.

The post How long can a dog go without peeing? appeared first on Whole Dog Journal.

There are several conditions that can cause blood in your dog’s urine. Let’s look at the different causes and how each one is diagnosed and treated.

Bacterial Infection

Dog bacterial infections, specifically, bladder infections (also known as urinary tract infections or UTIs) and kidney infections (also known as pyelonephritis) can cause bloody urine. Of the two types of infection, bladder infections are far more common, especially in female dogs.

Female dogs are more likely than male dogs to develop bladder infections at some point in their lifetime due to their anatomy. Female dogs have a much shorter urethra than male dogs, meaning that bacteria have less distance to travel from the outside world to the bladder.

The most common bacteria implicated in bladder infections is Escherichia coli (E. coli), a normal part of the bacteria flora in the colon that is present in a dog’s stool. In female dogs, where the poop comes out is just north of where the pee comes out. This makes it easy for bacteria to cross the bridge between the anus and the vulva and travel upstream through the urethra to the bladder.

Other common bacteria that cause bladder infections are part of the normal skin flora. Female dogs who have a hooded vulva or who have less than ideal hygiene of the coat and skin around their vulva are more likely to develop bladder infections. A hooded vulva is where the vulva is partially covered by an extra fold of skin.

Kidney infections can develop from one of two routes. Bladder infections, if left untreated, can develop into kidney infections. This occurs because bacteria in the bladder can travel up to the kidneys through the ureters, the tubes that carry urine from the kidneys to the bladder.

The second method by which a kidney infection can develop is from an infection elsewhere in the body outside the urinary system. This is called a systemic infection – where bacteria travel through the bloodstream to the kidneys and take up residence there.

Dogs with bladder infections may strain to urinate or may urinate more frequently. They may also have urinary accidents in the house. They continue to eat and drink normally and typically have a normal energy level. Dogs with kidney infections tend to be much sicker. They are lethargic, eat less or not at all, may drink more water than usual, and may also vomit or have a fever.

If your veterinarian suspects that your dog may have a bladder or kidney infection, she may order a urinalysis to look for bacteria in the urine, and blood tests to examine your dog’s kidney values and white blood cell count. If bacteria are found in your dog’s urine, then a sample of your dog’s urine should be submitted to the laboratory for urine culture and sensitivity. This identifies the type of bacteria causing your dog’s infection and determines which antibiotic is appropriate. A urine culture and sensitivity takes about three to five days to complete, so your dog will be started on a broad-spectrum antibiotic pending the results of this test.

Uncomplicated bladder infections are typically treated on an outpatient basis with an oral antibiotic and pain medication. Kidney infections typically require hospitalization with intravenous fluids and antibiotics until your dog is eating and no longer vomiting.

Stones and crystals

Bladder stones and crystals in the urine can cause bloody urine. Crystals are microscopic structures with sharp edges. When thousands of crystals join together, they create a bladder stone. Some bladder stones are smooth and others have a hard, spiked surface.

Crystals and stones in the urine circulate in the bladder like a snow globe, causing microtrauma to the lining of the bladder. This causes the lining of the bladder to bleed, resulting in bloody urine.

Dogs with bladder stones or urinary crystals will act much like dogs who have a bladder infection. In fact, many dogs with bladder stones or urinary crystals will have a concurrent bladder infection.

The presence of urinary crystals can be detected on routine urinalysis. Treatment for urinary crystals will depend on the type of crystals present. If your dog has crystals in his urine, your veterinarian may recommend imaging to look for stones in your dog’s bladder and urethra.

Some dogs will have bladder stones but may not have crystals detected on their urinalysis. This is because the production of urinary crystals can be transient, not constant. If other causes of bloody urine have been eliminated, then your veterinarian will recommend imaging to look for bladder stones.

Some types of bladder stones are radio-opaque (can be seen on routine x-rays) and others are radio-lucent (are not easily seen, if at all, on routine x-rays). Struvite, calcium oxalate, and xanthine stones are radio-opaque. Cystine and urate stones are radio-lucent. Veterinarians remember which stones cannot be seen on routine x-rays with the mnemonic “I can’t C U!”

If your veterinarian is highly suspicious that your dog has bladder stones but cannot find any on routine x-rays, then she may recommend either an abdominal ultrasound or a cystogram. With abdominal ultrasound, the ultrasound waves wrap around bladder stones, creating a unique shadow on the image of your dog’s bladder.

A cystogram is a series of contrast x-rays of the bladder. The bladder is first emptied of urine and then filled with gas (usually room air or carbon dioxide), then contrast dye, then emptied and filled with air again. An x-ray of the bladder is completed after each step. This allows any bladder polyps, tumors, congenital abnormalities, or radio-lucent stones to be seen that would otherwise not be seen on conventional x-rays.

Struvite stones can often be dissolved by feeding a prescription urinary diet, such as Hills c/d or Royal Canin Urinary SO. Dissolving struvite stones can take weeks to months of feeding exclusively the prescription diet. Meanwhile, your dog will continue to experience pain, bloody urine, and will be at increased risk of developing a urethral obstruction. A urethral obstruction is when a stone becomes lodged in the urethra and your dog can no longer urinate.

Other types of stones typically require surgical removal through a procedure called a cystotomy. There are non-surgical and minimally invasive surgical techniques for removing bladder stones. However, other than voided urohydropulsion, these methods require specialized training and equipment and are only available at a limited number of hospitals throughout the country. Voided hydropulsion can be completed by a general practitioner that has been trained in the technique but is limited to removing very small stones and is often limited to female dogs.

After bladder stones are removed, your veterinarian will submit the stones to the University of Minnesota Urolith Center for stone analysis. Once the stone analysis is complete, recommendations will be made regarding your dog’s diet and potentially medications to minimize the risk of developing bladder stones in the future.

Polyps, pockets, and tumors

Bladder polyps are typically benign growths that originate from the lining of the bladder. These polyps bleed readily and can cause bloody urine. Bladder polyps are diagnosed by ultrasound or cystogram; they are not readily seen on routine x-rays.The treatment for bladder polyps is surgical removal.

A pocket or pouch in the bladder – such as a vesicourachal diverticulum – is usually a congenital malformation that has been present since birth. Sometimes a bladder diverticulum can be acquired later in life. Urine collects and is retained in this outpocketing, leading to urinary incontinence and recurrent UTIs. Chronic UTIs can cause cystitis, or a thickened and inflamed bladder. Both UTIs and cystitis can cause bloody urine.

The treatment for a malformation of the bladder is surgical correction of the defect. A sample of the removed pouch is submitted for a urine culture and sensitivity to determine the correct antibiotic for the dog. Dogs receive an antibiotic for about four weeks post-surgery.

Tumors of the bladder and urethra can be either malignant or benign. The most common malignant tumor of the bladder and urethra is transitional cell carcinoma (TCC). Benign bladder and urethral tumors are much less common in dogs. Tumors of the urinary system are typically diagnosed by ultrasound.

The treatment for bladder and urethral tumors is surgical resection. Some tumors cannot be surgically resected because of their location or size. Medical treatment with a medication called piroxicam may improve a dog’s quality of life if the tumor cannot be removed.

Prostate disorders

Disorders of the prostate can cause bloody urine in both neutered and intact male dogs. Male dogs with prostate disorders are more likely to strain when defecating than urinating. They may also have thin, ribbon-like stools. Prostate disorders cause enlargement of the prostate. Unlike in human males, a dog’s prostate tends to grow outward, not inward, putting more pressure on the colon and rectum than the urethra. This is why dogs with an enlarged prostate have more difficulty pooping than peeing.

Prostate disorders that affect primarily intact male dogs include benign prostatic hyperplasia (BPH), prostatic abscess and prostatitis (prostate infection), and prostatic cysts. Treatment for these disorders include both medical and surgical management. Neutering these dogs helps involute, or shrink, the prostate.

Prostate cancer can affect both intact and neutered male dogs. The most common form of prostate cancer in the intact male dog is adenocarcinoma. Neutered male dogs see an increased prevalence of transitional cell carcinoma (TCC), the same type of cancer that can affect the bladder. Unfortunately, prostate cancer in the dog is usually advanced by the time it is detected, making the prognosis for this condition poor.

Other causes for blood in the urine

Other causes for bloody urine include pelvic fractures or blunt-force trauma to the abdomen, coagulation disorders, and the recent administration of cyclophosphamide (a chemotherapy drug for treatment of lymphoma). Kidney disease, diabetes mellitus, and hyperadrenocorticism (Cushing’s disease) can also increase the risk of developing cystitis and therefore bloody urine.

With proper diagnostics and treatment, the cause of your dog peeing blood can be found and, in most cases, treated. If your dog’s urine looks pink or red, have him or evaluated by your veterinarian as soon as possible.

The post Why is my dog peeing blood? appeared first on Whole Dog Journal.

Increased urinary accidents in the house can point to a health issue and should not be ignored. It could be something as treatable as a simple urinary tract infection or it could be more serious. When you notice that your dog is urinating more, it is important to observe what is happening so that a veterinarian can help you sort out the cause.

With that said, how many times a day should a dog urinate? The truth is, it varies. Large breed dogs may only go every 6-8 hours, while a smaller dog may need to pee more often. As a general rule, every 4-8 hours is normal. Most dogs can hold urine overnight.

What Causes Frequent Urination in Dogs?

To gain more information, watch your dog closely when outside on walks. Many of us let our dogs outside in a fenced yard without direct supervision. Walk with your dog and scrutinize urinary behavior. Is your dog squatting often but only passing a small amount of urine, or is it large puddles each time? Is your dog straining during urination? Is there blood? This information is very helpful in determining the cause.

After a few walks, it’s time to call the veterinarian. During an examination, several things will happen. Your veterinarian should take a thorough history on your pet that includes vaccination status, previous illnesses including urinary tract infections, any medications your dog takes (this DOES include over-the-counter supplements and non-prescription medications such as Benadryl), diet, and possible exposures to any toxins. After this, a head-to-toe examination is in order.

If the symptoms your dog exhibits are straining to urinate, frequent, small accidents or repeated, small puddles when going outdoors, a likely cause is a lower urinary tract issue such as a bladder infection, bladder stones, or cystitis (bladder inflammation). Diagnostics will include a urine sample, urine culture, and possibly x-rays of the bladder. Some breeds such as Schnauzers are more prone to certain lower urinary tract issues like bladder stones.

If the symptoms are large puddles of urine frequently with increased drinking, this is referred to as polyuria/polydipsia or “PU/PD.” These symptoms require a much more thorough diagnostic approach. Your veterinarian will likely recommend bloodwork, urinalysis, and abdominal xrays to start. PU/PD has a host of causes ranging from metabolic diseases like kidney failure or Cushing’s disease to toxin exposure and elevated blood calcium levels.

Read more on frequent urination here.

Can Spaying Caused Urinary Incontinence?

This isn’t an easy question to answer unfortunately. It does appear that there is a relationship between spaying (called an OHE) and the development of urinary incontinence. It tends to happen within about 3 years after the spay is done and in dogs > 45 lbs. (though any size dog can be affected). The exact cause is unknown. Age of the dog at OHE may play a role, but this is controversial. When deciding a time to spay your female, it is best to have a frank discussion with your veterinarian and weigh the benefits and risks of timing.

Is My Dog Urine Marking?

In some cases, urination in the house can be a marking behavior. This tends to be in unaltered animals, particularly males. It would be unusual for a neutered male or female to suddenly start marking territory, although it does happen – often with the introduction of new pets into the household.

Summary

A sudden change in a dog’s urinary habits is always a cause for further investigation. Monitor your dog’s bathroom breaks, then schedule an appointment. Your veterinarian will help determine the cause through a history and physical exam, as well as diagnostic testing. What may seem like a “wee” problem could be something serious, so speak with your veterinarian if you have any concerns.

The post Is Frequent Urination in Dogs Normal? appeared first on Whole Dog Journal.

Can Dogs Get UTIs?

The urinary tract is comprised of the kidneys, ureters, bladder, and urethra. Dogs have two bean-shaped kidneys located in the mid abdomen. The kidneys are responsible for filtering blood and excreting waste in the form of urine. As the urine is continually created, it exits each kidney via a small tube called the ureter. The ureters dive into the bladder, which is a muscular collection tank. When the dog is ready to urinate, the muscles of the bladder contract and the urine is emptied through a tube called the urethra, which transports the urine out of the dog.

Problems can develop anywhere along this path, but the most common area of concern is within the bladder itself. When referring to UTIs, veterinarians are almost always referring to infections within the lower urinary tract, or the bladder itself. Infections of the upper urinary tract, or kidneys, are more commonly referred to as pyelonephritis and are more serious in nature.

Signs of a UTI in Dogs

Signs that your dog has a urinary tract infection can be quite variable. Typically, dogs with a lower urinary tract infection do not develop a fever and behave in a normal fashion, other than changing the pattern of their urination habits. Some dogs can be completely asymptomatic, while others show dramatic urgency or frequency while voiding very small volumes of urine. Some dogs will drink excessive amounts of water, and some will lick at their genital region, especially after urinating. Occasionally, an owner will notice hematuria (blood or blood clots in their dog’s urine).

It is important to note, however, that not all dogs with increased frequency, urgency, and hematuria have a urinary tract infections. There are other medical problems that can appear clinically similar, including sterile cystitis (inflammation of the bladder without bacteria), uroliths (bladder stones), and cancer. Therefore, it is very important to make a trip to your veterinarian if you notice any change in your dog’s usual urination pattern.

UTI Diagnosis in Dogs

Diagnosing a UTI is relatively straightforward. Your veterinarian will collect a urine sample and put it through a number of tests.

Typically, the urine is first evaluated macroscopically by analyzing its color and turbidity (cloudiness or clarity). Then the urine is tested for its specific gravity (concentration). Urine that is either too dilute or too concentrated can be an important factor to consider in the analysis of the other urine values and may be an important clue in an underlying medical disorder.

Then the urine is placed on a urine test strip, which checks the biochemical nature of the urine. The pH, protein level, presence of red blood cells, white blood cells, bilirubin, glucose, and ketones are documented.

The last step is to look at the urine under the microscope. Cytology (microscopic analysis) will confirm urine-strip findings and allow for the estimation of the number of red blood cells and white blood cells. Cytologic analysis will also look for the presence of crystals, casts, and bacteria, all of which are important in the diagnosis of a UTI and other urinary-tract disorders.

A normal urine sample is sterile (does not contain bacteria). Typically, urine is a clear, light yellow color and microscopically there is very little sediment – no red or white blood cells and no bacteria present. Many parameters can change when a patient has a UTI, so all of the information from the urine test strip along with the cytology of the urine needs to be considered in the diagnosis.

By compiling all of this information your veterinarian will be able to conclude whether or not your dog has an infection of the bladder. However, she will not be able to identify the type of bacteria that caused the infection without further testing.

In order to identify the exact bacteria present, a culture will need to be performed. The urine will be collected in a sterile fashion via cystocentesis (insertion of a needle into the bladder to withdraw a small volume of urine). The urine is then placed into a sterile tube and sent to a laboratory for analysis.

At the laboratory the urine sample will be placed on a petri dish and allowed to incubate for several days. If nothing grows, then it is likely your dog does not have a bacterial urinary tract infection. If bacteria grows, the laboratory technician will identify the bacteria and give your veterinarian a susceptibility pattern, which will tell her which antibiotics will be effective for the present infection.

Pros and Cons of Different Ways to Collect Your Dog’s Urine

Causes of Urinary Tract Infections

A number of medical and physical conditions can make a patient prone to developing an infection in the urinary tract. Females are more susceptible than males for developing a UTI. Bacteria (often fecal contaminants) can more easily travel up the urethra in female dogs due to the relatively short urethral length compared to the male. Also, some female dogs have an anatomical abnormality called a “recessed” or “juvenile” vulva, where the vulva is tucked under an excessive fold of skin, creating a perfect environment for organisms to grow. If this is the case, a straightforward surgical procedure called a vulvoplasty can correct the anatomy to remove the excessive tissue and evert the vulva (make it turn outward).

In the male dog – especially the intact male – benign prostatic hypertrophy and prostatitis (infection or inflammation of the prostate gland) can make him susceptible to infection. Castration is often recommended for intact male dogs with recurrent urinary tract infections. However, sex and anatomy are not the only conditions that make dogs prone to infection.

Systemic disease and some medications can also predispose your dog to urinary tract infections. Diseases like diabetes, renal disease, Cushing’s disease, and neurologic disorders can cause UTIs. If your dog develops recurrent urinary tract infections, it may be worth investigating further to see there is an underlying predisposing medical condition. Certain medications, such as prednisone or other immunosuppressive medications, can also make a dog prone to urinary tract disease.

UTI Treatment for Dogs

Treatment for first-time urinary tract infections often involves treatment with broad spectrum antibiotics. However, as bacterial resistance becomes more commonplace in veterinary medicine, cultures are being recommended sooner than previously suggested. Checking a urine sample at the end of the course of antibiotics is wise to confirm the infection has resolved.

Following your veterinarian’s recommendations for treatment and finishing the whole course of antibiotics will help prevent against the development of resistant bacteria.

Occasionally, we see a patient with recurrent urinary tract infections. This can be very frustrating for both the dog owner and the veterinarian. Trying to identify and correct the underlying predisposition is the best course of action to prevent future recurrence. However, this is not always possible.

In these cases, supplementation is sometimes recommended. Other things you can do at home include encouraging water consumption by adding water to your dog’s food and allowing more frequent potty breaks to flush out the bladder.

Urinary tract infections, although common, are typically not very serious in nature. That said, they should never be ignored, as sometimes they are a clue to another, more serious underlying problem. Quick recognition on your part will help with a speedy diagnosis and treatment for your dog.

Supplements That Help Prevent UTIs

• Cranberry and D-Mannose have been shown to inhibit certain bacteria from binding to the bladder wall
• Probiotics help repopulate the gut and vagina with normal microbial flora
• A good-quality diet will strengthen the immune system

Lauren Brower Wacholder is an integrative veterinarian at Canyon Animal Hospital in Laguna Beach, California. She practices both conventional and integrative medicine including acupuncture, herbal medicine and cold laser therapy.

The post Urinary Tract Infections in Dogs appeared first on Whole Dog Journal.

If you’ve lived your life with dogs, chances are you’ve cared for one with a bladder infection. The normal urinary bladder is sterile, meaning devoid of bacteria. Infection occurs when bacteria find their way into the bladder and set up housekeeping. Bacterial cystitis (medical-speak for a bladder infection) is a common diagnosis in the canine world. The term urinary tract infection (UTI) is often used synonymously with bacterial cystitis. Technically speaking, a UTI can mean infection anywhere within the urinary tract, and is not specific to the bladder.

Bacterial cystitis occurs most commonly in female dogs. This is attributed to the fact that, compared to males, female dogs have a shorter urethra, the conduit through which urine flows from the bladder to the outside world. With only a short distance to travel in female dogs, bacteria have an easier time migrating from the skin surface up into the urinary bladder.

There is no breed predisposition for bladder infections. However, small-breed dogs are more susceptible to some of the underlying causes of infection described below.

Causes of Bladder Infection in Dogs

While not always easy or even possible to diagnose, there are several underlying issues that make it easier for bacteria to colonize and thrive within the urinary bladder. Anything that disrupts the normal architecture of the urinary tract or reproductive tract (the two are anatomically connected) predisposes to infection. Examples include:

1. Stones within the urinary tract

2. Tumors or polyps within the urinary or reproductive tracts

3. Foreign body within the urinary or reproductive tracts

4. Anatomical birth defects within the urinary or reproductive tracts

5. Prostate-gland or testicular disease

6. Vaginal, vulvar, or uterine disease

Urine that is less concentrated (more dilute) than normal creates an environment that is bacteria-friendly. So, it’s not unusual for bacterial cystitis to accompany diseases associated with increased thirst and increased urine volume, such as kidney failure, liver disease, and some hormonal imbalances. Bladder infections occur commonly in dogs with diabetes mellitus, a hormonal imbalance that creates dilute urine. The sugar in the urine of diabetic dogs creates an ideal growth media in which bacterial organisms absolutely thrive.

Suppression of the immune system caused by disease or medication also promotes bladder infections. Prednisone, a commonly prescribed steroidal anti-inflammatory medication (NSAID), causes urine dilution along with immunosuppression. Not surprisingly, about one third of female dogs receiving prednisone develop spontaneous bladder infections.

Symptoms of Bladder Infection in Dogs

If ever you’ve experienced a bladder infection, you know just how miserable the symptoms can be. Dogs vary a great deal in terms of how dramatically they show evidence of a bladder infection. Some exhibit every symptom in the book, while others demonstrate none whatsoever. Additionally, symptoms can arise abruptly or gradually. Every dog reads the textbook a little bit differently!

Symptoms most commonly observed in association with canine bladder infections include:

– Straining to urinate
– Urination in inappropriate places
– Increased frequency of urination
– Blood within the urine
– An unusual odor to the urine
– Urine leakage
– Increased thirst
– Excessive licking at the penis or vulva

It is unusual for plain and simple bladder infections to cause lethargy, loss of appetite, or fever. Such “systemic” symptoms, in conjunction with documentation of bacteria within the urinary bladder, create suspicion for infection elsewhere within the urinary or reproductive tracts (kidneys, prostate gland, uterus).

It’s important to remember that dogs are creatures of habit, and any change in habit is a big red flag beckoning you to take notice. Filling the water bowl more than usual? Is your girl squatting more frequently than normal on her morning walks? Is she waking you up in the middle of the night to go outside to urinate? Has your well-house-trained dog begun urinating in the house? All such symptoms are worthy of medical attention. For your dog’s sake, please don’t blame urinary issues on negative behavior before first ruling out an underlying medical issue.

Collection of Canine Urine Samples for Testing

If a bladder infection is suspected, testing the urine will be one of the first steps your veterinarian takes. There are a few different ways to collect urine from a dog.

A “free-catch” sample involves catching some urine in a container as the dog urinates. The presence of bacteria in a free-catch sample is nonspecific, meaning the bacteria might have originated anywhere en route to the collection container, including the bladder, urethra, vulva, prostate, and even the hair around the opening of the penis or vulva. In other words, bacteria found in a free-catch sample may not be all that meaningful. Other possible downsides to collecting free catch urine samples are a wet hand and suspicious looks from the neighbors.

Urine can also be collected via a plastic or rubber catheter, inserted into the end of the urethra and advanced forward into the urinary bladder. Once in the bladder, the catheter withdraws the urine. There are a few drawbacks to this sampling method: Most dogs experience some discomfort with the process. Additionally, it is tricky business finding the opening to the urethra in female dogs. And because the catheter comes in contact with the urethra and reproductive structures (vagina, penis, prostate gland) before reaching the bladder, one cannot be certain as to the origin of bacteria found in the sample.

The preferred method of urine collection is a technique called cystocentesis. This involves introducing a small needle directly into the urinary bladder. Urine is collected into a syringe attached to the needle. Other than the stress associated with restraint, there is typically no more discomfort for the dog than would be associated with a vaccination. The beauty of a cystocentesis sample is that, if bacteria are detected, one can be certain they were living in the bladder.

Diagnosis of Canine Bladder Infection

A bladder infection is definitively diagnosed when bacteria are identified within a urine sample that has been collected via cystocentesis. Supporting evidence of infection includes the presence of red blood cells and excessive white blood cells, and/or protein within the urine. Keep in mind, these ancillary abnormalities can occur with a variety of urinary-tract diseases other than infection.

Bacteria in the urine can be documented by two tests: urinalysis and urine culture. The combination of the two is always ideal.

A urinalysis measures urine concentration and pH, screening for red blood cells, white blood cells, and protein, and viewing the urine sample under the microscope. While this test is relatively reliable, it can produce false negative results, particularly if the urine sample sits for several hours prior to testing (certainly the case when samples are sent to a commercial laboratory rather than tested in house). Over time, the bacteria have a way of disappearing from view. Additionally, if the urine sample is dilute (more water than sludge), small numbers of bacteria can readily be missed during the microscopic evaluation.

The gold-standard method for documentation of bacterial infection is a urine culture. Urine is inoculated onto agar (a sterile growth medium) and incubated for 48 to 72 hours. There, the bacterial growth can be documented, and their identification and sensitivity testing can be performed. These tests clarify the species of bacteria as well as which antibiotics the bugs are sensitive to. This is important information, particularly when treating dogs with recurrent bladder infections.

Managment of First-Time Bladder Infections

For dogs experiencing their first bladder infection, the treatment of choice is a 7 to 14 day course of an antibiotic. Performing a urinalysis and urine culture is ideal, but antibiotic sensitivity testing really isn’t necessary with first timers as it is unlikely that the bacteria will have developed any antibiotic resistance.

The antibiotic chosen should be one that is known to be effective against the most common urinary-tract bacteria. Successful treatment is defined by the resolution of symptoms along with normal urinalysis results and a negative urine culture performed two to three weeks following completion of antibiotic therapy.

Managment of Repeated Bladder Infections in Dogs

Sometimes, the minute a dog with a bladder infection completes a course of antibiotics, his or her symptoms begin all over again. With these dogs it’s important to do dig deeper, diagnostically, to identify and eliminate the underlying cause of their recurrent infections.

In addition to the urine testing described above, this investigation begins with an extremely thorough physical examination (including a rectal exam) looking for any abnormality that might predispose the dog to bladder infections. In males, these abnormalities include an enlarged prostate gland or an infection within the sheath (pouch surrounding the penis), or in females, an infection in the skin fold covering the vulva.

If the physical exam and urine testing are not revealing, next is blood work (complete blood cell count and chemistry profile). Specific testing to rule out Cushing’s disease (a hormonal imbalance commonly associated with recurrent bladder infections) may be recommended. Abdominal ultrasound comes next. This test allows inspection of the kidneys, prostate gland, and urinary bladder, in search of stones, tumors, polyps, and/or anatomical defects.

Unfortunately, unless they are significantly diseased, ultrasound does not do a good job imaging the “three U’s”: the uterus, the urethra, and the ureters (structures that transport urine from the kidneys to the bladder). Ultrasound creates no discomfort for the dog, so sedation is usually not needed. Clipping the hair over the belly is necessary for good visualization (something the dog could care less about, but the human often objects to).

Buyer beware: the information gleaned from ultrasound is extremely user-dependent. This skill has a steep learning curve, and the more experience the ultrasonographer has, the greater the likelihood the results will be meaningful.

If all of the above testing does not reveal the underlying cause of recurrent infections, the final diagnostic steps are contrast studies (urethrogram, pyelogram) in which dye is used to visualize portions of the urinary tract not seen with ultrasound. These studies are performed using x-rays or computed tomography (CT scan).

Antibiotic Therapy for Canine Bladder Infections

The ideal way to manage recurrent bladder infections is to define and remove the underlying cause. In some cases, this underlying problem is not definable and/or treatable. When this happens, the judicious use of antibiotic therapy is key to keeping the dog comfortable and preventing issues that can arise secondary to chronic infection (bladder stones, spread of infection to the kidneys or bloodstream).

Choosing the most appropriate antibiotic regimen relies on multiple urine-culture results including bacterial identification and antibiotic-sensitivity testing. Just as in human medicine, some urinary-tract bugs manage to develop a resistance pattern to multiple if not all antibiotics.

Patients with such resistant infections are tricky to manage. They may need big-gun antibiotics (many of which have significant potential side effects) or, if feasible, some “time off” from any antibiotic exposure with hopes that the bacteria will revert back to a more normal pattern of antibiotic sensitivity. If your dog has recurrent bladder infections, anticipate multiple urine cultures over time. Without these results a veterinarian is treating “in the dark,” and this is definitely not in the best interest of the patient.

For dogs with recurrent bladder infections, there are a two ways antibiotic therapy is typically managed:

Long-term, low-dose therapy – An antibiotic is selected based on urine-culture results and the dog is treated at the standard dosage for 14 days. After 14 days, the total daily antibiotic dosage is reduced by 50 to 75 percent and is administered once daily at bedtime. This time of day is chosen because it precedes the longest stretch of urine retention (assuming the dog does not work the graveyard shift).

This regimen will continue for months or even years, following a strict schedule of recheck urine cultures to verify the absence of bacteria. Long-term, low-dose antibiotic therapy is a safe and often effective means to manage recurrent bladder infections.

Pulse therapy – An antibiotic is selected based on urine-culture results and the dog is treated at the standard dosage for 14 days. Just as with the protocol described above, a urine culture is repeated 7 to 10 days after treatment begins to make sure that the antibiotic has successfully eliminated the bacteria. If not, a different antibiotic is chosen and the process begins again.

After 14 days, therapy is discontinued for three weeks, and then pulse therapy is begun. This involves treating the dog with the antibiotic (at the standard dosage) for one week each month. There should be three-week, treatment-free intervals between treatment weeks. Pulse therapy may be continued for months or even years. Periodic urine cultures determine if a change in treatment is needed.

Additional Therapies for Bladder Infections

Cranberry extracts may help prevent recurrence of some bladder infections. Cranberries contain compounds called proanthocyanidins (PACs) that prevent bacteria from adhering to the inner lining of the bladder wall. If the bugs can’t adhere to the bladder wall they are incapable of colonizing, multiplying, and causing infection. This PAC effect works only against E. coli, the bacteria most commonly cultured from canine bladder infections.

Be aware that not just any cranberry formulation will do. Essential for success is the presence and bioactivity of PACs within the product. If interested in using cranberry extract, be sure to check with your veterinarian for his or her product and dosage recommendation. By the way, the notion that cranberries prevent infection by acidifying the urine is nothing more than an old wives’ tale.

Probiotics may help prevent recurrent bladder infections. This is based on the notion that altering bacterial populations in the gut will alter bacterial populations in the feces. Given that fecal microorganisms that linger on the coat may be the source for some bladder infections, probiotics may (emphasis on “may”) have a beneficial effect. If you decide to try a probiotic, get the most bugs for your buck by purchasing a product with the highest concentration of microorganisms.

Methenamine is a drug that may help prevent bladder infections. It is converted to a dilute formaldehyde product within the bladder, where it acts as an antiseptic. Methenamine is effective only in a very acidic environment (the urine pH must be low). For this reason, it is often administered with a urinary-tract acidifier.

Cleansing the skin area surrounding the vulva two to three times daily provides benefit for some female dogs with recurrent bladder infections. I recommend using baby wipes for this purpose. The hope is that the concentration of normal bacteria hanging out on the skin surface will be lessened, thereby lessening the likelihood of bacterial migration up into the urinary bladder.

If your dog continues to experience recurrent bladder infections despite your family veterinarian’s best efforts, I encourage scheduling a consultation with a veterinarian who specializes in internal medicine. Visit the American College of Veterinary Internal Medicine to find such a specialist in your neck of the woods.

Nancy Kay, DVM, DACVIM, is the author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, and Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet. She lives in North Carolina. You can read her blog at speakingforspot.com/blog.

The post Canine Bladder Infections appeared first on Whole Dog Journal.

Fourteen generations later, more than 99.98 percent of the offspring’s genes are identical to those of a purebred Dalmatian. The one critical exception is that, unlike every other dog registered by both the British and American Kennel Clubs, these dogs are no longer at risk of forming urate bladder stones, a painful and potentially deadly condition caused by a genetic mutation carried by all Dalmatians.

Since that article was written, there have been some new developments. First, an update on what has been happening in Britain: Fiona (Fiacre First and Foremost), the first low uric acid (LUA) Dalmatian registered with the Kennel Club, has been winning at shows. While naysayers claimed her first win was “fixed,” Fiona’s group win the following week proved that these dogs are indistinguishable from other Dalmatians, and worthy of inclusion in breeding programs.

Meanwhile, back here in the States, theAmerican Kennel Club (AKC) Health & Welfare Advisory Committee submitted a report with the following recommendation:

“Because the introduction of the low uric acid dogs into the AKC registry gives Dalmatian breeders a scientifically sound method of voluntarily reducing the incidence of the condition, this committee strongly recommends some controlled program of acceptance of these dogs. Where the strict health and welfare of the breed is the over-riding concern, no other argument can be made.”

Despite these findings from its own committee, the AKC board voted in November to defer a decision until after June 2011, when a vote of the Dalmatian Club of America’s membership would be held. Since the breed clubs in both Britain and the U.S. have remained staunchly opposed to registration of LUA dogs, it seems unlikely that this vote will show them putting the welfare of their breed above their concerns of genetic purity. While AKC says it will “consider this vote, along with other factors in reaching its final decision,” don’t hold your breath in hopes that they will do the right thing.

In the meantime, another dog has paid the ultimate price for the breeders’ shortsightedness. Armstrong, a seven-year-old Dalmatian who worked as a therapy dog at the children’s cancer unit at the Primary Children’s Medical Center in Salt Lake City, Utah, was put to sleep due to uncontrollable urate stones.

Armstrong had previously undergone multiple surgeries to remove stones, followed by a urethrostomy, where the dog’s urethra is rerouted away from the penis to a new, surgically created opening. Even after such a drastic measure, Armstrong continued to form stones, requiring two more surgeries just five months apart.

His owner, Shelley Gallagher of Sandy, Utah, had been feeding Armstrong a low-purine diet, giving him extra fluids to help dilute his urine, letting him out to urinate every few hours (including every night at 2 am), and obsessively monitoring him – all, ultimately, to no avail.

If you’d like to let the Dalmatian Club of America know how you feel about this, email its president, Meg Hennessey, at president@thedca.org. For those interested in LUA Dalmatians, they are currently registered in the U.S. only with the United Kennel Club (UKC). – Mary Straus

The post An Update on “Low Uric Acid” Dalmatians appeared first on Whole Dog Journal.

1. Get an accurate diagnosis and follow nutritional guidelines for your dog’s type of uroliths.

2. If your dog is prone to urate stones, consider switching to a low-purine home-prepared diet.

3. Avoid low-protein prescription foods when they are unnecessary or ineffective at preventing stone formation.

4. For male dogs who continue to form stones, consider urethrostomy surgery to greatly reduce the risk of obstruction.

Canine kidney and bladder stones may be painful and life-threatening, but an informed caregiver can help prevent them. By far the most common uroliths or stones in dogs are struvites (see “Canine Kidney Stone and Bladder Stone Prevention“) and calcium oxalate stones (see “Preventing Bladder and Kidney Stones in Dogs“). These two types represent about 80 percent of all canine uroliths.

Now we address the remaining stones that can affect our best friends: urate, cystine, calcium phosphate, silica, xanthine, and mixed or compound uroliths.

Urate or Purine Stones

Of the remaining stone categories, urate or purine stones are the most common. They contain ammonium acid urate, sodium urate, or uric acid.

Only 6 to 8 percent of all uroliths are urate or purine stones, but their presence in certain breeds is significant. Dalmatians, English Bulldogs, Russian Black Terriers, and Large Munsterlanders develop urates because of a genetic metabolic abnormality. Miniature Schnauzers and Yorkshire Terriers do so as a result of their tendency to have portosystemic shunts, which are abnormal blood vessels that bypass the liver, predisposing dogs to urate stones. These stones can form in dogs of any age, from very young puppies to seniors, but the most common age for forming urates is 1 to 4 years.

Of the breeds that develop urate stones, Dalmatians are most adversely affected. Between 1981 and 2000, the University of Minnesota College of Veterinary Medicine’s Minnesota Urolith Center analyzed 7,560 stones from Dalmatians. Of these, 97 percent were from males and 95 percent were composed of urates. It’s estimated that between 27 and 34 percent of male Dalmatians form urate stones, while the incidence in females is much lower.

It’s tempting to assume that any stone a Dalmatian forms is a urate, but although 97 percent of stones from male Dalmatians were urate, they also included small percentages of struvite, xanthine, calcium oxalate, cystine, calcium phosphate, silica, and mixed or compound stones. The uroliths formed by female Dalmatians were 69 percent urate and 29 percent mixed or compound, with 2 percent struvite and 0.7 percent xanthine. Correct identification is a crucial first step in treating and preventing uroliths in all breeds, including Dalmatians.

The culprits in urate stone formation are purines, a type of organic base found in the nucleotides and nucleic acids of plant and animal tissue. As dietary purines degrade, they form uric acid, which is best known in human medicine for its connection to gout, a sharply painful form of arthritis. In susceptible dogs, purines trigger the formation of urate uroliths.

Urate stones are radiolucent – that is, they cannot be identified in abdominal X‑rays – so their diagnosis is often made by the use of ultrasound, contrast dye X-rays, or analysis of urinary crystals or stones that were collected or removed.

Signs of Stones

As noted in our previous articles, an accurate diagnosis is essential because what prevents or treats one type of stone may actually cause another. The only way to be sure of a stone’s identity is to have it analyzed. However, your veterinarian can make an educated guess based on urinary pH; the dog’s age, breed, and sex; the identification of urinary crystals; radiographic (X-ray) density; whether infection is present; and certain blood test abnormalities.

When should your veterinarian become involved? As soon as you notice symptoms or, if your dog’s breed is strongly predisposed to developing stones, even sooner. Not all bladder and kidney stones are dangerous; some are flushed during urination while still small in size and others remain unnoticed in the kidney or bladder. Stones don’t create complications until they interfere with urination. It’s important to become familiar with urinary stone symptoms, which include straining to urinate, blood or pus in the urine, painful or difficult urination, increased frequency of urination, the passage of small amounts of urine, licking the genitals more than usual, “accidents” in house-trained dogs, or discomfort in the lower back.

A dog who strains and then releases a flood of urine may have just passed a stone and should be examined. If you can find the stone, take it with you so it can be accurately identified. A dog who is unable to urinate needs immediate medical attention because a plugged urethra can cause urine to back up into the system, resulting in a ruptured bladder or kidney failure. A bladder that has been stretched can lose muscle tone, making it difficult to empty completely, which can lead to infection or more stones. Bladder stones are much less likely to cause an obstruction in females than in male dogs, thanks to the shorter and wider urethra in females.

Increasing urine volume and opportunities to void urine are important factors in preventing uroliths of all types. The more a dog drinks and the more frequently he urinates, the less concentrated his urine and the less likely the formation of crystals that can become stones. Encourage your dog to drink more by adding water to his food and offering flavored water in addition to plain. For dogs with urate stones, you can add salt
to food to increase thirst (start with a pinch, watch your dog’s response, and add more in small steps until your dog drinks more water), but added salt should be avoided for dogs prone to forming cystine, calcium phosphate, or silica stones.

Be sure that your dog has frequent opportunities to urinate because when dogs have to hold their urine for extended periods, their urine is more likely to become supersaturated, at which point its minerals begin to precipitate out as crystals.

Treating and Preventing Urate Stones

The key to keeping urate-forming dogs healthy is to feed them a low-purine diet. Without the purines that trigger urate stone formation, even susceptible dogs can lead normal lives.

Some Dalmatian owners believe that giving dogs who are prone to forming stones only mineral-free distilled water has helped prevent more stones from forming. However, no scientific evidence for this exists. The quantity of water the dog consumes may be more important than its mineral content.

Because urate stones develop in acidic urine, an added prevention strategy is to feed foods that have an alkalizing effect. In general, meat is an acidifying food while most fruits and vegetables have an alkalizing effect. Vegetarian dog foods are sometimes recommended for this reason, but we consider vegetarian foods incomplete. Also, foods that use soy as a protein source are inappropriate for dogs who are prone to forming urate stones because soy is high in purines. However, soy-free vegetarian foods could be used as a base to which eggs, yogurt, cheese, and other low-purine protein sources are added.

The same is true of some dog food pre-mixes, such as Sojo’s Grain Free Dog Food Mix. Sojo’s Complete is based on sweet potatoes, turkey, and eggs and might also be appropriate for dogs with hyperuricosuria (excessive amounts of uric acid in the urine). Avoid mixes that contain a lot of alfalfa, oats, barley, or other foods that are high in purines (see “Purine Content of Various Foods”).

Urate stones can be dissolved with a combination of a low-purine diet, urine alkalization, and control of secondary infections. The target range of urine pH during dissolution is 7.0 to 7.5. Care must be taken not to alkalize too much, making the urine pH higher than 7.5, because that can lead to the formation of calcium phosphate stones or shells around urate stones, making them difficult or impossible to dissolve.

The xanthine oxidase inhibitor allopurinol (brand name Zyloprim) may be prescribed short-term to reduce or inhibit the dog’s production of uric acid, which can help dissolve stones. This drug should not be used in patients with portosystemic shunts. A low-purine diet must be fed while giving allopurinol, as otherwise it predisposes dogs to the formation of xanthine stones and shells, making dissolution difficult. The long-term use of allopurinol as a preventative is not recommended but can be considered at low dosages when problems persist despite other treatment.

On average, it takes about 3½ months for stones to dissolve using allopurinol in combination with a low-purine diet and urinary alkalizination, but it can take as little as one month or as long as 18 months. As stones become smaller, they may move into the urethra and cause obstruction.

Some cases of severe kidney stones presumed to be ammonium urate resolved spontaneously following surgical shunt correction alone.

Monitoring Urine pH

Urinary pH can be monitored using test strips with the goal of maintaining a neutral (7.0) pH in dogs prone to urate stones. Test strips can be held in the urine stream or urine can be collected in a paper cup, bowl, or other container for testing. Collecting the urine makes it possible to check for tiny stones or gritty “gravel” that the dog might be passing as well as any blood, pus, or other indications of infection. The recommended testing time is first thing in the morning, before feeding.

A change in urinary pH does not indicate the presence or absence of stones but does reveal conditions that are more or less likely to trigger stone production and will show the effect of dietary changes on the dog’s pH. A sudden jump in pH may signal a bacterial infection, which requires medical attention. It’s important to control urinary tract infections in dogs prone to forming stones. If urine remains acidic and crystalluria (the formation of urinary crystals) persists, alkalizing agents such as potassium citrate or sodium bicarbonate can be added.

Testing for Canine Hyperuricosuria

Hyperuricosuria is characterized by the excretion of high levels of uric acid leading to urate stone formation. After the defective gene that causes hyperuricosuria was discovered by researchers at the University of California, Davis, a test was developed to detect the mutation associated with the disease. This test is valid for all breeds.

Dogs affected by hyperuricosuria have two copies of the mutation, one inherited from each parent. Dogs with only one copy of the mutation are symptom-free carriers who pass the mutation on to an average of 50 percent of their offspring. Breeders can use DNA testing to identify carriers and effectively erradicate hyperuricosuria from their lines in breeds other than Dalmatians. (At present, all Dalmatians registered in the United States are affected by the mutation. See “LUA Dalmatians”. When both dam and sire are clear of the mutation, all of their puppies will be clear as well.

The DNA test identifies dogs in three categories: clear of hyperuricosuria (the dog has two copies of the normal gene and no mutation), a carrier of hyperuricosuria (the dog has one copy of the normal gene and one of the mutation), or affected with hyperuricosuria (the dog has two copies of the mutation, causing high acid levels that can lead to urate stone disorders).

All dogs affected with hyperurico-suria are potential urate stone-formers. At any time, a combination of high-purine foods, insufficient fluids, insufficient opportunities to urinate, and overly acidic urine might cause the formation of urate uroliths. Periodic routine urinalysis to check for urate crystals can be used to monitor dogs with hyperuricosuria. The most accurate sample for this purpose is collected in the morning, assuming the dog has not urinated all night, so the urine is more concentrated. The sample should be collected in a clean glass, plastic, or other chemically inert container. To avoid false crystallization, the sample should not be refrigerated and should be tested within 30 minutes or as soon as possible.

While many Dalmatians never generate stones, it isn’t safe to assume that they can’t. In one widely reported case, a 13-year-old Dalmatian who had never shown symptoms began receiving two spoonfuls of a new supplement per day. Prior to this, his diet had been the same for all of his adult life. Within a few weeks, his urinary tract became completely obstructed by urate stones. While the supplement was low in protein (only 14 percent), its protein source was liver, a high-purine food.

The Low-Purine Diet

Reducing purines in food is an effective way to reduce the risk of urate stones. Because most high-protein foods are also high in purines, veterinarians often recommend switching urate-forming dogs to a low-protein diet. However, it is not the quantity of protein that causes urate problems; it’s the type of protein. Dalmatians and other urate-prone dogs thrive on protein-rich diets that are low in purines, while these same dogs can develop stones after eating low-protein foods that contain even small amounts of high-purine ingredients. Low-protein diets can lead to nutritional deficiencies when fed to adult dogs for long periods, and they are not appropriate for puppies and pregnant or nursing females at all. (See “The Side Effects of Low-Protein Diets,” below.)

Because it’s difficult to find commercial pet foods that are low in purines without being nutritionally deficient, many owners of urate-forming dogs feed a home-prepared diet. Australian veterinarian Ian Billinghurst, whose book Give Your Dog a Bone introduced the BARF (Bones and Raw Food or Biologically Appropriate Raw Food) diet to dog lovers around the world, describes how to adapt his menus for urate-forming dogs in a report posted at several websites.

“In Western countries today,” he says, “I am led to believe that a typical homemade diet for stone formers would contain about 80 percent rice, 10 percent vegetables, and 5 percent meat. This is an appalling diet to feed any dog. This is borne out by dogs forced to endure it. They suffer from numerous problems including continual hunger, a lack of energy, poor coat condition, and difficulty in maintaining weight or severe losses of weight.” Such a diet is not only deficient in protein, fat, vitamins, and minerals, he says, but it does not prevent stone formation.

The raw meaty bones Dr. Billinghurst recommends are chicken necks, chicken backs, chicken wings, and turkey necks. “Use plenty of puréed or pulped vegetables,” he says, “including lots of leafy greens. The diet could also include eggs, cottage or ricotta cheese, yogurt, and olive or flaxseed oil, supplemented with vitamin B complex, vitamin E, kelp, and a teaspoon of cod liver oil several times a week.” Cod liver oil is important for urate-forming dogs fed a homemade diet that does not include liver.

Feeding a changing variety of eggs, cheese, dairy products, and small amounts of medium-purine meat, poultry, and fish along with low-purine vegetables, fruits, and supplements – as well as ample water to keep urine diluted – can help any urate-forming dog stay healthy and happy.

Cystine Stones

Cystine is a sulfur-containing amino acid essential to the health of skin, hair, bones, and connective tissue. Excess cystine is normally filtered by the kidneys so that it doesn’t enter the urine, but some dogs are born with cystinuria, an inherited metabolic disorder that prevents this filtering action. When cystine passes into the urine, it can form crystals and uroliths.

Cystine stones are rare, representing 1 percent or less of uroliths identified in laboratories. Although any breed can develop cystinuria, certain breeds are most affected. An estimated 10 percent of male Mastiffs have cystinuria. It is also common in Newfoundlands, English Bulldogs, Scottish Deerhounds, Dachshunds, Staffordshire Bull Terriers, and Chihuahuas. Cystine stones are faintly radiopaque, which makes them more difficult to see on X-rays than stones that contain calcium.

There are at least two types of cystinuria. The more severe form affects Newfoundlands and, rarely, Labrador Retrievers, and possibly some other breeds and mixes. In these dogs, males and females are equally affected (though as always, males are more likely to become obstructed). The age at onset can be as young as 6 months to 1 year. Recurrence of stones following surgery is more rapid in these dogs, and they are more likely to form kidney stones. The gene that causes cystinuria in these breeds has been identified and a simple, reliable genetic test can identify both affected dogs and carriers.

In other breeds, dogs with cystinuria are almost always male. No genetic test is available for them, though the University of Pennsylvania School of Veterinary Medicine (PennVet) is collecting blood samples from affected Mastiffs and their genetic relatives to try to produce a DNA test. The average age at onset of clinical signs is about 5 years.

A basic urinalysis can sometimes detect cystine in urine, though this is the least reliable method of detection. A nitroprusside (NP) test performed at the University of Pennsylvania (PennGen) is considered more reliable. A quantitative amino acid analysis performed by PennGen or a human medical laboratory is most reliable but very expensive. If cystine is found in the urine on any of these tests, the diagnosis is considered positive for cystinuria, though that doesn’t necessarily mean the dog will form stones.

Unfortunately, a negative result on any of these tests does not guarantee that the dog is “clear.” Note that sulfa drugs and supplements, including sulfa antibiotics, MSM, and Deramaxx, may cause false positive results.

“Cystinuria is a particularly frustrating condition to manage,” says San Francisco Chronicle pet columnist Christie Keith, who started a Canine Cystinuria e-mail list and website when one of her Scottish Deerhounds developed cystine uroliths. “A dog known to have cystinuria may go his whole life without obstructing, while another dog, never diagnosed, can have a life-threatening obstruction as his first symptom. It’s not known at this time why some dogs with cystinuria form stones and others do not.”

Cystine, like all amino acids, is one of the building blocks of protein. That’s why most veterinarians (including many kidney specialists) prescribe a low-protein diet, speculating that reducing the cystine supply will reduce the formation of cystine stones. Another common recommendation is to alkalize the dog’s urine because cystine stones form in acid urine.

Unfortunately, says Keith, these strategies are ineffective. “Most of us on the Canine Cystinuria list have found that diet and urinary alkalization have failed to prevent our dogs from forming stones,” she says, “and they have sometimes caused other problems, including other types of stones that form in alkaline urine. If the urine goes into acidity even briefly, cystine stones can form and they won’t dissolve just because alkaline urine is achieved soon after. In addition, feeding ultra-low-protein diets can be dangerous, especially to giant breeds and breeds prone to cardiomyopathy.” (See “The Side Effects of Low-Protein Diets”, below.)

It’s important to provide your dog with extra fluids and frequent opportunities to urinate in order to keep his urine from becoming supersaturated. Salt should not be added to increase fluid consumption for dogs with cystinuria; according to studies conducted on humans, a low-sodium diet may decrease the amount of cystine in the urine.

If urine alkalization is attempted, the target pH is 7.0 to 7.5; higher can predispose dogs to calcium phosphate uroliths. Potassium citrate is preferred for alkalization when needed rather than sodium bicarbonate because sodium may enhance cystinuria.

Cystine stones cannot be dissolved with diet or supplements, but two prescription drugs can help dissolve and prevent them. Cuprimine (d-penicillamine) has potentially serious side effects but is less expensive and more readily available, and many dogs do well on it. According to Keith, Thiola (tiopronin, also referred to as 2-mercaptopropionylglycine or 2‑MPG), has fewer side effects, but one of them is the depletion of the owner’s bank account. Maintaining a giant-breed dog on Thiola can cost as much as $500 per month. Because the severity of cystinuria tends to decline with age, the dosage of preventative medications can sometimes be decreased or even stopped.

Dissolution requires a combination of medication, low-protein diet, and urinary alkalinization. Even then it may not be successful or practical for a dog with numerous stones. When it does work, dissolution commonly takes one to three months.

For some dogs, the solution has come not from prevention strategies or medication but from surgery. “It sounds extreme,” says Keith, “but many of us who have stone-forming male dogs with cystinuria have opted for a scrotal urethrostomy. This surgery redirects the dog’s urethra away from the penis to a new, surgically created opening in front of the scrotum.”

The wider opening that results enables males to more easily pass small stones and help prevent urinary blockages. “While future obstruction is not impossible,” says Keith, “this procedure reduces the risk substantially.” Still, she cautions, this surgery should not be undertaken lightly. It’s expensive, requiring the expertise of a skilled board-certified surgeon, and because the affected area is rich in blood vessels, there can be significant post-surgical bleeding, though the surgery is not particularly painful.

“The good news,” she says, “is that many dogs, including stone-formers and those who had serious complications when their condition was first diagnosed, have lived not just normal but longer-than-normal lives.”

The Remaining Three

Like cystine stones, stones composed of xanthine, calcium phosphate, and silica are rare, each representing less than 1 percent of analyzed uroliths. Ironically, they often occur while the patient is undergoing treatment for the prevention of other stones.

– Although xanthine is a type of purine, xanthine stones are associated not with diet but with the use of allopurinol. Xanthine crystals almost never occur naturally, though they have been reported in some cats, Cavalier King Charles Spaniels, and Dachshunds. The average age at onset is 6 to 7 years. Like urate stones, they are radiolucent; that is, they cannot be seen on X-rays.

In some cases, discontinuing allopurinol while feeding a low-purine diet has dissolved xanthine uroliths, but in general, treatment consists of surgical removal, urohydropropulsion (a nonsurgical procedure performed with the dog under anesthetic, in which the bladder is filled with saline through a catheter, and the bladder is manually squeezed to force stones out through the urethra), or lithotripsy (the use of high-energy sound waves to break up the stones).

A low-protein diet is usually recommended for dogs receiving allopurinol treatment (to help prevent formation of xanthine uroliths); but again, what’s really needed is a low-purine diet.

– Calcium phosphate stones often develop when the urine is over-alkalized (at a pH greater than 7.5), in an effort to prevent the formation of calcium oxalate, urate, or cystine stones. The average age at onset is 7 to 8 years, but these stones have been found in dogs of all ages, including puppies and seniors.

Calcium phosphate stones are commonly called apatite uroliths, with hydroxyapatite and carbonate apatite the most common. They are radiographically dense, so they are easily seen on X-rays. Uroliths composed primarily of calcium phosphate are rare and associated with metabolic disorders such as hyperadrenocorticism (Cushing’s disease), hypercalcemia, renal tubular acidosis, or excessive calcium and phosphorus in the diet.

Because they cannot be dissolved medically, these stones are usually removed surgically, though that may be unnecessary if the stones are clinically inactive (not growing or causing problems). They have been known to dissolve spontaneously following parathyroidectomy surgery for primary hyperparathyroidism. Unless the patient has a metabolic condition that contributes to calcium phosphate stones, the strategies used for prevention are similar to those used for calcium oxalate stones, although it’s important to avoid excessive alkalization of the urine.

Medications that can enhance calcium excretion, including prednisone and furosemide (Lasix), should be avoided if possible. Salt should not be added to the diet, as sodium increases urinary calcium.

– Silica stones are most common in male German Shepherds, Old English Sheepdogs, Golden Retrievers, and Labrador Retrievers, although other breeds and mixed breed dogs have developed them as well. More than 95 percent of silica stones occur in males. The problem can develop in dogs as young as four months or as old as 12 years, but most stones occur in dogs aged 6 to 9 years. Silica stones are radiopaque and can be seen on X-rays. No relationship has been found between urinary pH and silicate urolith formation.

The formation of silica stones is associated with diets high in cereal grains, particularly corn gluten and soy bean hulls, both of which are high in silicates. Corn gluten and soy bean hulls (also called soybean mill run) are ingredients in low-quality prescription diets and dog foods.

Other foods that are high in silica, and which should be avoided, include the hulls of wheat, oats, and rice (hulls are found in whole grains); sugar beets; sugar cane pulp; seafood; potatoes and other root vegetables; onions (which shouldn’t be fed to dogs, anyway); bell peppers; asparagus; cabbage; carrots; apples; oranges; cherries; nuts and seeds; grains; soybeans; and the herbs alfalfa, horsetail, comfrey, dandelion, and nettles. Bentonite clay, a mineral supplement, is also high in silicates.

Because no drug or diet dissolves silica stones, they may be removed surgically, flushed out with urohydropropulsion, or shattered with lithotripsy; no treatment may be required for clinically inactive stones. Silica stones do not usually recur, but it makes sense to feed a diet that is high in protein from animal sources and low in plant foods, including fiber and bran. As with all stones, keep the urine diluted by increasing fluids and giving your dog frequent opportunities to urinate. Don’t add salt, which is another source of silica.

Dogs who drink water from sources containing sand may develop silica uroliths, so water that contains silica (a primary mineral in sand) should be avoided. In hard-water areas, distilled water is recommended for dogs who form silica stones. Silica stones have also been associated with pica, an eating disorder that causes dogs to eat dirt, rocks, and other non-food items.

Mixed and Compound Uroliths

Most bladder stones are caused by a single type of mineral. Sometimes a stone consists of two or more minerals in approximately equal proportions, in which case it is called a mixed urolith. These stones are rare, comprising only 2 percent of analyzed uroliths.

A stone that consists of a core mineral surrounded by a smaller amount of a different mineral is called a compound urolith. These make up 10 to 12 percent of analyzed stones. Compound uroliths can sometimes be identified based on differing radiographic density of their stone layers.

Compound uroliths develop when a stone’s environment changes, such as when a struvite stone is treated by reducing urinary pH, magnesium, and phosphorus, resulting in a calcium oxalate shell around the struvite core. Struvite shells caused by infection commonly form over calcium oxalate and other cores, especially since all stones predispose dogs to bladder infections.

One treatment strategy is to try to dissolve the outer layer first. This is especially effective for stones with an infection-induced struvite shell, which make up more than 80 percent of compound uroliths with cores other than struvite. The struvite shell should dissolve with appropriate antibiotic or infection-fighting treatment. X-rays can be used to monitor dissolution. Once the outer shell disappears, treatment strategy switches to the inner core, also called the nucleus, or the stones may then be small enough to remove by urohydropropulsion.

More than half of the compound uroliths analyzed in 2002 by the Minnesota Urolith Center contained a calcium oxalate core, and almost all of these were surrounded by a struvite shell caused by infection. Unlike calcium oxalate uroliths, these compound uroliths were found primarily in female dogs; again, this is because the female dogs’ anatomy makes them more susceptible to urinary tract infections, which play a role in causing struvite stones. Treatment and prevention should be focused on controlling infections and reducing the risk of calcium oxalate stones.

Stones with a struvite core made up amost a quarter of compound uroliths, more than half of which were surrounded by a calcium phosphate shell and most of the rest by a calcium oxalate shell. As is common with infection-induced stones, most of these dogs were female.

Urinary acidifiers can contribute to urinary calcium that leads to the formation of calcium-containing stones. Treatment is the same as for struvites: appropriate medication for the infection and possibly a reduced-protein diet short-term to help dissolve the stones quickly. Urinary acidification is not recommended due to the increased risk of calcium oxalate and calcium phosphate formation.

Small percentages (3 to 5 percent each) of compound uroliths were comprised of the following:

- Silica core. Most of these had a calcium oxalate shell and were found in male dogs. Since both silica and calcium oxalate stones are associated with plant-based foods, diets containing substantial plant proteins should be avoided.

– Calcium phosphate core surrounded by struvite or calcium oxalate shells. These are treated the same way as struvite or calcium oxalate stones.

– Urate core, most of which were surrounded by struvite. Treatment is aimed at controlling the infection along with management of the urate core.

– Compound uroliths with a core or shell of xanthine are treated by discontinuing or reducing the dose of allopurinol.

Sulfa drugs may create a shell around struvite uroliths when used at high doses for prolonged periods, or in dogs with acidic or highly concentrated urine. For this reason, sulfa drugs should be avoided when treating lower urinary tract (bladder) infections, particularly for dogs known to have stones or one of these risk factors.

Preventive treatment should focus on whatever minerals comprised the stone’s inner core. As with all types of stones, increasing fluid intake and opportunities to urinate are recommended. Adding salt to the diet is not recommended, however, as it increases urinary calcium and calcium is commonly found in uroliths.

The Side Effects of Low-Protein Diets

Without sufficient protein in the diet, protein is pulled from muscles to meet the body’s requirements. Nutritionally inadequate, low-protein diets should never be fed to puppies or dogs who are pregnant or nursing, and they can cause health problems if given to adult dogs for prolonged periods.

According to the Merck Veterinary Manual (9th Edition, 2008), “The signs produced by protein deficiency or an improper protein-to-calorie ratio may include any or all of the
following: weight loss, skeletal muscle atrophy, dull unkempt coat, anorexia, reproductive problems, persistent unresponsive parasitism or low-grade microbial infection, impaired protection via vaccination, rapid weight loss after injury or during
disease, and failure to respond properly to treatment of injury or disease.”

Ultra-low-protein diets such as Hill’s Prescription u/d have been linked to dilated cardiomyopathy (DCM) in English Bulldogs, Dalmatians, and other breeds. Dogs with cystinuria, which predisposes dogs to carnitine deficiency even when a normal-protein diet is fed, are particularly at risk. Some Newfoundland dogs are prone to taurine deficiency leading to DCM even when fed regular commercial diets, especially lamb and
rice diets, though many manufacturers now add taurine to their lamb and rice diets to help prevent this side effect.

According to a study of cardiac function in healthy dogs fed protein-restricted diets published in the American Journal of Veterinary Research in 2001, “Dogs fed protein-restricted diets can develop decreased taurine concentrations…The possibility exists that AAFCO [Association Of American Feed Control Officials] recommended minimum requirements are not adequate for dogs consuming protein-restricted diets. Our results also revealed that, similar to cats, dogs can develop DCM secondary to taurine deficiency, and taurine supplementation can result in substantial improvement in cardiac function.”

Low-protein diets are not needed in most cases to prevent the development of kidney or bladder stones. lf you choose to feed a low-protein diet, you should supplement with carnitine and taurine to help prevent the development of DCM. Dogs with cystinuria may benefit from supplementation even if fed a regular diet. Suggested preventative dosages are 25 to 50 mg L-carnitine and 5 mg taurine per pound of body weight two or three times a day. For example, a 50-pound dog should receive 1,250 to 2,500 mg L-carnitine and 250 mg taurine twice or three times a day. Higher dosages are needed to treat DCM.

You can also add eggs and dairy products to a low-protein diet for dogs with hyperuricosuria to increase protein.

Preventing Recurrence

Once your dog’s stones are successfully treated, you’ll want to use the strategies described in this article to help keep them from coming back. Stone-forming dogs can be monitored by their veterinarians with X‑rays, ultrasound, and urinalyses.

Infection-induced struvites can recur in as little as a few days to a few weeks, while calcium oxalate and silica stones may take a few months to recur. Cystine and urate stones can recur rapidly. Some dogs continue to form stones despite diet changes and medical therapy. For them the key is monitoring with radiographic imaging (X-rays or ultrasound) at least every 3 to 6 months (more often to start with and for rapidly recurring types) in order to detect stones while they are still small enough to pass through the urethra using urohydropropulsion or catheter-assisted retrieval.

A final solution for males with recurring stone blockages is urethrostomy surgery, which redirects the flow of urine to avoid its normal narrow passage.

CJ Puotinen is the author of The Encyclopedia of Natural Pet Care and other holistic health books. She lives in Montana, and is a frequent contributor to Whole Dog Journal. San Francisco Bay Area resident Mary Straus has spent more than a decade investigating and writing about canine health and nutrition topics for her website, DogAware.com.

The post Treatment and Prevention of Kidney and Bladder Stones appeared first on Whole Dog Journal.

Last month, we described struvite stones. Struvites contain magnesium, ammonium, and phosphate. They almost always occur in the bladder in combination with a bacterial infection and are most frequently found in small-breed females.

This month, we examine calcium oxalate or “CaOx” stones.

Calcium oxalate stones
CaOx stones occur in both the bladder (lower urinary tract) and kidneys (upper urinary tract) of male and female dogs. Most calcium oxalate uroliths are nephroliths (found in the kidney), and most of the affected patients are small-breed males. CaOx uroliths are radiopaque and most are easily seen on radiographs (X-rays).

In addition to breed and sex, risk factors for CaOx stones include being overweight, under-exercised, neutered, and eating a dry food diet, which contributes to more concentrated urine. Small dogs are thought to be more susceptible because they drink less water relative to their size than large dogs do.

One risk factor is insufficient or abnormal nephrocalcin, a strongly acidic glycoprotein present in normal urine that inhibits calcium oxalate crystal growth. Dogs who produce normal and sufficient nephrocalcin have a reduced risk of developing calcium oxalate stones.

Certain prescription drugs contribute to the formation of CaOx uroliths. Prednisone and other cortisone-type medications prescribed for inflammatory illnesses such as arthritis, itchy skin, or inflammatory bowel disease, can contribute to the formation of CaOx stones. So can the diuretic drug furosemide (brand names Lasix or Salix), which is given to dogs with congestive heart failure. Thiazide-class diuretics are recommended in place of furosemide for dogs who are prone to forming CaOx stones. Some nutritional supplements, such as vitamins C and D, are believed to contribute to oxalate stone formation.

Uroliths can develop in any breed, but the greatest number of calcium oxalate stones presented for analysis have come from Miniature Schnauzers, Bichon Frises, Standard Schnauzers, Lhasa Apsos, Shih Tzus, Yorkshire Terriers, Miniature Poodles, Pomeranians, Parson Russell Terriers, Papillons, Keeshonds, Samoyeds, Chihuahuas, Cairn Terriers, Maltese, Toy Poodles, West Highland White Terriers, Dachshunds, and mixed breeds.

Cocker Spaniels, German Shepherds, Golden Retrievers, and Labrador Retrievers are believed to be at decreased risk of CaOx stones.

Conventional veterinary practitioners tend to consider calcium oxalate stones irreversible, unaffected by diet or medical therapy, and untreatable except by surgery. They may attempt to remove small bladder stones by flushing the bladder with sterile saline, or perform shock wave or laser lithotripsy (processes that break stones into small pieces that can be flushed out or excreted in the dog’s urine).

Uroliths pose a more serious problem for male dogs than females, because their urine travels through a hollow bone (os penis) that surrounds the urethra within the penis. The bone cannot stretch or expand to accommodate a stone traveling through it, and obstructions readily result.

For males with recurring stones, a surgical procedure called urethrostomy sends urine on a new path, avoiding the os penis. The urethrostomy creates a new urinary opening in the scrotum area. This type of surgery cannot be performed unless the dog is neutered; if he is intact, he can be neutered at the time of the urethrostomy.

In up to 60 percent of conventionally treated patients, calcium oxalate stones recur within three years. In dogs with Cushing’s Disease (hyperadrenocorticism) or excessive calcium in the blood (hypercalcemia), both of which predispose dogs to CaOx stones, the recurrence rate is faster. It’s important to treat these underlying causes, if found, to help prevent recurrence. The recurrence rate among Bichons is higher than for any other breed.

Calcium oxalate crystals are of concern, but their presence doesn’t necessarily mean your dog is at risk of forming stones. Crystals are significant only if found in fresh urine. Crystals that form when urine is refrigerated or analyzed more than 30 minutes after collection may be incidental and not indicative of a problem. Dogs with calcium oxalate crystals in fresh urine should be monitored, and if the finding continues, steps should be taken to reduce the risk of stone formation, particularly in breeds most commonly affected.

Death sentence to discovery
In 1997, Molly McMouse, a 14-year-old Lhasa Apso belonging to Leslie Bean of Houston, Texas, was diagnosed with very dense, inoperable calcium oxalate stones affecting both kidneys. Bean owned three more Lhasas – 15-year-old FuzzerBear, 13-year-old Peepers, and 11-year-old CB Wigglesworth – who were closely related to Molly. Fearful that her other dogs could be afflicted by the same condition, Bean had them tested, and was shattered when each received the same diagnosis.

“My husband and I were told that oxalates only proliferate in size and number,” she recalls, “and that as the calcification of their kidneys increased, all four of our dogs would die, probably within six to nine months.”

At the time, Bean was founding director of patient advocacy at the University of Texas MD Anderson Cancer Center, a position that helped her contact medical experts of every description. She checked with veterinarians, veterinary researchers, and directors of veterinary schools and laboratories around the country, only to receive the same sad news from all.

“Every one of them said these stones cannot be dissolved,” she says. “They all felt bad about it, but they agreed that the prognosis for my dogs was hopeless.”

Bean’s Lhasas had been on a premium, holistic food, but after their diagnoses, at the recommendation of their veterinarians, Bean put them on a low-protein, low-phosphorus, low-sodium prescription diet. The dogs disliked the new food and their to-the-floor show coats rapidly dulled.

At that point, Bean says, “I accepted the fact that my dogs were going to die but I wanted to make their final months as terrific as possible.” Tossing the prescription food, she began feeding fresh foods such as lamb and peas, chicken and rice, and beef and broccoli. “I figured if they had so little time, they were damned well going to enjoy what they ate,” she says, “and they loved it. I can still see them dancing with joy when I carried their bowls to their places. Literally within two weeks they began acting more energetic, looked younger, had a spring in their step, and their eyes were clearer. Their coats looked better, too, and we soon had to cut almost an inch in length from each dog every month. Although that is common in young Lhasas in show coat, the rate of growth slows with age, so this was a really noticeable difference.” Because oxalic acid forms strong mineral bonds that can become calcium oxalate crystals and eventually CaOx stones, Bean speculated that low-oxalate foods might help prevent the stones’ formation (see “Oxalates in food,” page 9), and she made those ingredients the foundation of her dogs’ menus.

Protein
In the past, diets restricted in both protein and phosphorus were thought to reduce the risk of calcium oxalate formation. Studies found, however, that dietary phosphorus restriction increased calcium absorption and the risk of calcium oxalate formation, while higher levels of dietary protein reduced the risk of uroliths. Current recommendations for dogs prone to forming CaOx stones say that diets should not be restricted in protein, calcium, or phosphorus.

In February 2002, The American Journal of Veterinary Research published a study conducted at the University of Minnesota College of Veterinary Medicine’s Minnesota Urolith Center that compared dietary factors in canned food with the formation of calcium oxalate uroliths in dogs, with surprising results. Canned diets with the highest amount of carbohydrate were associated with an increased risk of CaOx urolith formation. Contrary to commonly accepted beliefs, the study concluded that “canned diets formulated to contain high amounts of protein, fat, calcium, phosphorus, magnesium, sodium, potassium, chloride, and moisture and a low amount of carbohydrate may minimize the risk of CaOx urolith formation in dogs.”

In contrast, Hill’s Canine u/d, often prescribed for dogs prone to forming CaOx stones, is low in protein, calcium, phosphorus, magnesium, and potassium.

At the beginning of her nutritional experiment, Bean reduced her dogs’ protein levels so much that they began to lose muscle mass. “After much research, analysis, and discussion with my veterinarians,” she says, “I increased their protein levels to 33-40 percent of the total volume of food. They quickly regained their lost weight and muscle, and there were no further problems with muscle loss.”

As Bean discovered, it’s very important not to reduce protein too much. Even the most severely phosphorus-restricted diets for renal failure recommend feeding a minimum of 1 gram of protein per pound of body weight daily.

Recheck
As the Lhasas continued to thrive, their primary veterinarian, Jane Milan, encouraged Bean to return them for another ultrasound test to the veterinarian, a specialist in internal medicine, who had first diagnosed them. “I just didn’t want to hear bad news,” says Bean, “so I kept putting it off.”

Eight months after their diet change and past or near their predicted death dates, she made the appointment. “I was really nervous,” she says. “They looked terrific, but I had no way of knowing what was going on inside them. And the vet was with them for an unusually long time, which made me even more anxious.” Finally the somber-looking veterinarian returned to the waiting room carrying two of the dogs and said, “I don’t know how to tell you this.”

Bean assumed that her other two dogs had died during their ultrasound tests and she nearly fainted, but the vet’s good news revived her. The calcium oxalate stones that had been ticking time bombs were nowhere to be found. That’s what caused the long delay – he could not at first believe his test results. “The two older dogs still had five tiny stones,” she says, “but they had shrunk to the size of pin-dots, and they soon disappeared.”

Despite the kidney damage already caused by their calcium oxalates, each of the already senior Lhasas lived several more years. FuzzerBear died at age 19, the other three lived to be 18, and frequent check-ups showed all four to be completely free from calcium oxalate stones for the rest of their lives.

At the suggestion of their veterinarians, Bean continued to study canine nutrition and assembled a set of guidelines that described her dogs’ regimen.

“I am not a veterinarian licensed to practice veterinary medicine in any state and make no claims or representations as such,” Bean reminds everyone. “I am simply a pet owner whose dogs suffered from intractable problems. I developed FuzzerFood, named for Fuzzerbear, based upon the independent research I conducted to help my own dogs. My discoveries are not intended to be veterinary advice, nor are they a drug, biologic, or other therapeutic or diagnostic substance or technique designed to replace a consultation with a qualified veterinarian.”

She recommends that owners of dogs with calcium oxalate stones work closely with their veterinarians, beginning with a baseline ultrasound, complete blood panel, and urinalysis. “Start now if you have not already,” she suggests, “to maintain records of blood work and urinalysis reports as well as your own notes as you go.”

Water, the key ingredient
The most important thing you can do for a stone-prone dog is increase fluid consumption and opportunities to urinate. Urine becomes concentrated when insufficient fluids are consumed or when dogs are not able to relieve themselves and have to hold their urine for long periods. And concentrated urine contributes to supersaturation with minerals that can precipitate into crystals and lead to stones.

One way to encourage dogs to increase their water consumption is to add salt to their food, but salt is controversial when it comes to calcium oxalate uroliths. Increasing dietary salt encourages the kidneys to excrete more calcium, raising urinary calcium levels.

One might predict that increased sodium would therefore lead to increased calcium oxalate formation, but that isn’t necessarily true. In a 2003 study, dogs were fed dry diets containing varying amounts of sodium. The diets that contained 300 mg sodium (about ⅛ teaspoon of salt) per 100 calories significantly reduced urinary calcium oxalate supersaturation over diets containing 60 mg or even 200 mg sodium per 100 calories. Increased fluid consumption resulting from the thirst generated by additional salt probably offset the increase in calcium excretion. A human retrospective study published in 2009 concluded, “Increasing urine sodium does not appear to increase the risk of calcium oxalate nephrolithiasis (kidney stones).”

Bean, however, does not add salt to food. The majority of human studies indicate that adding salt is inadvisable, and many who elected to apply the FuzzerFood regimen for their own dogs were unsuccessful in attempts to dissolve or prevent recurrence of calcium oxalate stones when they departed from the guidelines Bean developed for her own dogs.

You can help your dog drink more by providing fresh water in clean dishes in several locations; changing the water frequently; adding small amounts of tuna water, salt-free or low-sodium broth, a favorite juice, or other flavoring agent to drinking water in addition to offering plain water; adding water to food; offering ice cubes as treats; using a pet water fountain to provide continuously filtered fresh running water; offering water at every opportunity; and carrying water and a portable bowl while hiking or traveling.

What type of water should you use? Bean prefers steam-distilled water because it contains no minerals that might combine with excess oxalic acid. Physicians she consulted with told her that both hard and soft water may increase the risk of calcium oxalate formation. Reverse-osmosis water filters remove 95 percent of minerals, making RO-filtered water nutritionally similar to distilled water.

Not all minerals in water contribute to kidney or bladder stones. In several studies conducted in the 1990s, human patients who formed calcium oxalate nephroliths drank a French mineral water containing high levels of calcium (202 parts per million) and magnesium (36 ppm). Nearly every risk factor for calcium oxalate nephroliths improved significantly. The same patients also drank local tap water and mineral water with low calcium/magnesium concentrations, neither of which improved the measured risk factors. The researchers concluded, “The risk of calcium oxalate stone formation can be significantly reduced by consumption of mineral water which is rich in calcium and magnesium.”

Other research on the effects of hard and soft water on urolith formation has shown mixed results regarding risk, possibly due to variations in mineral content and ratios, along with factors such as whether the water was given with or between meals. For this reason, distilled water may be safest, particularly for dogs with kidney stones or recurrent bladder stones.

Getting extra water into your dog is only part of the urolith-prevention strategy. Just as important is the frequent release of urine. Give your dog many opportunities to go outside during the day. If your dog is indoors alone or crated for hours each day, find a way to create a convenient elimination area using plastic, newspapers, towels, a patch of sod, or whatever you can devise to keep your dog from having to hold her urine for long periods.

Urinary pH
Calcium oxalate stones form in urine that is acidic, typically measuring between 5.0 and 6.5 on the pH scale. Calcium oxalate crystals are generally not sensitive to urinary pH, but marked acidification that induces metabolic acidosis can promote calcium oxalate stone formation due to increased urinary calcium concentration.

A common recommendation for dogs prone to forming calcium oxalate stones is to alkalize the body with foods or medications to bring the urinary pH closer to 7, which is neutral. Alkalizing the urine will not cause existing stones to dissolve but may help prevent new stones from forming. It’s important not to try to alkalize the urine too much, as this can lead to the formation of calcium phosphate stones.

You can monitor your dog’s urine by holding a pH test strip in the stream or by collecting urine in a paper cup or clean dish for testing.

But don’t be surprised if your dog’s urinary pH stays where it is. Leslie Bean describes her careful monitoring of her dogs’ urinary pH as a source of discouragement. “I thought that unless I could bring their pH higher, their stones would increase,” she says. “To the contrary, not only did they not increase, the stones dissolved. I learned that the key is to monitor the pH and know where you are, but not to panic if the urine stubbornly remains more acidic than you would like.”

Oxalates in food
Oxalic acid is found in both plants and animals, with plants containing higher levels. It forms strong bonds with sodium, potassium, magnesium, and calcium, creating oxalate salts. The term “oxalate” usually refers to a salt of oxalic acid, one of which is calcium oxalate. Sodium and potassium oxalate salts are water-soluble, but calcium oxalate is not, and it is what forms CaOx uroliths.

Interest in low-oxalate diets has increased recently because of possible links between oxalates and human kidney stones, arthritis, fibromyalgia, female vulvar pain, autism and other pervasive developmental disorders, and chronic inflammation. As a result, there is growing demand for accurate data on the oxalate content of foods. When Bean began her research 13 years ago, much of the information published about this subject was quite old. Eventually she found a small booklet published by the University of California at San Diego, “Oxalate Content of Select Foods,” which featured more current data and gave her a list of foods to include and avoid.

Today, the Oxalosis and Hyperoxaluria Foundation publishes an up-to-date list of foods and their oxalate content. Based on research from 2008 and revised as new figures become available, this report divides foods into very high, high, medium, and low levels of oxalates according to serving size. The foods in Group 1 (very high-oxalate foods) are best avoided by dogs prone to calcium oxalate stones. Group 2 (high-oxalate) foods should also be avoided.

Group 3 foods have moderate oxalate levels. They can be fed in moderate amounts as long as calcium is also given with the meal. Group 4 (low-oxalate foods) are “green light” ingredients, and can be fed in any quantity, though they should still be combined with calcium. See the complete list, available through the Oxalosis and Hyperoxaluria Foundation, for information about additional foods, including herbs, spices, combination foods, and beverages.

Some websites and publications incorrectly list meat, liver, other organ meats, shellfish, cheese, yogurt, broccoli, sardines, cherries, brussels sprouts, olives, and strawberries as dangerous for CaOx-sensitive dogs, based on outdated information. All of those foods are actually low in oxalates.

Designing the menu
Because it’s difficult to find commercial foods made without ingredients that are problematic for dogs prone to CaOx stones, home-prepared diets may produce the best results. For those who already feed a home-prepared diet to their dogs, the adjustments are simple. For those who are new to dog food preparation, designing an effective menu need not be complicated. Your dog’s food can be prepared along with your own meals or made in advance and refrigerated or frozen in single portions for later use.

Start by feeding different types of meat, poultry, eggs, fish, and dairy in order to provide a variety of flavors and nutrients. The food Bean feeds her dogs is about 40 percent protein by volume, but higher protein levels work well for many dogs. The rest of the diet should be low-oxalate grains and/or vegetables.

While Bean doesn’t include organ meats in her FuzzerFood guidelines, adding ½ ounce (about 1 tablespoon) of liver per pound of other foods will add valuable nutrients to a home-prepared diet.

Meat can be ground, cut into cubes, or served in a single piece, assuming your dog doesn’t have problems chewing. It can be fed raw or cooked. Because CaOx dogs on raw bone-based diets have continued to form stones, the FuzzerFood regimen does not include bones. Freeze-dried liver and similar dog treats are appropriate for training and special occasions. Avoid treats that contain high-oxalate ingredients, and factor treats into the daily food allotment of overweight dogs.

Boiling vegetables in water greatly reduces their oxalate content, while steaming reduces levels slightly. Of course, boiling reduces nutritional content, so it’s a trade-off. When you feed Group 3 (moderate-oxalate) vegetables, consider giving smaller amounts raw and larger amounts cooked. Adding digestive enzymes to food at serving time helps replace enzymes destroyed by heat.

Most 10-pound dogs need less than 1 cup of food by volume, while dogs weighing 50 pounds may need closer to 3 cups per day. Bean’s Lhasas maintain their 12- to 14-pound body weight on slightly more than 1 cup per day. The amount to feed will vary according to your dog’s activity level and the amount of low-calorie vegetables in the diet. Because key supplements should be given twice a day with food, consider feeding breakfast and dinner rather than one meal per day.

Calcium
In the past, calcium was thought to be a risk factor for the formation of calcium oxalate stones. Later studies found, however, that calcium binds oxalate and thus actually reduces the risk of calcium oxalate stones when given with meals.

When she spoke with urologists who deal with human kidney stones, Bean learned that supplementing homemade food with calcium citrate neutralizes oxalates in urine, so she began giving it to her dogs with meals while avoiding all other mineral supplements. “Citrate is an important natural inhibitor of calcium oxalate stones,” she says. “When calcium citrate is combined with food at mealtime, it helps absorb and bind excess oxalic acid in the gut. This bound oxalate cannot be absorbed and is excreted through the feces. This means that it does not get into the bloodstream or kidneys to cause stones.”

Pure calcium citrate powder is inexpensive and easy to use. Bean adds 300 to 350 mg of NOW brand Vegetarian Powdered Calcium Citrate to each 8 ounces (½ pound) of fresh food to balance the diet’s calcium:phosphorus ratio. Calcium citrate should only be added to homemade diets, or to the fresh portion of a combined diet, as commercial diets should already contain the right amount of calcium (though, unfortunately, they rarely use calcium citrate).

Supplements
For more than 40 years, the medical literature has reported on the success of a simple nutritional therapy for the prevention of calcium oxalate stones in humans using magnesium and vitamin B6. In studies published in The American Journal of Clinical Nutrition, The Journal of the American College of Nutrition, and other medical journals since 1967, patients with longstanding, recurrent calcium oxalate kidney stones received 200, 300, or 500 mg magnesium oxide with or without 10 mg pyridoxine (vitamin B6) daily for five years or more, during which their stone formation fell by more than 90 percent. When measured, their urine increased its ability to keep calcium oxalate in solution.

Because vitamin B6 deficiencies can contribute to an increase in oxalate production, many veterinarians prescribe this vitamin for dogs prone to CaOx stones. Severe vitamin B6 deficiencies may result from genetic disorders. Vitamin B6 is available as an oral supplement or by injection. Follow label directions or, if using a human product, give ¼ of the total dose for each 25 pounds of body weight.

A B-complex supplement provides all of the needed B-family vitamins. Give 50 mg twice per day to dogs weighing 50 pounds or more, and one-fourth or half that amount to smaller dogs. The FuzzerFood regimen includes Omega-3 fish or salmon oil, a B-complex vitamin, and vitamin E, with optional CoQ10, magnesium, glucosamine, digestive enzymes, and probiotics.

Magnesium can have a laxative effect, so begin at the low end of the range, which is 3 to 5 mg per pound of body weight per day, divided into morning and evening doses and given with meals. Magnesium supplementation is contraindicated for dogs in renal failure, so if that is your dog’s condition, use this under your veterinarian’s supervision only as long as there are stones, then discontinue.

Bean does not use either vitamin C or vitamin D (including cod liver oil, which contains vitamin D) because vitamin C is reported to convert to oxalate, thus possibly increasing the risk of stone formation, and vitamin D promotes calcium absorption, which leads to increased urinary calcium.Most multi-vitamins contain vitamins C and D, so it’s important to read labels.

Supplements manufactured for human consumption come in a wider variety than do veterinary supplements, making it easier to find human products that avoid these ingredients. Adjust the recommended human dose for your dog by weight.

Some researchers have found that glucosamine supplements, which are commonly used for arthritis, may help prevent calcium oxalate crystals from adhering to the bladder wall. While this treatment is still speculative, glucosamine is safe to give and may be helpful in preventing CaOx bladder stone formation.

When Bean asked Traditional Chinese Medicine veterinarian Cory Stiles, DVM, for advice from that perspective, Dr. Stiles recommended Lysimachia-3, a traditional Chinese blend of three herbs, Jin Qian Cao or Desmodium, Hai Jin Sha or Lygodium Spores, and Ji Nei Jin or Gallus, which is designed to treat human digestive disorders, gall stones, and kidney stones.

“Lysimachia-3 comes in tablets,” says Bean, “which we crushed and mixed with food, or the tablet can be placed in a small amount of low-fat cream cheese, or the dog can simply be ‘pilled’ by putting it down the throat. My dogs had no objection to having these tablets crushed and mixed with their food, and Lhasas are notoriously picky.” Dr. Stiles’ recommended dose is 1 tablet per 25 pounds body weight given twice daily until stones are dissolved. Then give Lysimachia-3 daily for another month, then start using it every other day, then every three days, and if all looks good, dose it three times per week every other week, and finally, daily for one week out of every four to six weeks.

Preventive medical treatment
Potassium citrate is a nutritional supplement that increases citrate levels in the urine, attracting calcium away from oxalates. When calcium binds to citrate, the resulting calcium citrate tends to remain dissolved instead of precipitating out as a mineral deposit. Potassium citrate also has an alkalizing effect on the urine, which can help to prevent the formation of calcium oxalate stones, though it won’t dissolve existing stones. High blood potassium levels are dangerous, so a veterinarian’s supervision and follow-up blood tests are recommended when using potassium citrate. This supplement should usually not be given when dietary changes alone maintain the urine’s pH at 6.5 or above.

Calcium citrate achieves the same goals of alkalizing urine and binding oxalates without the risk of elevated potassium that can be posed by potassium citrate. That’s why Bean considers calcium citrate a better option for her dogs’ homemade diets.

Dogs who continue to form stones despite other steps to minimize risk may be prescribed hydrochlorothiazide, a thiazide diuretic, to increase the amount of urine produced while reducing urinary calcium oxalate saturation.

The stress connection
In addition to good food and ample water, dogs need a stable home life, active exercise, and interesting activities. Some researchers speculate that stress plays a role in the development of kidney and bladder stones. When changing your dog’s diet, do what you can to keep the introduction of new foods fun and stress-free. Fortunately, most dogs love fresh food. Just as importantly, do what you can to relax and let go of the stress that concern about your dog’s health brings to your own life. The more you and your best friend enjoy each other’s company with play, exercise, and shared quiet moments, the better you’ll both feel.

Next month: The final installment of our bladder/kidney stone series examines cystine, calcium phosphate, silica, and ammonium urate or uric acid uroliths.

CJ Puotinen is the author of The Encyclopedia of Natural Pet Care and other holistic health books. She lives in Montana, and is a frequent contributor to WDJ.

San Francisco Bay Area resident Mary Straus has spent more than a decade investigating and writing about canine health and nutrition topics for her website, DogAware.com.

The post Preventing Bladder and Kidney Stones in Dogs appeared first on Whole Dog Journal.

1. Become familiar with the symptoms of dog bladder stones and respond quickly if you see them.

2. Request a urine culture and sensitivity test to check for infection even if your veterinarian doesn’t think it’s necessary.

3. Encourage your dog to drink extra water and give her frequent opportunities to urinate.

4. Don’t expect a low-protein diet to cure or prevent struvite stones.

5. Learn how to test your dog’s pH to check for recurring urinary tract infections.

Humans aren’t the only ones who get kidney and bladder stones. Our dogs develop these painful and dangerous conditions, too. But much of what is said and done about canine urinary tract stone disease (also known as bladder stones, urolithiasis, urinary stones, ureteral stones, urinary calculi, ureteral calculi, or urinary calculus disease), including its causes and treatment, is either incorrect, ineffective, or potentially harmful. Here’s the information you need in order to make informed decisions regarding dog bladder stones on behalf of your best friend.

Most canine uroliths, or bladder stones, fall into six categories, depending on their mineral composition:

• Magnesium ammonium phosphate (also called struvites)

• Calcium oxalate

• Ammonium urate or uric acid

• Cystine

• Calcium phosphate

• Silica

There are also compound or mixed stones consisting of a core mineral surrounded by smaller amounts of another mineral, most commonly a struvite core surrounded by calcium phosphate. In veterinary reports, the terms stone, urolith, and calculus (its plural is calculi) are used synonymously.

Because different stones require entirely different treatment -and often completely opposite treatment -it’s critical to identify the type of stone accurately. Without removing a stone there is no way to know for sure, but a good guess can be made based on urinary pH; the dog’s age, breed, and sex; type of crystals, if present; radiographic density (how well the stones can be seen on x-ray); whether infection is present; and certain blood test abnormalities.

Between 1981 and 2007, the Minnesota Urolith Center at the University of Minnesota’s College of Veterinary Medicine analyzed 350,803 canine uroliths. The highest percentage came from mixed breeds (25 percent), Miniature Schnauzers (12 percent), Shih Tzus (9 percent), Bichons Frises (7 percent), Cocker Spaniels (5 percent), and Lhasa Apsos (4 percent). The remaining 38 percent were collected from 154 different breeds.

Veterinary studies conducted around the world on millions of urinary stones show similar demographics. Although kidney and bladder stones can afflict dogs of both sexes, all breeds, and all ages, those at greatest risk are small, female, between the ages of 4 and 8, and prone to bladder infections. Although male dogs develop fewer stones, the condition is more dangerous to them because of their anatomy. Stones are more likely to cause blockages in the male’s longer, narrower urethra.

In 1981, 78 percent of all uroliths tested at the Minnesota Urolith Center were struvites and only 5 percent were calcium oxalate stones, but by 2006 the struvite occurrence had fallen to 39 percent while the incidence of calcium oxalate stones rose to 41 percent. Researchers investigating the trend have not discovered a reason for the change but are exploring demographic risk factors such as breed, age, gender anatomy, and genetic predisposition along with environmental risk factors such as sources of food, water, exposure to certain drugs, and living conditions.

Bladder Stones in Dogs

When bladder stones form, their minerals precipitate out in the urine as microscopic crystals. If the crystals unite, they form small grains of sand-like material. Once grains develop, additional precipitation can lead the crystals to adhere together, creating stones. Some stones measure up to 3 or 4 inches in diameter. Problems develop when stones interfere with urination.

Some dogs with stones never develop symptoms and their stones are never diagnosed or are discovered during routine physical exams when the abdomen is palpated. X-rays, which can be used to confirm the diagnosis, reveal stones as obvious white circles unless they are radiolucent (invisible to X-rays), in which case a dye injected into the bladder makes them visible.

Symptoms of stones can include blood in the urine (hematuria), the frequent passing of small amounts of urine, straining to produce urine while holding the position much longer than usual, licking the genital area more than usual, painful urination (the dog yelps from discomfort), cloudy and foul-smelling urine that may contain blood or pus, tenderness in the bladder area, pain in the lower back, fever, and lethargy. If a stone blocks the flow of urine, its complications can be fatal.

When surgery is necessary, uroliths are removed by a cystotomy, a procedure that opens the bladder. Stones lodged in the urethra can be flushed into the bladder and removed. Stones that are small enough to pass in the urine can be removed in a nonsurgical procedure called urohydropropulsion. A catheter is used to fill the sedated dog’s bladder with a saline solution and the bladder is squeezed to expel the stones through the urethra. Other procedures are used for more complicated cases.

All dogs who have formed a urolith are considered at increased risk for a recurrence. According to Dennis J. Chew, in a paper delivered at the 2004 Small Animal Proceedings Symposium of the American College of Veterinary Surgeons, “Water may be the most important nutrient to prevent recurrence of uroliths. Increased water intake is the cornerstone of therapy for urolithiasis in both human and veterinary medicine. Increasing water intake to dilute urine and increase frequency of urination is an important part of treatment. Decreasing the concentration of potential stone-forming minerals in urine and increasing the frequency of voiding are the key elements of therapy to reduce the risk of formation of a new urolith.”

It’s easy to interest most dogs in drinking more fluids by making sure that plain water is available at all times, adding broth and other flavor enhancers to water in an additional bowl, and adding water or broth to food. Just as important is the opportunity to urinate several times a day. Stones and crystals form in supersaturated urine, which can occur when dogs have to hold their urine for long periods.

This month, we’ll discuss struvite uroliths. Calcium oxalate uroliths will be discussed in the next issue.

Struvite Stones in Dogs

Struvite uroliths belong to the magnesium ammonium phosphate (MAP) category. Struvites are also known as triple phosphate uroliths, a term dating from an old, incorrect assumption that the struvite crystal’s phosphate ion was bound to three positive ions instead of just magnesium and ammonium. Although struvites can develop in the kidneys, where they are called nephroliths, the vast majority are bladder stones. About 85 percent of all struvite stones are found in female dogs and only 15 percent are found in males.

Struvite stones usually form when large amounts of crystals are present in combination with a urinary tract infection from urease-producing bacteria such as Staphylococcus or Proteus. Urease is an enzyme that catalyzes the hydrolysis of urea, forming ammonia and carbon dioxide. It contributes to struvite stone formation as well as alkaline (high-pH) urine.

Caregivers and veterinarians obviously want to prevent and treat struvites as effectively as possible. But what works and what doesn’t is a topic of confusion.

Struvite Stone Facts or Fiction?

All of the following statements are believed by many veterinarians and their clients. Yet none of them are true. Which have you heard before?

1. Urinary struvite crystals represent disease and require treatment.

2. Struvite crystals require a change in diet, usually to a prescription diet like c/d, u/d, or s/d.

3. Dogs prone to forming struvite stones should be kept on a special diet for life.

4. The most important treatment for dogs with a history of struvite stones is a low-protein diet.

Here’s why these common beliefs are misconceptions:

1. The presence of urinary struvite crystals alone does not represent disease and does not require treatment. These crystals can be found in the urine of an estimated 40 to 44 percent of all healthy dogs and are not a cause for concern unless accompanied by signs of a urinary tract infection. According to the Merck Veterinary Manual (2005), “Struvite crystals are commonly observed in canine and feline urine. Struvite crystalluria in dogs is not a problem unless there is a concurrent bacterial urinary tract infection with a urease-producing microbe. Without an infection, struvite crystals in dogs will not be associated with struvite urolith formation.”(Our emphasis.)

Whether your struvite-crystal dog has a urinary tract infection is the key question. Researchers estimate that more than 98 percent of all struvite stones are associated with infection. Failing to eradicate the original infection and prevent new bacterial infections is the main reason struvite uroliths recur. A recurrence rate of 21 percent was recorded in one study, but the risk can be significantly reduced through increased surveillance and appropriate antimicrobial treatment. In one study, dogs were infected with an experimental Staphylococcal urinary tract infection, and their infection-induced struvites grew large enough to be seen on X-rays within two to eight weeks.

2. Struvite crystals do not require a change in diet. Because struvite crystals do not pose a problem unless the dog has a urinary tract infection, there is no required treatment for crystals, including dietary changes. If the dog does have a urinary tract infection, a prescription dog food will not cure it.

If your veterinarian finds struvite crystals in the urine and suggests a diet change, you’d be well advised to find a new vet. You have to wonder how many other things he or she is misinformed about. It isn’t just a case of not keeping up with newer research; this recommendation is just plain wrong.

3. Dogs prone to forming struvite stones should not be kept on a special diet for life. Struvites almost always form because of infections, for which dogs with a history of stones should be closely monitored and properly treated. No long-term dietary change is required, nor will a special diet prevent the formation of infection-induced struvites. However, short-term changes may help speed the dissolution of stones.

4. Low-protein diets do not prevent stone formation. A low-protein diet can speed the dissolution of struvite stones -when accompanied by appropriate antibiotic treatment -but it is not necessary for the prevention of struvite formation in dogs who are prone to this problem. For almost all dogs, controlling infections will prevent more stones from forming.

“Sterile Struvites”

Not all struvite stones are caused by Staphylococcus, Proteus, or other bacteria. Between 1 and 2 percent of struvites are called sterile because they do not involve an infection. They are also known as metabolic struvites.

These stones are treated in much the same way as infection-induced struvites, and they tend to dissolve more quickly. Urinary acidifiers can be used to help dissolve sterile struvites, and feeding a low-protein diet may help speed their dissolution.

Several reports in the veterinary literature describe the spontaneous dissolution of sterile struvite uroliths within two to five months in dogs fed a maintenance diet, demonstrating that these stones can disappear within a short time without the use of a calculolytic diet.

To prevent the formation of future sterile struvites, the most effective methods appear to be urinary acidification and increased fluid intake. The amino acid dl-methionine, which is available in tablet form, is commonly used when needed to keep the urine acidic. It will not help and should not be given to dogs who form infection-induced struvites.

The conventional recommendation for treatment and prevention of sterile struvites is to feed a diet with reduced phosphorus and magnesium content, but it’s questionable whether that’s needed as long as the urine is kept slightly acidic (at a pH below 7.0) and the dog is encouraged to drink more and has ample opportunity to eliminate in order to avoid supersaturated urine.

Even though a meat-based diet is high in phosphorus, meat has an acidifying effect on the urine and may therefore be beneficial for the prevention of sterile struvites as well as providing more complete nutrition in a form that the dog most enjoys.

Dietary starch and fiber potentially stimulate the formation of struvite crystals, so reducing dietary carbohydrates helps prevent struvite urolith formation.

The Low-Down on Low-Protein Diets for Dogs

Several prescription dog foods are marketed as a treatment for struvite crystals and struvite stones. These are called calculolytic foods or diets, and nearly all of them are severely protein-restricted, phosphate-restricted, magnesium-restricted, highly acidifying, and supplemented with salt to increase the patient’s thirst and fluid consumption.

While a low-protein diet is not required to dissolve struvite stones, it can speed their dissolution (when accompanied by appropriate antibiotic treatment). Protein provides urea, which bacteria convert or “hydrolyze”into ammonia, one of the struvite building blocks. However, this approach is not a long-term solution and will not prevent the formation of infection-induced stones. Feeding a low-protein diet to an adult dog to help dissolve stones is acceptable for short periods. Because they are not nutritionally complete, however, low-protein foods are harmful to adult dogs if used for more than a few months, and they should never be fed to puppies.

If stones are not present, there is no reason to feed a low-protein diet. According to Dr. Chew, “No studies exist to show that a specific diet is helpful for the prevention of infection-related stone development.”

In general, the benefits of a meat-based diet far outweigh the risks posed by protein’s ammonia generation. Plus, by feeding your dog a home-prepared diet of fresh ingredients, you can provide food that is higher in quality and much more to your dog’s liking than diets that come out of cans or packages.

Other prescription pet food strategies -such as keeping the diet low in fiber so that fluids are not lost through the intestines, using highly digestible ingredients for the same reason, and increasing the dog’s fluid intake by adding salt to the diet -can be better accomplished with a home-prepared diet and management techniques that encourage the dog to drink more water. The more concentrated the urine, the more saturated it becomes with minerals that can precipitate out, so extra fluids, which dilute the urine, reduce the risk.

Urinary acidifiers are not used to dissolve or prevent stones caused by urinary tract infections, since acidification does not help while an infection is present.

The Importance of Urinary Culture and Sensitivity Tests

It’s important to know that urinalysis can’t always detect a bladder infection; urinalysis may appear normal as frequently as 20 percent of the time when a urinary tract infection is present.

For this reason, if your dog shows possible signs of infection, you need to request a “urinary culture and sensitivity test.”This will verify the diagnosis (in some cases the problem is something other than an infection) and, if it is an infection, it will reveal which antibiotic will be most effective for treatment. Using an ineffective antibiotic not only harms the patient by delaying proper treatment, but also contributes to the spread of drug-resistant bacteria. Antibiotic therapy must be continued as long as struvite stones are present, since the stones harbor bacteria that are released as the stones dissolve.

Dogs who are prone to frequent infections may need longer antibiotic therapy -of at least four to six weeks -to completely eradicate the infection. Some dogs need continuous or “pulsed”antibiotic therapy to prevent recurring infections. A few may need surgery to correct structural defects that make them prone to infection, such as a recessed vulva. This condition usually corrects itself following first heat but may continue to cause problems for females who are spayed prior to their first heat.

Ureaplasma bacteria, which can cause struvite stones, will not show up on a regular urine culture, but you can request a special culture to look for this type of bacteria. This should be done before one assumes that the patient’s struvites are sterile (see “Sterile Struvites,”page 13) rather than infection-induced.

Follow-up tests will show whether the therapy your dog received, such as antibiotics from a conventional veterinarian or an alternative infection-fighting treatment from a holistic vet, was effective. You want to be sure that the treatment worked and that the infection isn’t coming back. For dogs with a history of forming struvite stones, or who suffer from multiple urinary tract infections, cultures should be repeated a few days after treatment ends and then periodically, such as monthly for a while and then at longer intervals, to be sure the infection is completely cleared.

At-Home Urinary Tract Infection Prevention

To keep your dog healthy, it’s important to prevent the conditions -especially, urinary tract infections -that can lead to stone formation.

Monitoring your dog’s urinary pH at home will alert you to any recurring bladder infection. The numbers refer to acidity and alkalinity, with 7 considered neutral (neither acid nor alkaline). Numbers less than 7 indicate acidity, and the lower the number, the more acid the substance. Numbers greater than 7 indicate alkalinity, and the higher the number, the more alkaline the substance. Most healthy dogs have a neutral to slightly acid urinary pH between 5.5 and 7.0.

Because urinary pH varies throughout the day, test your dog’s urine at the same time each day to determine her “normal”pH. The best time to do this is first thing in the morning, before she eats. Urine should be tested before it hits the ground. You can collect some in a paper cup or simply hold a pH test strip in the stream. An advantage to paper cup collection is that you can also check the urine for blood, cloudiness, and other indications of infection.

The urinary tract infections that cause struvite crystals to become uroliths have an alkalizing effect, raising urinary pH to as much as 8.0 or 8.5. If your dog’s urinary pH jumps from acid to alkaline, contact your veterinarian.

Other preventive measures include giving your dog cranberry capsules, apple cider vinegar, probiotics, and vitamin C.

Cranberry doesn’t cure existing infections, but it mechanically prevents bacteria from adhering to the tissue that lines the bladder and urinary tract. Because they are continuously washed out of the system, bacteria don’t have an opportunity to create new infections. Cranberry capsules are easier to use and more effective than juice, since they are far more concentrated. On product labels, the terms cranberry, cranberry juice, cranberry extract, and cranberry concentrate tend to be used interchangeably.

If your cranberry capsules are a veterinary product, follow label directions. If they’re designed for humans, adjust the dosage for your dog’s weight by assuming that the label dose applies to a human weighing 100-120 pounds. Giving cranberry in divided doses, such as twice or three times during the day, will make this preventive treatment more effective.

Probiotics are the body’s first line of defense against infection, and the more beneficial bacteria in your dog’s digestive tract, the better. Probiotics are routinely used by a growing number of medical doctors and veterinarians to treat urinary tract and vaginal infections in women and pets.

Several brands of probiotics are made especially for dogs. Because antibiotics destroy beneficial as well as harmful bacteria, the use of probiotic supplements after treatment with antibiotics helps restore the body’s population of beneficial bacteria. (See “Probing Probiotics,” WDJ, August 2006 for more information.) Many veterinarians recommend vitamin C for dogs who are prone to bladder infections and struvite stones because of its anti-inflammatory effects. Dogs (unlike humans) manufacture their own vitamin C, but the amount they produce may not meet their needs if they are under stress or fighting infection.

The ascorbate form of vitamin C is most often recommended for dogs, as it may be better absorbed and is less prone to causing gastrointestinal upset. Calcium ascorbate and sodium ascorbate are available in generic forms as a powder, but the most popular form is a product called Ester-C, which contains calcium ascorbate and vitamin C metabolites.

Veterinary recommendations range from 250 mg twice per day for every 15 to 30 pounds of body weight up to a maximum of 1,000 mg twice a day for large dogs. Because vitamin C can cause diarrhea, start with small doses and increase gradually. The maximum amount your dog can tolerate without the diarrhea side effect is called her “bowel tolerance”dose.

The herb uva ursi (Arctostaphylos uva-ursi) is used in many herbal blends for bladder infections because of its antibacterial properties. Uva ursi is best used for short periods rather than for months at a time as it can irritate the kidneys. The dosage for this herb depends on the individual blend and how it was prepared. Follow label directions for products formulated for dogs; adjust the dosage of products meant for humans by weight, assuming the human’s weight at 100 to 120 pounds.

While adding salt to your dog’s food is an effective way to encourage drinking more fluids for dogs who don’t tend to drink enough, consider switching from refined table salt to unrefined sea salt, which is sold in natural food markets and contains dozens of minerals and trace elements that are not present in refined salt.

Since most homemade diets are low in salt compared to commercial foods, the amount of salt to add will depend on the diet you feed. Start by adding a pinch of salt (small for a small dog, larger for a large dog) to your dog’s food and watch to see if it makes her more thirsty. Increase the amount by a pinch at a time until she is drinking more than usual.

Traditional broth or stock is easy to make at home by simmering chicken, beef, or other bones in water overnight or for 24 to 36 hours. If desired, add carrots and other vegetables. Replace evaporating water as needed. The longer the simmer, the more nutritionally dense the broth and the more interesting it is likely to be to your dog. Broth can be used as a flavor enhancer when strained and added to food or given in addition to water. Be sure to provide plain drinking water at all times.

Struvite stones can make any dog miserable, but by understanding how and why they occur and by taking the preventive measures described here, you can be sure that your dog lives a happy, stone-free life.

Resources

Minnesota Urolith Center at the University of Minnesota College of Veterinary Medicine

pH test strips from Solid Gold Natural Health for Pets

pH test strips from Micro Essential Laboratory

CJ Puotinen is the author of The Encyclopedia of Natural Pet Care and other holistic health books. She lives in Montana, and is a frequent contributor to WDJ.

San Francisco Bay Area resident Mary Straus has spent more than a decade investigating and writing about canine health and nutrition topics for her website, DogAware.com.

The post Canine Kidney Stone and Bladder Stone Prevention appeared first on Whole Dog Journal.

When my dog Popcorn woke up one morning many years ago in a puddle of urine, I panicked, certain that only a deadly illness could cause this perfectly housetrained dog to wet her bed. I rushed her to the vet, where he did a thorough physical exam and urinalysis. I can still remember the relief I felt when my vet told me it appeared to be a simple case of incontinence.

As it turns out, incontinence, which is defined as involuntary urination, is quite common in dogs, especially spayed females, where about one in five dogs (20 percent) is affected.

Estrogen responsive incontinence or hormonally responsive incontinence, commonly called spay incontinence, is the most frequent cause of involuntary urination in dogs. It can occur anywhere from immediately after spaying to 10 years later, with the average being around three years.

Low estrogen levels and other factors can lead to a weak bladder sphincter, resulting in anything from small urine drips to complete emptying of the bladder, usually while sleeping or resting. Leaking can happen daily or just periodically. Large breed dogs are more commonly affected than small breeds, and German Shepherds, Boxers, Spaniels, and Doberman Pinschers appear to be more at risk than other breeds.

A recent study showed that early spaying (before the first heat) reduced the chance of incontinence, from 18 percent to 9.7 percent in large breed dogs, but increased the severity when it occurred. It is possible that spaying midway between heat cycles may help prevent spay incontinence, but this is just speculation, as no studies have been done. Hormone-related incontinence can also affect neutered males, though much less commonly than females.

Incontinence can occur for many other reasons, including urinary tract infections, bladder stones, congenital structural defects (e.g., ectopic ureters), spinal cord disease, and excess water intake. Older dogs, overweight dogs, and dogs with neurological problems may develop a weak bladder sphincter. These causes of incontinence can affect dogs of both genders, whether intact or neutered.

When additional symptoms such as frequent urination, painful urination, trying to urinate without success, or blood in the urine are seen, then urinary tract infection (UTI) or stones (uroliths) are likely. Keep in mind that about 20 percent of UTIs will not show up on urinalysis alone, so it’s important to do a urine culture to rule out infection.

Neurological problems should be suspected when signs such as weakness in the rear, stumbling, or incoordination are present. Ectopic ureters are the most common cause of incontinence in young female dogs (under a year); they are uncommon in males.

Most causes of incontinence other than weak bladder sphincter can be identified from a urinalysis and urine culture, but sometimes it is necessary to see a specialist. Additional tests that can be done to find the cause of incontinence include X-rays or ultrasound to look for bladder stones or structural defects, dye contrast studies, and exploratory surgery.

In addition to being a problem for the owner who has to clean up after a leaky dog, incontinence can be very distressing to dogs who are housebroken, and can also lead to urinary tract infections, vaginitis, and sometimes skin ulcers caused by urine scald and licking.

Incontinence should be suspected as a contributing factor in dogs with recurrent bladder or vaginal infections. Incontinence aids such as doggie diapers and pads to protect furniture and dogs beds are available, but it’s very important to keep the dog clean and to get the incontinence under control, if at all possible. Baby wipes can be used to keep the skin clean, and will also soothe irritation, as does aloe vera gel. Use only those lotions that will not be a problem if a dog licks and ingests them.

Treatment
Treatment of incontinence is usually simple and effective. There are many different ways of treating incontinence, and the choice may depend on the cause. Phenylpropanolamine (PPA), a decongestant that helps to tighten the sphincter muscle, is the most commonly used treatment for incontinence in both male and female canines.

Spay incontinence can also be treated with estrogen supplements, usually in the form of DES (diethylstilbestrol), but estradiol, a more natural form of estrogen, can be used. Neutered males with hormonally caused incontinence may respond to monthly testosterone injections, though these can also lead to urine marking and an increase in aggressive behavior.

Ectopic ureters, where the tubes leading from the kidney do not properly connect to the bladder, require surgical correction. A new surgery using collagen injections is now available for incontinence that does not respond to any other form of treatment.

Natural treatments are frequently helpful for incontinence, once more serious conditions have been ruled out. Herbs, acupuncture, chiropractic treatment, and homeopathic remedies have each helped many dogs. Feeding a homemade diet can also make a difference.

Conventional treatment options
PPA (phenylpropanolamine) is the most commonly used veterinary treatment for incontinence in both male and female dogs. It is a decongestant that works by tightening the sphincter muscle from the bladder. PPA is effective in controlling incontinence in about 70 percent of dogs who try it, with improvement in most of the rest. A veterinary PPA product called Proin comes in chewable tablets made for dogs, and is also available in liquid form.

PPA must be given daily, usually two or three times a day, as its effect lasts only 8 to 12 hours. It can be used on an as-needed basis for dogs who have only occasional problems with incontinence. Most dogs tolerate PPA without any problems, but side effects can include irritability, nervousness, panting, restlessness, rapid heartbeat, and excitability. PPA should not be given to dogs with high blood pressure or heart disease. PPA has been removed from over-the-counter human products due to an increased risk of stroke, but this side effect is not a concern with dogs.

DES (diethylstilbestrol), a synthetic form of estrogen, can be used to treat spay incontinence. It is given daily for the first week, and then dosage is dropped to once or twice a week. It’s important when using this treatment to experiment and find the lowest possible dose that will work to control the incontinence, once it has been found to be effective. Estrogen supplements are considered relatively safe, but in rare cases they can cause bone marrow suppression leading to anemia that does not go away when the treatment is stopped. Higher doses and non-DES forms of estrogen are more likely to cause this effect. DES is readily available thru compounding pharmacies.

PPA can be combined with DES when needed to control difficult cases. Imipramine (Tofranil), a tricyclic anti-depressant that causes urine retention in some patients, is occasionally combined with PPA for dogs who do not respond to other medications.

A natural estrogen supplement called Genesis Resources Canine Incontinence Support is available for treating spay incontinence, as are ovarian glandular products. I have heard reports of each of these working for some dogs.

Herbal treatment options
There are several natural treatment options for incontinence, including a number of different herbs. Corn silk is the herb most commonly used to treat incontinence. It can be given in capsules, brewed into tea, or made into a tincture.

Beth Teffner of Ohio has a four-year-old Doberman, Inga, who was rescued from a puppy mill. Inga has spay incontinence, which Teffner has treated successfully with corn silk. “We first tried giving her Proin, but it made her cranky,” says Teffner. “Inga now gets three capsules of corn silk (425 mg) a day, two in the morning and one in the evening, opened and sprinkled over her food. She leaks only when extremely tired. She is dry 90 to 95 percent of the time.”

Teas made from corn silk (and other herbs) may be more effective than capsules. To make an herbal tea, add 1 tablespoon of fresh or dried herb per 2 cups of boiling water. Give 1 teaspoon of strong tea per 20 pounds of body weight, twice a day. Other herbs that can help with incontinence include raspberry leaf, horsetail, saw palmetto, nettle root, couch grass, uva ursi, agrimony, marshmallow, and plantain.

Glycerin tinctures (also known as glycerites) containing these herbs in any combination are another alternative. Give 12 to 20 drops of glycerite per 20 pounds of body weight, twice a day.

There are also commercial herbal blends made for dogs with incontinence. Products that have worked for some include Azmira’s Kidni Kare, Animals’ Apawthecary’s Tinkle Tonic, and Vetri-Science Bladder Strength for Dogs.

Traditional Chinese medicine (TCM) also offers herbal combinations for controlling incontinence. Chinese herbs helped Ben, a 13-year-old Border Collie owned by Laura Miller of Lovetteville, Virginia, after the dog started leaking urine about six months ago. The leaking began with a urinary tract infection, but continued after the infection was gone.

“While Proin controlled the problem, it seemed to make him grouchy to the point where the other dogs in the house were avoiding him,” says Miller. “With the help of a veterinarian who practices both conventional and holistic medicine, we were able to switch him to a Chinese herbal combination that has been as effective as the Proin, without the grumpiness.”

The formula her vet prescribed is called Sang Piao Xiao San – Mantis Formula 524, from Sun Ten. (Note: Chinese herbal formulas are typically custom-prescribed for the unique needs of the patient, rather than indicated for specific sumptoms. Your veterinary TCM practitioner may prescribe a different Chinese herbal forumula for the same condition in your dog.)

Diet can make a difference
Some dogs stop being incontinent when all grains are removed from their diet. Maizey, a 12-year-old Bull Terrier owned by Shari Mann of San Francisco, is one of those dogs. “Soon after she was spayed, Maizey started dribbling, especially at night or when taking a long nap,” Mann says.

“Maizey has eaten a raw, grain-free diet since 12 weeks of age. The only grains she ever got were in my home-baked cookies made from liver and organic wheat. I stopped giving her the cookies, in an effort to help with a yeasty ear problem. To my utter surprise and delight, not only did her ears clear up, but her dribbles also stopped. I did not believe it. Just to be sure, I again gave her one cookie a day for two weeks, and she began dribbling again.” Maizey has been off all grains, and free of incontinence, for 10 years.

Judi Rothenberg’s Doberman Lucy is another dog who responded to the elimination of grains from her diet. Although DES was effective in controlling Lucy’s spay incontinence, Judi preferred something natural. “I give Lucy corn silk (¼ teaspoon twice a day), but removing grains from her diet helped the most. As long as I remember not to give her treats with grains in them, Lucy no longer needs the DES.”

Sometimes, just a homemade diet can help, even if it includes grains. Judy Coates of Pennsylvania had two male beagles, Guillaume and Darwin, who were neutered in April 2003, when Guillaume was 10 and Darwin was 9 years old.

“At the time of neutering they were eating a high quality dry food,” Judy says. “After a few months they started leaking while they were relaxed or sleeping. I increased the amount of fresh food I added to their kibble, and eventually began feeding all home-cooked meals at the beginning of 2005. As soon as they started to get fresh food, their water intake dropped and the leaking went away. Even now, with Guillaume testing positive for Cushing’s and drinking more water than he did, he still has no problem with leaking.”

When preparing homemade diets, keep in mind that certain vegetables, such as parsley and celery, have diuretic properties and may increase leaking.

Other natural treatments
Incontinence may respond to alternative treatments such as chiropractic adjustments and acupuncture. Acupuncture may be particularly effective if done on the spay incision.

Maggie is a 10-year-old Vizsla owned by Maisie Griffiths in Canberra, Australia, and fed a raw, grain-free diet. “Maggie began to have some episodes of incontinence about a year ago, just dribbles that only occurred in her sleep,” says Griffiths.

“The leaking increased at the same time that she began to show more obvious signs of the effects of her spondylosis. My vet is also a chiropractor; we began to give Maggie chiropractic treatments. The urine dribbles turned into floods for a few days following each treatment and then returned to dribbles. We continued the treatments as her movement was improving. Gradually, the incontinence following each treatment completely disappeared, along with the original dribbles.” Griffiths reports that Maggie now moves better than she did two years ago and has no incontinence at all.

Homeopathic remedies, both individual and combinations, have helped many dogs. Jo Wells of Euless, Texas, has a 10-year-old Rottweiler mix also named Maggie who was diagnosed with spay incontinence about a year ago.

Wells says, “We tried corn silk capsules with no success. The homeopathic formula Leaks No More from Homeopet worked for us, but I quit using it because of the expense. It comes in such a small bottle and using it three times a day it only lasted about 10 days for a large dog. I switched to Herbasaurs Bedwetting homeopathic formula made for children. It has worked for us and a bottle lasts me for three to four weeks. I just put it in her food and she scarfs it right down.”

Other homeopathic remedies recommended for dogs with incontinence are Sepia, Solidago (goldenrod), and Hyland’s EnurAid.

A combination of treatments
For some dogs, the treatment isn’t so simple. Mindy Fenton of Southern California adopted a two-year-old Chow also named Maggie who leaked urine continuously. Maggie was diagnosed with an ectopic ureter using a dye test. Fenton explains, “The ureter was attached to the kidney but at the distal end it emptied right out instead of going into the bladder. The vets said it was probably genetic. Maggie could hold no urine; her bladder never filled. She would squat and try to pee but she also constantly leaked.”

Maggie required surgery to correct this defect. The surgery was successful and allowed Maggie to urinate normally, but she continued to have problems with dribbling during any kind of stress. “The specialist had told me at the time of surgery that it is common for dogs with an ectopic ureter to not be fully continent post-surgery. Within a couple of months after surgery, Mags was greatly improved but she would still leak from time to time, and the leaking made her susceptible to bladder infections.”

Fenton tried DES, which didn’t help at all, but she had success using Proin. She preferred more natural methods, however. “I used a number of supplements, including vitamin C, cranberry capsules (which help prevent bladder infections), and Animals’ Apawthecary’s Tinkle Tonic. I would make my own tincture using corn silk in an alcohol (brandy) base and I added uva ursi. I tried adding corn silk directly to her food, but that did nothing. Switching to a raw, grain-free diet helped quite a bit. Mags was nine years old when I made the switch.”

This approach worked most of the time, but under stress, the dribbles would return. “When she would drip, I would give her PPA, twice a day, which I usually had to do only for about three days at a time. I also used PPA as a preventative when I knew there was going to be stress and thus a high likelihood that she would drip.”

Incontinence secondary to other diseases
Sometimes incontinence is secondary to other disorders, so treatment is directed at the primary disease. Any illness that causes the dog to drink excess amounts of water, including diabetes mellitus, kidney disease, liver disease, Cushing’s disease (hyperadrenocorticism), and more, can lead to incontinence. Most of these can be ruled out by blood tests. Certain drugs can also cause increased water intake.

Kathy Moffett of Le Roy, Illinois, has a Brittany Spaniel named Abby who began having major incontinence issues associated with drinking lots of water at age 11. “Abby turned out to have a rare condition called diabetes insipidus,” Moffett explains. “The only symptoms of this condition are drinking lots of water and increased urination, including problems with incontinence.”

The treatment for DI involves injections twice a day with desmopressin, which controls the excess drinking and also the incontinence. (Note that there is no relationship between diabetes insipidus and the more common diabetes mellitus. See “Yo Adrenals!” July 2006.)

My own dog Nattie developed some incontinence when she was diagnosed with kidney disease and put on subcutaneous fluids. I did not give her medication for this, but solved the problem by getting up during the night to let her out one extra time, and by using washable waterproof pads under her bedding to protect the beds and furniture.

I found the mattress pads and liners made for children’s beds to be the most cost-effective and reliable way to keep dog beds and other places she liked to sleep dry. You can also find waterproof liners and pads made for dogs and dog beds in pet supply stores and catalogs. Diaper garments made for both female and male dogs can also be purchased.

Incontinence has also been known to develop following corticosteroid treatment. Steroids such as prednisone cause excess drinking, which may lead to temporary incontinence, but sometimes, the incontinence continues even after the steroids are stopped.

Steroids also suppress the immune system, which can lead to increased risk of urinary tract infections. In addition, steroids can push a dog with a tendency toward diabetes into exhibiting symptoms. It makes sense to have a urinalysis done if your dog develops incontinence following the use of prednisone.

Dawn Lange of Duluth, Minnesota, has a retired racing Greyhound named Sly who experienced problems following the use of prednisone.

“Sly’s incontinence started at about eight years old, almost immediately after receiving multiple steroid injections for pannus.” says Lange. “It took about six months before the incontinence gradually stopped. None of the treatments that are used for spay incontinence worked. We chose to diaper her during the problem period, using Female Pet Bloomers from Drs. Foster & Smith, with a maxipad inside.”

Surgical options
Once in a while, you may have a dog who does not respond to any of the traditional or natural treatments for incontinence, or who cannot take them for various reasons. In those cases, surgery may help.

One older procedure for female dogs, colposuspension, surgically tacks the vagina to the belly wall, compressing the urethra.

Colposuspension surgery has been shown to be effective in curing incontinence in 40 to 55 percent of dogs initially, though many relapse within the first year. Most dogs show improvement, which is often increased when medications are added back in. Male dogs can have a similar procedure called a cystourethropexy.

Collagen injections (performed under anesthesia) into the area around the urethra offer a newer and more effective surgical method for controlling incontinence in female dogs. Studies show these injections to be completely successful in up to 75 percent of the dogs who receive them, with most of the rest improved and many of those responding to the use of PPA after surgery when they did not before.

The major drawback to this approach is cost, which can run more than $1,000 – and the treatment may have to be repeated, as the body removes the collagen over time. Retreatment with collagen is usually easier and may be less expensive. The average duration of effectiveness was 17 months in one study, though the effects can last more than five years. It has few side effects, usually only transient problems with urination immediately after surgery in a small percentage of dogs. There is a current study of this procedure being done at Purdue University.

Beth Teffner is involved with Hand Me Down Dobes, a rescue group in Columbus, Ohio, that recently took in a two-year-old Doberman named Reese. Surrendered by her original owner due to incontinence, Reese would leak urine while standing and walking around, even immediately after urinating. Exploratory surgery did not find a cause.

The group contacted Ohio State, where the collagen injection procedure is being studied on Dobermans. “Fortunately, our group had an angel who donated money, and Reese has had the injections. She did not need additional surgery and is leak-free,” Teffner says. “She is now in a foster home waiting to be adopted.” (If you can help, contact Hand Me Down Dobes at 614-470-2851 or www.handmedowndobes.org.)

Experimental treatment
A recent report from Europe involves the use of use of GnRH (gonadotropin releasing hormone) analogs to control spay incontinence that does not respond to traditional treatments.

In one small pilot study, seven of 11 dogs treated this way once or twice were cured for periods ranging from two months to two years, with all but one of the remaining dogs becoming continent when PPA was added. This treatment is still experimental and has not yet been approved, though GnRH is used with dogs for other purposes involving reproduction.

Be persistent
With the many different treatments available for incontinence, it’s important to keep trying various remedies when needed. Many people try a number of different remedies before finding the one that works best for their dogs. Don’t give up when your dog does not respond to the first or second remedy you try.

When natural treatments and traditional medications do not work, look for other possible causes, and if needed, consider surgical options. Almost all dogs with incontinence can be successfully treated with persistence.

-Mary Straus does research on canine health and nutrition topics as an avocation. She is the owner of the DogAware.com website. She lives in the San Francisco Bay Area with her dog Piglet, a 14-year-old Chinese Shar-Pei.

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