Your experience with Bethanechol Chloride Please

[Pugwinkle]

My pug Lily is pretty much paralyzed in her back end. She is having yet another urinary tract infection and is on antibiotics for a month in order to clear that up. Rather than her dripping urine her back end has actually been shutting down. The vet has put her on Bethanechol Chloride 2 - 3 times per day - 5 mg per dose.

I believe some of you have had some experience using this medication and I would appreciate hearing what affect it had on your dogs. I gave Lily a pill yesterday when I got the meds and within about a half hour her bladder emptied all over the floor. She had no idea what was happening the poor thing and I hadn't expected it to work quite that quickly.

So I guess I'm wondering if this is what I can expect while she is on this medication? Will she empty her bladder after each pill or do you think it was just because her bladder was so full at the time from not having gone for so long. The day before she barely peed at all. Usually I express her three times daily, outdoors of course.

Also, is this a medication that she will likely have to always take or is this medication meant to strengthen the bladder in order to one day not have to take the meds?

Thanks for any insight you can offer.

[FYI]

http://www.marvistavet.com/html/bethane ... oride.html

http://www.drsfostersmith.com/Rx_Info_S ... nechol.pdf

[critters]

Buddy had a spastic bladder, and it made him worse. He needed PBZ--phenoxybenzamine. I'm seriously considering trying it with Koi, who has a floppy bladder.

[CarolC]

I've never used that medication but I found something helpful in the Veterinary Drug Handbook, 4th ed. It says

No information was located on the pharmacokinetics of this agent in veterinary species. In humans, bethanecol is poorly absorbed from the GI tract, and the onset of action is usually within 30-90 minutes after oral dosing. After subcutaneous administration, effects begin within 5-15 minutes and usually peak within 30 minutes. The duration of action after oral dosing may persist up to 6 hours after large doses and 2 hours after SC dosing.

It does not give any information on long term use. I am really interested in what you said about the change in her ability to urinate.

I think I would still try expressing her and see how well she is emptying. Incomplete emptying is the main source of UTI. I find I need to be pretty firm with my expressing, if you are in doubt how firmly to express you might ask the vet to check you. I found I actually need to express quite a bit more firmly than I thought, it depends on the individual pet.

I express in the house! So much easier to express my dog on a pad on the counter, than to have to bend over or kneel in the grass in all kinds of weather. Here is an article about different styles of expressing, and even some videos at the end.

http://www.handicappedpets.com/mediawiki/index.php?title=Express_a_dog_or_cat

[Pugwinkle]

I have two dogs that I have to express and a third one passed away in January so I'm very experienced with expressing the bladder. I have to express both the urine and the colon. Yes, I agree that sometimes you have to really press hard to express the bladder. Unfortunately with Lily, expressing the bladder, even very firmly, is not working very well anymore that is why the vet has said we can try this medication in hopes it will build up the muscles a bit. I don't think the vet is holding out a lot of hope though. As you mentioned, not being able to express the bladder fully is probably the reason she has a UTI as well.

So far the pills are helping a bit but they certainly aren't the miracle I had hoped they would be. She has only had a few pills so far though so I'm still holding out hope.

[CarolC]

I am not a vet, so this is only my best layman's understanding of all this. I absolutely believe you. There are two things needed for successful urination, the bladder must contract and the sphincter must relax so urine can flow out. Bethanechol is for contracting. Above critters mentioned phenoxybenzamine (PBZ). It works to relax the sphincter. It can be used in conjunction with bethanachol, or it can be used alone and you express (your squeezing substitutes for contracting and bethanechol is not needed) . Since you are experienced with expressing (3 dogs) and you can tell the dog has changed so that now even expressing really firmly is not doing the trick, I would really recommend asking the vet about PBZ. It takes about a week to reach full effect in the system but it is a standard medication many pets here have been on. If I had known about it when I first got Katie, I think life would have been much easier as she was very hard to express--it took a LOT of pressure and a LOT of time even though she's little. If this is what you are going through, too, I would ask.

I would also want to have her checked right away to see if she has stones or crystals causing a partial blockage. Handicapped pets can get them just like other pets, and when you see trouble urinating your first thought is that it is related to the handicap...but you don't want to risk overlooking a common cause like stones. This is especially important to check if she is on bethanechol, since bethanechol causes the bladder to contract and if the bladder is full and the urethra is blocked, you could theoretically rupture the bladder. There have been quite a few incontinent pets here who developed stones. I do not know the frequency of stones in the population of healthy pets so I do not know if they would have developed them anyway. But sometimes I wonder privately if dogs who do not empty well may have extra residue/sediment in the bladder that could lead to stones. If anyone knows the answer to that, I'd be interested.

It is unusual for a dog that was a dribbler to change and become a dog with a tight sphincter. As far as I know, dribbling comes from a problem in the lower back, while having a tight sphincter causing urine retention comes from having a problem farther up the spine. My dog has an upper back injury, so it made sense she would have a really tight sphincter. Your dog was originally a dribbler from some kind of spinal degeneration (no one has mentioned sphondylosis, that's what it sort of sounds like to me, but it doesn't matter) and I have never heard of a dog changing over to having a tight sphincter like this. I hope when you find the answer you will update and explain what you find out?

[Pugwinkle]

Hi Carol, thanks for your post. I will definitely ask the vet about the PBZ. Rest assured that the first thing I did was have a urinalysis done and we did find that Lily has a raging urinary tract infection but she does not have any stones at this point. You are correct in your assumption that dogs that don't empty well are more inclined to get urinary infections which if left untreated can eventually turn into problem with crystals and stones. In fact that is what my boy passed away from in January. Jasper had a blockage due to stones. I had no idea that he may have had a urinary infection until is was too late.

As for Lily being a dribbler. I'm not sure I would classify her as a dribbler. What use to happen before I started expressing them myself several times a day, when they would get excited say at breakfast or supper time they lose control of their bladders. Once I started expressing them several times a day at specific times each day they no longer would lose control. So therefore, I wouldn't really consider her to be a "dribbler".

[Bobbie]

While expressing inside is probably easier, some dogs won't let down until they are in their normal spot for peeing- I wish Merlin would let me do it inside while he was lying down (at 3 am) but he won't go. Once he starts to pee I can empty his bladder but its very, very hard to get it started if he isn't in the mood to go.

[critters]

It is unusual for a dog that was a dribbler to change and become a dog with a tight sphincter. As far as I know, dribbling comes from a problem in the lower back, while having a tight sphincter causing urine retention comes from having a problem farther up the spine. ?

Koi fits this. His pellet is in the vertebra right above his pelvis.

[Reid]

Not sure if you are still looking for info since over a month has passed since you asked the question, but just in case...

We have a elderly pug with peripheral myelopathy that was also recently started on Bethanechol. I have no way of knowing if our experience is statistically 'typical', but I can say that I for us the first couple of days the medicine didn't seem to do anything. We varied between lack of peeing and accidental peeing pretty randomly. I think really it was just a case of no signal travelling the nerves, and bladder spillovers when our attempts to express weren't keeping up. When we got to the third day there was a slight change, not enough to cheer success, but enough to make us wonder if we were gaining ground. By the 4th and 5th days the change was definite. She is also back to pooping reliably on her own, something else we were having difficulty with.

That is where we are now. The delicate dance at the moment is watching for side-effects to ensure she continues to tolerate the 10mg/day dose she is on. Right now I'm pretty sure we won't be increasing it. This stuff seems to build day by day, so I won't be surprised if need to trim it down. Watch for the side effects your vet probably told you about.

As to any ongoing bladder infection, having fought through one with our pug about 6 months ago, I can say that our experience is that dietary content can help with the battle. I'd suggest talking to your vet about vitamin C (we use Ester C because it is buffered). Our pug is also on a home-made diet one of her vets came up with, which also has fruit in it. Duoxo shampoo and cleaning pads have also helped to keep the skin in good shape.

[Pugwinkle]

Thanks for sharing your experience. Originally Lily was on 5 mg twice per day but it wasn't doing the job so now she takes 5 mg three times daily and it seems to be working. Keeping my fingers crossed. The only side affect she seems to have is she drools for a bit after about an hour of receiving her pills.

So far so good.

[Pugwinkle]

Lily, my pug, has been on the Bethanocol Chloride for quite some time now and also the Phenoxbenzamine. Originally Lily could barely pee at all, she was on .5mg three times a day of the BC it wasn't doing that great a job so we added the PBZ at 2.5 mg twice a day.

I have reduced the BC to .5 mg twice a day and continue to use the two PBZ capsules each day as well. She is now much easier to express but now she is peeing the bed at night and also seems to be having some side effects from the pills. Often throughout the night I will awaken to find her sitting up. She drools quite a bit as well from the pills which isn't a big deal how ever I feel that somehow these pills are causing her to feel ill, thus the reason she is sitting up at night. Of course there is no real way for me to know other than to ask you guys what you have noticed in your pets when they have been on these two meds together.

I am wondering if I should be cutting her down to .5 mg of the BC and continue with the two PBZ capsules each day or the other way around? Should I be continuing the BC twice a day and only give her one capsule of the PBZ??

Another question is about diapers. How many of you use them and if I were to use human baby diapers what size would I need for a pug? She is probably about 15 pounds

Thanks for any help you can give me.

[CarolC]

On the baby diapers, hopefully one of the members here with pugs will know exactly what is best. There is a diaper size chart here that may help. If you find a size and brand that works for your dog, please let me know and I will add the information to the size chart to help the next person!

https://www.handicappedpets.com/mediawiki/index.php/Diapers_and_male_wraps

I do not use disposables with my dog, I use a denim diaper with a pad inside. The diaper fastens at the waist with velcro. All I have to do is stick a fresh pad in it as needed. Since my dog is small, I use a moderate incontinence pad for humans and cut it in half. When it is time to change her pad, I pick her up, pull the diaper off with my free hand, put her in her playpen for a minute, stick a fresh pad in the diaper, and put it back on her. It is very simple. I find it much easier than when I used to use disposable diapers for my bunny.

I cut the pad in half and put the cut end in the front of the crotch and the sealed end of the pad by the tail. This way the stuffing of the cut diaper doesn't come out. (My dog has 3 legs so I angle the pad, that's why it looks crooked.) I put the pad so it actually overlaps into the tail hole a little to prevent leakage.

I am trying to think how you can test the diaper on your dog. I think if you take a human thin menstrual pad and cut it in half and put it in your purse and take it to PetsMart, probably you could open the diaper package, place the pad in the diaper to keep it clean, and try it on her for waist size. Those denim diapers are kind of expensive so it isn't something you necessarily want to buy to try, it's better if you can try it without having to buy it.

The way I put it on her is I lay it flat on the kitchen counter (left side of sink is sanitary cooking side, right side of sink is all else) and stick the pad in. Then I sit her little bottom on the pad. This way I can work at waist level to hold her still while I fasten the first velcro tab with one hand. When that is done I can use 2 hands to fasten the other tab snugly. I am sure it is easier if your dog can stand up, but you get good at wrangling on that diaper one-handed with just a little practice.

I've never used bethanecol, I hope someone else will reply on that.

[Pugwinkle]

Thanks Carol, I actually have one of those reusable diaper things from when I was breeding and the girls were in heat. I use to put a mini pad in and it worked great. I tried it on Lily but the waist goes right where she has her lump from the cancer and I didn't want anything that would irritate that lump. At this point I'm simply using a waterproof mattress pad on my bed as well as some puppy pads and I try to keep her sleeping on the puppy pads in case she pees the bed. Maybe I'll just continue with that.

[Shaz]

Hi, sorry I am so late here on this thread, so interesting, how did I miss it?

My Pug is around 20lbs and going up a few Posts ago, I have yet to find a diaper, either baby or small adult that fits her.

I did successfully express Duchess the Pug once, great result and I was so relieved (so was she)....but it didn't happen again. She knows when she wants to go, so if on my chair or bed I lift her off and she will pee then and there on the floor.

At times, I get concerned she hasn't gone and this is the method I use.....I take her out and with a fine hose spray, I wet her and then massage in a mild shampoo (Tea Tree) and she goes a treat, then I repeat and she goes again usually around 5 times for 5 seconds at a time, by which time I guess she is empty. She holds herself pretty well at night.

I have no expert advice here in Spain to call on and very sadly I don't like to approach the Vet, I get the feeling they think I am rather odd to be a Caretaker?

I too, use the waterproof mattress pads, sometimes they are needed, saves a lot of Laundry doesn't it??? I am sorry to railroad your thread, but have no idea what drug she needs, if I did I would ASK the Vet for it.

Sharon:)