Questions about bladder control

Neurological Disorders Resources. Treatment and care for pets having pain or trouble walking or standing due to spinal injuries or neurological disorders like IVDD, FCE and DM.
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jacksmomemily
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Questions about bladder control

Post by jacksmomemily »

Hello! For some background history, my 8 year old dog Jack, who is mixed with GSD, is about 70lbs now (almost 80lbs before surgery), had surgery for IVDD 6 weeks ago, and I've noticed in the past few days it has become more difficult to express his urine. He had 3 sites of herniation between L1-L4. They didn't stage his IVDD, but gave him a 50-50 chance of walking again with surgery and his deep pain sensation just prior to surgery was questionable because he was/is very stoic. However, when we were at our regular vet, the day prior to surgery and he had lost function in his hind limbs, he did respond to deep pain. At our 4 week follow up, there was no sign of return of deep pain or functional movement.

Anyway, I had been getting pretty good at urine expression this last month! Now, when I express, it is more difficult to get it started, he tenses up more, and when I do get a stream going, it stops abruptly and then when I release the pressure more comes out. I'm wondering if he is gaining some control or something, and wondering if anyone has had this experience? He has not regained mobility or deep pain sensation, however, recently I have noticed when I stimulate toes in a walking movement, the opposing toes begin to move slightly and a strange leg extension type movement happens when I express his bowels. I don't even know if it's possible to regain some control of urination without regaining control of ambulation or deep pain?
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CarolC
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Re: Questions about bladder control

Post by CarolC »

Hi jacksmomemily!

Replies in blue


:group:
jacksmomemily wrote: Sat Mar 26, 2022 12:19 pm Hello! For some background history, my 8 year old dog Jack, who is mixed with GSD, is about 70lbs now (almost 80lbs before surgery), had surgery for IVDD 6 weeks ago, and I've noticed in the past few days it has become more difficult to express his urine. He had 3 sites of herniation between L1-L4. They didn't stage his IVDD, but gave him a 50-50 chance of walking again with surgery and his deep pain sensation just prior to surgery was questionable because he was/is very stoic. Right, that makes it hard to tell with some dogs. However, when we were at our regular vet, the day prior to surgery and he had lost function in his hind limbs, he did respond to deep pain. At our 4 week follow up, there was no sign of return of deep pain or functional movement. I do not know if this is more of the same stoicism or simply lack of deep pain. The good news is that deep pain can return even months after the injury. My dog was left with no feeling at all in her back feet. At 149 days after her accident (nearly 5 months) they found she had feeling again.

Anyway, I had been getting pretty good at urine expression this last month! That's really good, with a large male dog! :trophy: Now, when I express, it is more difficult to get it started, he tenses up more, and when I do get a stream going, it stops abruptly and then when I release the pressure more comes out. I'm wondering if he is gaining some control or something, and wondering if anyone has had this experience? I would wonder the same thing. I don't know either, but that seems like the best guess. As far as you can tell, no signs of a urinary infection, and you did not just start or stop a medication when this change occured? I do not know if this would be possible for you, considering his size, and I do not know your house, whether there are a lot of steps out to the yard, etc. But is there a way you could take him out to his former chosen potty spot and see if he'll sniff and urinate voluntarily? Even that can be a little tricky. I am dealing with a male dog that was quadriplegic and has regained a lot. He has good bladder control most of the time, he might wet his bed once a week. If I take him out, I try to help him find a place to mark. This often means the fenceline. He seems to prefer marking live green weeds, versus dead grass. I sometimes have to position him at several successive locations along the fence, till he finds something interesting to sniff. When that happens, then he'll go. I'm not suggesting you take him out every time he needs his bladder emptied, with his size, but maybe just for a test to see if he sniffs the grass with interest and is inspired to void on his own... (Please don't try it if it's going to be too much for your back.) All I can think is, if he doesn't have signs of a urinary infection, and no change of meds, then the best guess is he's exerting some control. He has not regained mobility or deep pain sensation, however, recently I have noticed when I stimulate toes in a walking movement, the opposing toes begin to move slightly and a strange leg extension type movement happens when I express his bowels. Does he extend his hind legs in kind of a mule kick, or do you mean an extension in the front legs? I don't even know if it's possible to regain some control of urination without regaining control of ambulation or deep pain? Some dogs lose mobility but retain bladder control. Some dogs regain ambulation but never regain bladder control. Some regain bladder control but not bowel control. Some regain partial control but not full control. When you are 6 weeks out, it's still early, and it may just be a case of what you are seeing first.
jacksmomemily
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Re: Questions about bladder control

Post by jacksmomemily »

Hi CarolC!

As far as you can tell, no signs of a urinary infection, and you did not just start or stop a medication when this change occured?
No signs of a UTI, from what I can tell. I have been tapering him off of Gabapentin for 1-2 few weeks. He's gone down to 1 dose/day for the past week. He's not completely off of it yet, though. Maybe he can feel more pressure now.

But is there a way you could take him out to his former chosen potty spot and see if he'll sniff and urinate voluntarily?
I've been taking him out a few times a day, once to the fence line once a day and once just 3-5 minutes down the sidewalk. I'll try to be more conscious about taking time to let him sniff and mark when we go to the fence.

Does he extend his hind legs in kind of a mule kick, or do you mean an extension in the front legs?
The back leg extends a bit, I guess it's like a very slight gentle mule kick (the leg kind of just extends out) and I also noticed some very slight movement in the toes (on the side that is more active) today at the same time as the leg extension (when expressing the bowels). It seems like maybe just a reflex, but still movement in the leg area. His tail lift with the perianal reflex got stronger in the last week, although it never went away completely.

Today after I had expressed him at breakfast and before I got to the mid-day expression, his bladder had completely emptied out, which is also unusual. I mean, he does leak a little bit, but doesn't usually empty out like that.

Thanks for the feedback!
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CarolC
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Re: Questions about bladder control

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Hi jacksmomemily,

I'm not sure why he emptied out like that. They can really keep us busy adjusting to changes and trying to understand where they're at, at different stages of recovery. I wonder if he resisted (if that's what's going on) during the morning express and then left himself with some retained urine, when he didn't used to do that? No idea... There is an expressing technique called 'Express, rest, express' where you empty him the best you can, then wait a few seconds or minutes and do it again. Often you will get more out the second time. One of the moderators here had a medium size male dog she expressed multiple times during every session, as it was the only way she could get him empty.

There are 2 types of incontinence. If the injury was at L3 or higher, you would call it an upper motor neuron injury and expect him to have tight urinary sphincters (so you express). If it was L4 or farther back toward the tail, that is considered lower motor neuron and the dog tends to leak and dribble (and you diaper, or express and diaper). Your dog had surgery spanning both areas, and I don't know what to expect in that case. I suppose the best you can do is just go with what you are seeing at any given time, sort of a practical nursing approach.

Are you using male wraps with him? They're a big help if he's going to wet his bed. If he wets and lies in a wet spot, that can cause a urine burn, and in a pressure area like the hip the damaged skin can quickly turn into a pressure sore. They are much easier to prevent than to treat. Malewraps are a wide belt that goes around the waist and you put an absorbent pad (like Poise) in them over the male area. The pad asborbs the urine and his bed stays dry and you're protecting the hip and other skin.
:malewrap:
You're doing good if you are taking him outside (several times a day) and even to the fence. When I take Pip out (the dog I mentioned recovering from quadriplegia), he needs a few minutes before he's ready to mark, even though he has bladder control. I can't just take him to the fence, and we're done. During the day, or especially at night, he first has to assess the environment. I think maybe (?) it's a doggy survival trait, where he wants to be sure there are no threats around so he doesn't get caught by surprise while he's standing there urinating. He has to test the wind and look every direction for a couple of minutes. It's part of the process. If I take him straight to the fence, he won't even put his nose down to check the vegetation till he's satisfied. Instead he'll keep his head up, trying to catch hints of smells in the surrounding area/yards/alley. When he is actually sniffing the weeds, it's pretty much yes-or-no. If there's nothing there, then having him remain in that spot longer won't cause him to sniff more closely and find something he overlooked. He's already decided it's not interesting and we might as well move on. I give him a verbal cue when we are going to move to another spot. If we find a spot that interests him, he will sniff and sniff some more, and then put his head up and urinate.

The little signs in the tail and toes sound hopeful. Recovery from spinal injury is by baby steps. :)
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critters
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Re: Questions about bladder control

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:whale:
jacksmomemily
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Re: Questions about bladder control

Post by jacksmomemily »

Hi CarolC and critters,

Yes, I thought he retained some urine that day, because he was fighting more. He definitely didn’t use to do that, and I think he might be resisting. He has only had a big puddle a few times since coming home. He usually keeps fairly dry if I can express him well enough, but there is occasional dribble. I have a similar routine to the “express, rest, express”, where I express him while he lays on one side and then I wait a minute or two and flip him and express him on the other side. Glad to hear this routine works for others, I’ll keep with it.

We did get him some male wraps, which I use when he does exercises or goes into different areas of the house, they are great, but he usually doesn’t fill them, just a dribble at times. I also use baby powder and sort of prop his leg open with a towel when he is resting. I’ll look into the poise pads for him, thanks for the advice.

I’ll try to wait a little longer at different spots when I take him out today and continue to keep an eye out. I’ll have to let his sister out first, because he loves to mark on top of wherever she goes.

Thanks again for the advice, support and warm welcome!
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CarolC
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Re: Questions about bladder control

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jacksmomemily wrote: Mon Mar 28, 2022 8:36 am I’ll have to let his sister out first, because he loves to mark on top of wherever she goes.
Thats genius! :smart: I love it!!

If you find he is voiding too much even for the Poise pad (since he's a big boy) another option is to get a disposable baby diaper and lay it flat against him inside the wrap. The wrap will hold it in place. Today's disposables have a lot of gussets and extra papery fitting material to them, so you might need to do some trimming first to make it lie flat.

Another option is booster pads. They make "diaper doublers" for both children and for incontinent adults. Basically you would stick your Poise (or similar) into the wrap, then lay the booster/doubler over that. Urine both absorbs and flows through to the Poise beneath, making for extra absorbency. Here is an example.

https://www.walmart.com/ip/NorthShore-D ... /228636125

booster.jpeg
jacksmomemily
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Re: Questions about bladder control

Post by jacksmomemily »

Thanks for the pad recommendations CarolC. Sorry for the delay! -Emily
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CarolC
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Re: Questions about bladder control

Post by CarolC »

Totally cool! 8-) When my Merlin was down, he was 63 lbs, and your baby is even bigger so I know you have your hands full. Merlin drank a lot of water because he also had renal insufficiency. I had to buy him a bigger water bowl. I tried putting 2 Poise pads side by side in his wrap and it didn't work. :? I still don't know why. It seems like it should have, but it didn't. :pardon:
jacksmomemily
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Re: Questions about bladder control

Post by jacksmomemily »

Oh wow! My malamute mix has renal issues, so I know what it's like with all of the water drinking!

Although expression is becoming more difficult, I'm really grateful Jack isn't leaking too much in between expressions. When I use the belly bands, he doesn't do much but dribble, if anything. I emailed the doctor, and he told me methocarbamol may be helpful to make expression easier. I recently tapered the dose down, so if it becomes too painful for us to express him, I may have to get back on a regular dose.

I can usually get away with one water bowl fill per day. I bought him his own buddy bowl (link below), which is a non-spilling bowl and it's awesome. If he flips it over when he's moving around, there is no mess. I bought one a while back for my malamute mix who has always liked to play in the water bowl and it prevents big spills. The only thing I don't love about these bowls, is they are difficult to open for cleaning, because they close so tightly to prevent spilling.

https://www.rayallen.com/buddy-bowl/
coxmaria3
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Re: Questions about bladder control

Post by coxmaria3 »

:hotpink:
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CarolC
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Re: Questions about bladder control

Post by CarolC »

I wonder what Dolly would think about a bowl like that. She used to have her water in a tip proof bowl, but she likes to bounce on her bottom in her crate when she is excited about dinnertime, and she bounces the water out of the bowl onto her blanket(!) Then I got her a kennel crock you screw onto the wires of the side of the crate. It's better, but if I fill it more than half way she still bounces the water out of it. The Ray Allen bowl might work, but I need to be able to get it apart to clean it. Interesting...

[EDIT: removed off topic comments, sorry]

Phenoxybenzamine is another bladder med that is commonly prescribed to help relax the urinary sphincters in paralyzed pets. Jean used Robaxin (methocarbamol) with her cat with paraparesis, Jaime, for a long time.
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critters
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Re: Questions about bladder control

Post by critters »

I second the little pads that increase capacity of a diaper. I don't know why they weren't invented earlier, but they're great for heavy peepots. I know your boy's a dribbler, but knowledge is power!
jacksmomemily
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Re: Questions about bladder control

Post by jacksmomemily »

Thanks again for the welcome, coxmaria3!

CarolC and critters!

I'll keep the Phenoxybenzamine in mind. Jack also takes prazosin to relax his sphincter, which is small for his size I guess.

I most certainly appreciate all the feedback and will keep all of it in mind as things change.

:D :D :D
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