Urinary incontinence (UI) is defined as the involuntary loss of urine during the filling phase of the bladder [1], and can be due to hormonal, structural and functional changes in the bladder, as well as changes in the composition of the urethra [11]. Young bitches can present congenital incontinence [14], but studies show that half recover continence after the first or second heat [7].
In adult bitches, as well as congenital incontinence, the acquired form of the disease can be found [6]. This is a common problem in veterinary practice, as well as a common and predictable complication of neutering in bitches [5].
Incompetence of the urinary sphincter mechanism is the most common cause of urinary incontinence in dogs [10], occurring mainly in neutered females several years after neutering [4]. It mainly affects neutered females over eight years old and over 20 kg in weight [5]. Despite this data, in my own clinical practice I can say that at least 70% of my patients were small size. Regarding the age at which castration is carried out, there is no relationship with the development of the disease, unless it is done before 12 weeks of age [12]. In addition, a higher rate of urinary incontinence was observed in bitches castrated before their first heat [13].
As for racial predisposition, some studies show that certain breeds are more predisposed to developing the disease, such as the Dobermann Pinscher, Giant Schnauzer, Old English Sheepdog, Rottweiler, Weimaraner and Boxer [3].
The etiology of the disease is complex and involves the smooth muscles of the urethra, as well as adjacent tissues and other factors. When this system collapses, there is less muscle contraction and altered tone in the periurethral tissues. In females, these changes seem to be associated with a reduction in estrogen and an increase in FSH (follicle stimulating hormone) and LH (luteinizing hormone) after castration, which is called hormone responsive incontinence [2].
The disease can appear several years after neutering, but its onset varies greatly. In dogs with comorbidities such as polyuria (increased urine production), the problem can increase, since the rise in stored volume causes an increase in intravesical pressure and the sphincter, which is already compromised, cannot contain the leakage of urine [3].
Among the main clinical signs is the involuntary loss of urine when the animal is lying down or relaxed, which does not occur when the animal is awake and active.
There may also be increased licking in the area around the vulva due to incontinence. This licking can contribute to the development of perivulvar dermatitis which can lead to an increased risk of developing a urinary tract infection [3] caused by ascending bacteria [5]. No major changes are observed on physical examination of these animals, except for urine stains or dermatitis in the perivulvar region (around the vulva).
Treatment in conventional veterinary medicine can be carried out using estrogen replacement, alpha agonist drugs or a combination of both, as their effects are synergistic (SPAIN et al., 2004; 4].
However, this form of treatment has adverse effects, including the development of mammary glands, an increase in the volume of the vulva and attraction to males. These effects are dose-dependent and usually resolve with a reduction in the dose. The most serious and irreversible side effect is bone marrow aplasia. However, it is important to note that the doses that cause bone marrow aplasia are much higher than the dose used for the clinical treatment of urinary incontinence [3].
If the animal does not tolerate or respond to clinical treatment, there is the possibility of surgical intervention, but the results are variable and have little long-term efficacy [5].
There is also the possibility of homeopathic treatment. Homeopathy is a form of medicine discovered by the German physician Samuel Hahnemann in 1796, based on the law of similars ("like cures like"), representing a method that adapts to the patient's totality of symptoms [8]. This totality of symptoms is of great importance in choosing the appropriate medicine to stimulate a healing response in the patient [15].
It can be seen as a method of individualization of the most similar drug to the patient, i.e. the homeopathic remedy will have as many similarities as possible with the totality of physical and emotional conditions observed in an individual, in order to effect a cure in a deep and lasting way [15].
In this sense, we can't say that there is a specific medicine for the treatment of urinary incontinence, but rather several homeopathic medicines which, among their many characteristics, have a tropism for the urinary system and are successfully applied in the treatment of post-castration urinary incontinence. The veterinarian must consider all the patient's symptoms, not only on a physical level, but also on a mental level, which will determine the choice of the best medicine, through an individualized prescription.
A study carried out in the United Kingdom [9] showed that homeopathic treatment for urinary incontinence was successful in more than 70% of cases, and in the majority of cases, an individualized prescription was made.
As for the length of treatment, just like any other homeopathic treatment, the response will depend on the patient's reaction. There are cases where repeated doses of certain potencies are required over a long period. In others, one or two doses of the medicine will be enough. Normally, in homeopathy, what is observed is that the older and more chronic the patient's condition, the longer it will take for the body to restore balance, but there is no general rule, since homeopathic treatment, as previously mentioned, is individualized.
In my clinical practice, I have successfully managed cases of post-castration urinary incontinence with homeopathy. In addition, this subject was the subject of my monograph in the Homeopathy Specialization course and in addition to the clinical cases, the literature, although restricted, also demonstrates that this treatment modality is successful and can be used successfully, providing a gentle, deep and lasting healing process.
REFERENCES
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3. BYRON, J. K. Diseases of abnormal micturition. In: ETTINGER S. J., FELDMAN, E. C. Textbook of Veterinary Internal Medicine, 8 ed., Saunders, 2017, cap. 333, p. 2010 - 2016, v. 2.
4. BARTGES, J. W. Urethral diseases. In: ETTINGER S. J., FELDMAN, E. C. Textbook of Veterinary Internal Medicine, 8 ed., Saunders, 2017, cap. 335, p. 2020 - 2027, v. 2
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11. REICHLER, I.M.; HUBLER, M. Urinary incontinence in the bitch: an update. Reproduction in Domestic Animals, v. 49, Suppl. 2, p. 75-80, 2014.
12. SPAIN, C.V. et al. Long-term risks and benefits of early-age gonadectomy in dogs. Journal of the American Veterinary Medical Association, Schaumburg, v. 224, n. 3, p. 380-387, Feb. 2004.
13. STÖCKLIN-GAUTSCHI et al., The relationship of urinary incontinence to early spaying in bitches, Journal of reproduction and fertility, Cambridge, Suppl. 57, p. 233-236, Jan. 2001.
14. THOMAS D.M.; YOOL, D.A. Delayed-onset urinary incontinence in five female dogs with ectopic ureters, Journal of Small Animal Practice, v. 221, p. 224-226, 2010.
15. VOKEROTH, W. G. Veterinary homeopathy: an overview, Complementary and alternative veterinary medicine, Ottawa, v. 40, n. 8, p. 592-594, Aug. 1999.
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