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​"Ditch the Diapers"
​Excerpts from A Great Post
​by Lisa Smith Weber

​Printer friendly PDF version: 

It can happen suddenly, an accident, injury or major illness — but more often it happens slowly, gradually. Your older pug wets the bed a little overnight. They may have a bowel movement when they get really excited. You may notice more accidents in the house from a dog that has always been well housebroken. In males, they will often start to urinate consciously, but then walk away before they are done, leaving a little trail behind them. They start to smell bad, and their bedding does too. Eventually things get worse and worse. 

You visit the vet, who checks your dog for a urinary tract infection and/or bladder stones. Either the test comes back negative, or if it is positive and they are treated, they continue to have leakage and accidents. Your vet may tell you your pug is getting older. They may give you a medication like Proin to help tighten the urinary sphincter and delay the inevitable. After that, they will likely recommend diapers... but diapers may only intensify your dog’s problems with incontinence. 

Incontinence is a deal-breaker for many pet owners. Once their dog is unable to control their bladder or bowels, many owners choose to euthanize. Others consign the dog to a life outside where they won’t mess up the house. For a pug, a breed that lives to be close to their human, that can be even worse than death. 

Some owners heroically try diapers and belly bands, lining the beds with plastic and old towels or urine pads. But slowly it gets worse: the dog begins to develop stones and chronic or recurring UTIs. They need multiple baths a day to avoid odors. The dog begins to look uncomfortable. Their energy level is poor; their eyes speak of discomfort and pain. The chronic / resistant UTIs can go systemic and cause the dog to become very ill. Stones can cause blockages that are deadly if not quickly treated. Eventually it ends... badly.  

​But it doesn’t have to happen like this: Incontinence can be managed. Your dog can live with great urinary health and comfort, your home can be clean, and you don’t need to constantly mop up accidents and urine and wash beds multiple times per day. 

Why doesn’t your vet tell you? Sometimes they just don’t know. Managing the chronic conditions of geriatric dogs beyond the pill is not heavily emphasized in vet school. They often don’t have much practice at it, so don’t know what works well. Most of all, they sell owners short: Rightly or wrongly, they assume we don’t have the dedication and commitment required. 

I’m going to do my best to teach you. I want you and your dog to have a wonderful life—and I want incontinence to not be the problem that parts you. 
First, we have to do away with some common misconceptions:

1. Your incontinent dog is not incontinent because their bladder sphincter muscle is weak. Most people assume that the bladder works like a gate: When the gate is closed, the urine stays in. When it is open it comes out, when a dog is incontinent the gate is always open and the urine just runs out. WRONG! 
2. The bladder sphincter muscle and the bladder itself are controlled by nerves that transmit the feeling of a full bladder (or colon) to the brain, where the dog consciously relaxes the sphincter muscles to allow urine (or feces) to be expelled. It is the same in people. You don’t consciously hold your bladder shut. It stays shut until you consciously relax it. You feel an ever more urgent need to go as the bladder (or colon) gets more full. 
3. When the nerves that give the sensation of fullness and/or the nerves that allow the sphincter muscle to relax become pinched, severed or otherwise damaged, you have incontinence. The gate sticks CLOSED, and the urine eventually overflows it. The dog has a chronically overfull bladder. If there is any sensation left, this is very uncomfortable. If the dog has partial or intermittent nerve function, they may be able to start the flow, but can’t feel when the bladder is empty and stop too soon. Urine sits in the bladder and stagnates. The chronically overfull bladder loses its tone. Like a balloon blown up and left in a closet for a month, once it is emptied, it doesn’t return to its original size and shape. Instead, it becomes flaccid, atonic and oversized, like that old balloon. 
4. When feeling the bladder through the abdomen, a healthy bladder, when full, feels firm and muscular, very similar to what a package of fresh mozzarella cheese feels like, and about the size of a plum or tangerine. When empty, it is small and round and firm — a little bigger than a walnut. But when a dog has been struggling with incontinence for months or years, the full bladder takes up all or much of the abdomen behind the ribs. It will be anywhere from the size of a navel orange to grapefruit sized. It will feel smooshy like a water balloon. When empty, which is not often, it feels flat and large, with little or no healthy roundness or firmness. 
5. If you catch your dog’s incontinence in the early stages, before the bladder has become flaccid and tonic, you will find expressing pretty easy once you get the hang of it. The small, thick-walled, muscular bladder stays between your hands and you can easily feel it empty and run your fingers along it to ensure it is completely empty. If the dog has already been incontinent a long time, expressing completely will be much more difficult. When you push on the flaccid, tonic bladder, the fluid just moves around in the huge bladder, which escapes between your fingers, ballooning out in front of or behind your hands. You almost have to wait until the bladder is tautly full to express it, and even then, emptying out all of the old urine is almost impossible. 
6. SO START EARLY! Don’t be intimidated, don’t be afraid, and don’t be lazy. The sooner you start the easier for you and the healthier for the dog the whole process will be. 
7. The colon sphincter is a little different: unlike the urinary sphincter, it does get weaker. The dog will pass feces without realizing they are going. They don’t “push” — it just falls out. Often they lose the powerful muscles that help the fecal material move efficiently from intestine to colon to exit. When this happens, stool backs up in the colon, moving only when new stool from the intestine pushes it out. The dog becomes chronically constipated. You may notice their feces become larger in diameter – like German shepherd-size coming from your pug. 

1. Often, dogs lose control of their bowels before their bladder. Fecal incontinence is actually easier to live with than urine incontinence. I recommend feeding a frozen, prepared raw diet that includes RAW, GROUND BONE. Not only are most of these diets very healthful for your dog, they leave a stool that is small, very firm, dry, low odor, and when stepped on, it crumbles like wet sand instead of smearing and leaving a huge stinky mess. From there it is all a matter of training – you, not the dog. [K. Smiler – feeding probiotics often also changes the stool to a firm rubber ball that is easy to manage.] 
2. Normally, dogs will defecate about 20 minutes after a meal. If they are still able to walk, take them out and walk them around where they are supposed to go. The timing and exercise should cause a BM. If your dog is not mobile, just setting them outside in the bathroom area is sometimes enough. If you haven’t seen a stool, know they should be producing one and can’t wait for nature; you can insert a normal, lubricated glass thermometer into the rectum and gently wiggle it around a little. This usually gets things moving. If the dog is producing large-diameter stools that are difficult to pass, try adding some pumpkin or Metamucil to the food. If that doesn’t work, ask your veterinarian to prescribe them some lactulose, which will normally keep your dog regular without causing loose stools. 
3. Okay, now that you know why it is important to express the bladder, you need to learn HOW to do it. Bring your dog in to your veterinarian and have them demonstrate first. Some veterinarians are not skilled themselves, so you can also do a search on YouTube for “express bladder dog” and watch videos. I have found that each person has their own style that works for them... and also, each dog is different to express. At the moment I have four that need to be expressed. Each one requires a slightly different technique. In general, females are a little harder than males, especially if they are not spayed. 
4. Before attempting to express, have a urinalysis and x-ray or ultrasound done to make sure the dog does not have stones or tumors that might cause damage while expressing. 
5. This is my general technique: I stand the dog between my feet, which are about shoulder width apart. The dog’s head is pointing behind me, his tail ahead.
   I place my thumbs on the spine, just about where the pelvis joins it. With my flattened and slightly outstretched fingers, I grasp the abdomen sides between the knee and the ribs, and I feel for the bladder. I manipulate it with my fingers until it is fully (or as fully as possible) in my grasp. 
6. At this point, take a cleansing breath, exhale, clear your mind, find your Zen — whatever you need to do so that you don’t communicate anxiousness, fear, frustration, etc. to the dog. If you are tense, they won’t relax enough to allow you to express. Then I press the fingers of the hands together, making sure it doesn’t slip from my grasp. At some point you will feel the muscles relax, and a urine stream will begin. Continue applying pressure until no more urine is produced. 

1. Note: In some dogs, especially males, bladders “drop” when the muscles relax and the urine begins to flow. The bladder will literally slip from your mid-fingers to your fingertips. If your dog does this, you have to quickly slide your fingers down to re-grasp the bladder while you continue to apply pressure. It’s tricky at first, but fine once you get the hang of it. If you let go and try to reposition your fingers, you will have to start all over again. 
2. Once you are experienced, that will be all you need to do. But in the beginning, you should let the dog go for five minutes or so and try again. Often you have left a lot of urine after the first attempt. 
3. How hard should you press? That is a tough one. Some dogs are very easy to express and just require light pressure, but for others, you have to press with nearly all of the strength in your fingers. It is scary, I know. You worry about hurting the dog, rupturing the bladder, squishing kidneys and other organs... but you’ll be okay. The dog will be okay. I have expressed some VERY difficult-to-express dogs, and none have ever been injured from the process. 
4. Also, when learning how to express, it is often helpful if the vet will prescribe medication to help relax the urinary sphincter and make expressing easier. There are several different ones to try and each dog may do better with a different drug. Difficult-to-express dogs might stay on one permanently, but they all have side effects so don’t use drugs unless you need to. Proin is not the correct drug for this problem, urinary retention incontinence. 
5. How often should you express? About every 6 hours. Always express right before bed and as soon as you wake up. As long as you aren’t a late sleeper, you should be able to sleep with your incontinent dog in bed without accidents. 
6. There is one situation that you may need diapers for: A dog with a spastic bladder. Some dogs, even when expressed regularly, will have spasms of their bladder that cause them to expel urine at random times. These dogs still need expressed regularly, but may also need diapers to catch the random spurts. 
7. Lisa has other posts that discuss urinary tract infections (UTIs) and urinary crystals for the recommendations of medications and supplements to keep these dogs from getting UTIs and stones due to the bladder retaining urine.
8. Another note: In dogs with large, flaccid bladders, and having large, difficult-to-pass feces, the urethra is sandwiched between the bladder and the colon, so if both the bladder and colon are full, your dog may not be able to be expressed. This can be an emergency situation. Get an OK to use lactulose immediately to soften the impacted stool, and take your dog to the veterinarian to have a catheter passed to relieve the bladder. Once the bladder is drained and the feces are moving again, they should be fine. If your dog is male, you can discuss learning to have a catheter set-up to keep at home if this happens. It is extremely difficult to catheterize female dogs, but males are easy. They can show you how and possibly save you an ER vet visit someday. 
9. Normally, dogs will defecate about 20 minutes after a meal. If they are still able to walk, take them out and walk them around where they are supposed to go. The timing and exercise should cause a BM. If your dog is not mobile, just setting them outside in the bathroom area is sometimes enough. If you haven’t seen a stool, know they should be producing one and can’t wait for nature; you can insert a normal, lubricated glass thermometer into the rectum and gently wiggle it around a little. This usually gets things moving. If the dog is producing large-diameter stools that are difficult to pass, try adding some pumpkin or Metamucil to the food. If that doesn’t work, ask your veterinarian to prescribe them some lactulose, which will normally keep your dog regular without causing loose stools. 
10. Okay, now that you know why it is important to express the bladder, you need to learn HOW to do it. Bring your dog in to your veterinarian and have them demonstrate first. Some veterinarians are not skilled themselves, so you can also do a search on YouTube for “express bladder dog” and watch videos. I have found that each person has their own style that works for them... and also, each dog is different to express. At the moment I have four that need to be expressed. Each one requires a slightly different technique. In general, females are a little harder than males, especially if they are not spayed. 
11. Before attempting to express, have a urinalysis and x-ray or ultrasound done to make sure the dog does not have stones or tumors that might cause damage while expressing. 
12. This is my general technique: I stand the dog between my feet, which are about shoulder width apart. The dog’s head is pointing behind me, his tail ahead.
    I place my thumbs on the spine, just about where the pelvis joins it. With my flattened and slightly outstretched fingers, I grasp the abdomen sides between the knee and the ribs, and I feel for the bladder. I manipulate it with my fingers until it is fully (or as fully as possible) in my grasp. 
13. At this point, take a cleansing breath, exhale, clear your mind, find your Zen — whatever you need to do so that you don’t communicate anxiousness, fear, frustration, etc. to the dog. If you are tense, they won’t relax enough to allow you to express. Then I press the fingers of the hands together, making sure it doesn’t slip from my grasp. At some point you will feel the muscles relax, and a urine stream will begin. Continue applying pressure until no more urine is produced. 
14. Note: In some dogs, especially males, bladders “drop” when the muscles relax and the urine begins to flow. The bladder will literally slip from your mid-fingers to your fingertips. If your dog does this, you have to quickly slide your fingers down to re-grasp the bladder while you continue to apply pressure. It’s tricky at first, but fine once you get the hang of it. If you let go and try to reposition your fingers, you will have to start all over again. 
15. Once you are experienced, that will be all you need to do. But in the beginning, you should let the dog go for five minutes or so and try again. Often you have left a lot of urine after the first attempt. 
16. How hard should you press? That is a tough one. Some dogs are very easy to express and just require light pressure, but for others, you have to press with nearly all of the strength in your fingers. It is scary, I know. You worry about hurting the dog, rupturing the bladder, squishing kidneys and other organs... but you’ll be okay. The dog will be okay. I have expressed some VERY difficult-to-express dogs, and none have ever been injured from the process. 
17. Also, when learning how to express, it is often helpful if the vet will prescribe medication to help relax the urinary sphincter and make expressing easier. There are several different ones to try and each dog may do better with a different drug. Difficult-to-express dogs might stay on one permanently, but they all have side effects so don’t use drugs unless you need to. Proin is not the correct drug for this problem, urinary retention incontinence. 
18. How often should you express? About every 6 hours. Always express right before bed and as soon as you wake up. As long as you aren’t a late sleeper, you should be able to sleep with your incontinent dog in bed without accidents. 
19. There is one situation that you may need diapers for: A dog with a spastic bladder. Some dogs, even when expressed regularly, will have spasms of their bladder that cause them to expel urine at random times. These dogs still need expressed regularly, but may also need diapers to catch the random spurts. 
20. Lisa has other posts that discuss urinary tract infections (UTIs) and urinary crystals for the recommendations of medications and supplements to keep these dogs from getting UTIs and stones due to the bladder retaining urine.
21. Another note: In dogs with large, flaccid bladders, and having large, difficult-to-pass feces, the urethra is sandwiched between the bladder and the colon, so if both the bladder and colon are full, your dog may not be able to be expressed. This can be an emergency situation. Get an OK to use lactulose immediately to soften the impacted stool, and take your dog to the veterinarian to have a catheter passed to relieve the bladder. Once the bladder is drained and the feces are moving again, they should be fine. If your dog is male, you can discuss learning to have a catheter set-up to keep at home if this happens. It is extremely difficult to catheterize female dogs, but males are easy. They can show you how and possibly save you an ER vet visit someday. ​

c 2016 Lisa Weber Smith, Rusty Pug Retirement Ranch
                    Some of the supplements Lisa has used in her own dogs appear at: http://www.amazon.com/gp/registry/wishlist/104M0QBM5XSWW/ref=cm_wl_rlist_go_v/166- 4175906-3171448          Please consult your dog’s veterinarian regarding use of these supplements.

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