Pets can be incontinent for many reasons, including abnormalities in parts of the brain and spinal cord that control bladder function, birth defects, and disease. Fearful dogs are particularly prone to peeing under stress. Medication can be tried in different doses until an effective combination is found. This happens because of the dog's inability to regulate the muscles in a stressful situation. Other possible causes of male incontinence include: Your dog may release a few drops of urine during sleep or when licking his genitals, but the amount of urine is negligible compared to incontinence due to other causes. Canine incontinence. Aaron A, Eggleton E, Power C, Holt PE. Incontinence only when the dog is excited might indicate detrusor hyperreflexia. If your dog is exhibiting any signs of urinary incontinence, you should call your veterinary clinic or schedule an appointment with one of the internal medicine veterinarians at the WSU Veterinary Teaching Hospital by calling 509-335-0711. Byron JK, March PA, Chew DJ, DiBartola SP. FSH and LH plasma levels in bitches with differences in risk for urinary incontinence. In a review of 27 cases treated with an artificial urethral sphincter, all had significantly improved continence, with only 2 dogs having complications involving partial urethral obstruction.9, Injectable urethral bulking agents have been used, particularly bovine cross-linked collagen, to increase resting urethral pressure in dogs with UI. Both procedures have pros and cons, and careful patient selection is necessary for an optimal outcome. The most commonly practiced procedures in the United States are urethral collagen injections and placement of an artificial urethral sphincter. One of the most common causes of urinary incontinence in dogs is the Urethral Sphincter Mechanism Incontinence or USMI. UI must be distinguished from behavioral conditions and systemic problems (eg, polyuria, pollakiuria), and it is important to establish that the animal is unaware of the passage of urine. Urinary incontinence in male dogs is frequently caused by UTIs, old age, and prostate disease. FOIA . In many cases, a bladder infection or vaginitis in female dogs causes an inflamed sphincter, resulting in the dog leaking urine when relaxed. While it's not always immediately apparent why your dog has suddenly become incontinent, there are several possible reasons: Both male and female neutered dogs can experience hormone-responsive incontinence, but female dogs are more likely to have trouble with it. Based on two long-term reviews, postprocedure continence in female dogs with UI was 66% to 68%; of those who are not continent, 46% to 60% achieved continence with the addition of medical therapy.16,17 The largest drawback of this procedure is the variability in duration of effect. It is often necessary to use both smooth and skeletal muscle relaxants in these patients to achieve the desired result. The urethral sphincter is a muscle located between the urethra and the bladder. Hormone replacement therapy will be prescribed by your veterinarian and given at home. Epub 2021 Jan 14. Lane IF, Westropp JL. Some dog breeds are also prone to urinary incontinence, such as:, Your vet should thoroughly review your dogs history and conduct a physical examination before making a diagnosis. A relaxed or sleeping dog that can't hold their bladder is usually a sign of an underlying issue, such as age-related incontinence, urinary tract infections, or diabetes. Although this last example is not a bladder control problem, it could still be a reason why youre suddenly finding puddles around the house. Dogs that do not respond to appropriate medical therapy should be evaluated for other lower urinary tract disease via imaging, including abdominal ultrasonography and/or contrast radiography. From their personality and temperament to their breed characteristics, the care they need, and the life expectancy of a Beagle: heres how you can help your Beagle live a happy, healthy, and hopefully long life. -Agonists increase stimulation of the adrenergic receptors on the internal urethral sphincter, whereas estrogens may upregulate the expression of such receptors. Dog incontinence: causes and solutions for canine bladder control problems, Sores or inflammation on your dog's skin caused by frequent contact with urine, usually around the vulva and hind legs, A strong odor of urine coming from your dog and their bedding, A house-trained dog may suddenly act shy or uneasy and be peeing in the house, They may leave wet spots where they sat or walked, Peeing while sleeping and at random times throughout the day, Use behavior modification training to teach your dog coping skills when faced with stressors. By clicking Subscribe, I agree to the WebMD, Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Smoking Pot Every Day Linked to Heart Risks, Artificial Sweetener Linked to Heart Risks, FDA Authorizes First At-Home Test for COVID and Flu, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, Types of Dogs More Likely To Have Urinary Incontinence, Diagnosis and Treatment of Urinary Incontinence in Dogs, Management of Urinary Incontinence in Dogs, Inherited medical condition that occurs at or before birth, Diseases that cause excessive drinking of water, for example, diabetes, kidney disease, and Cushings disease, When the problem started and if its getting better or worse, If your dog needs to go outside more frequently, If your dog is drinking more water than usual, If you have noticed frequent or painful urination outside, If your dog has any other unusual symptoms, Using waterproof pads under their bedding, Maintaining proper hygiene to prevent skin infection. It is likely that the efficacy and adverse effect profile are similar to those of DES. Reichler IM, Hung E, Jochle W, et al. 2021 Mar 5;83(2):274-279. doi: 10.1292/jvms.20-0515. Behavioral changes are important factors as well. Radiographs can rule out urinary stones, and ultrasounds will rule out tumors or growth in the bladder. You can start by assessing your dog's lifestyle and diet. Keeping your dog's coat in tip top condition ensures they're comfortable, healthy and happy. This FDA-approved drug is commercially available in doses designed for use in dogs. While incontinence is common in aging dogs, it can also signify a more serious health problem. The .gov means its official. Conjugated estrogens (Premarin, pfizer.com) naturally derived from the urine of pregnant mares have been used to treat a variety of postmenopausal symptoms in women. A normal amount of testosterone will prevent incontinence, while a low amount or no testosterone will cause urinary incontinence. As an AAHA-accredited hospital since 1983, we voluntarily uphold the associations high standards in 18 areas, including patient care, cleanliness, and emergency services. Management of these patients can start out as being relatively straightforward; however, many dogs need adjustments in their therapy as they age or develop additional health concerns. Palerme JS, Mazepa A, Hutchins RG, Ziglioli V, Vaden SL. MeSH Although it can occur at any age, bladder control incontinence is most often seen in female and senior dogs. When they fall below .4ng/ml, the dog is considered infertile. No studies have been performed to assess its efficacy in male dogs with UI. Medical therapy is directed at the smooth, and sometimes skeletal, muscle of the urethra to either improve contraction or enhance relaxation. Additionally, medical conditions can begin slowly or suddenly and become a chronic problem if left untreated. In incontinent male dogs, steroid therapy may be prescribed. This is possibly caused by misdiagnosis of dogs with functional urethral obstruction and overflow incontinence. Reichler IM, Jochle W, Piche CA, et al. Storage and emptying are the two primary functions of the bladder and bowel. The goal of hormone replacement therapy is to return tone to the urethra to decrease the incontinence. Similarly, other compounds like L-carnitine help build muscle and may prevent the muscles in the urinary tract from atrophying. In this case, it is vital to note when this happens and in what context. Other adverse effects, such as behavioral changes and decreased appetite, are related to sympathetic stimulation. Byron JK, Taylor KH, Phillips GS, Stahl MS. J Vet Intern Med. These drugs can affect the bone marrow; your vet will need to do frequent blood work with this therapy. In the spayed female dog, the removal of the negative feedback effect of estrogen leads to increases in follicle stimulating hormone (FSH) and luteinizing hormone (LH). These include:, Certain Breeds. FIGURE 1. The hormone testosterone, in particular, is secreted by the male dog's testes and is known for producing several physiological and behavioral effects. Supplementing the female dog's hormones may help treat USMI. When evaluating the published success of these procedures, it is important to note that they have primarily been evaluated in patients that are not responding to medical therapy and thus may have a more severe form of urethral sphincter mechanism incompetence (USMI). Urinary tract infection can occur together with other causes of urinary incontinence or can be the cause of the incontinence. These effects generally resolve when the medication dose is decreased or stopped. Based on owners assessments, a good to excellent response was reported in three of eight dogs (38%) (Palme et al. Dr. Byron is a clinical professor in the department of veterinary clinical sciences at the Ohio State University (OSU) College of Veterinary Medicine. A weak urethral sphincter is treated with phenylpropanolamine. There is anecdotal evidence that the 2 drugs in combination may be synergistic and benefit patients that do not respond to either drug alone. However, caution should be taken when using these compounds in patients with underlying myelosuppressive disease or at high doses. Retrospective evaluation of urethral bovine cross-linked collagen implantation for treatment of urinary incontinence in female dogs. J Am Anim Hosp Assoc. In cases like bladder stones and congenital abnormalities, your vet may recommend surgery. Dog diapers could be helpful to avoid messes, but you must be on the lookout for any signs of urine scalding or infection on the dog's skin. Little is known about long-term outcomes in male dogs with DUD, and evidence for treatment efficacy is lacking. Although urine leakage may be exacerbated by a urinary tract infection (UTI), the incontinence itself may predispose the patient to a UTI. Effect of phenylpropanolamine and pseudoephedrine on the urethral pressure profile and continence scores of incontinent female dogs. The material is injected submucosally into the proximal urethra via cystoscopy (Figure). Hormone therapy can help spayed female dogs. MAIN : Urology : Urinary Incontinence in Male Dogs Search this Resource View main page Table of Contents Browse by Speaker Browse by Category Alternative Medicine, Homeopathy and Acupuncture TDP Lamp & Herbal Medicine for Tan-Huan Syndrome Wu Ling San to Treat KCS Anesthesia Lidocaine Injected into Epidural Space . Some medications could cause your dog to leak urine as a side effect. It was widely used in the United States and worldwide to reduce pregnancy complications and treat a variety of conditions in women until 1971; it was found to contribute to an increased risk of neoplasia and birth defects in the children of expectant mothers who took the drug. There are many causes of incontinence in dogs, including:. In cases like bladder stones and congenital abnormalities,. Surgical treatment is important especially when medication alone does not solve the problem. In addition, the implant may narrow the diameter of the urethral lumen, allowing the urethral sphincter to close more effectively. This can lead to a weaker urethral sphincter, the muscle that controls the flow of urine out of the urethra. In some cases, incontinence may be caused by a weak bladder. Then when they rise after lying down the urine pours out. Barth A, Reichler IM, Hubler M, et al. Diethylstilbestrol isnt commercially available in the US, but if your vet recommends it, a compounding pharmacy may be able to provide it. Success has been reported to be similar to colposuspension, but with shorter efficacy, likely because of avulsion of the urethropexy from the prepubic tendon. If the incontinence is caused by tumors of polyps, these should be examined and removed or treated with chemotherapy. Epub 2017 Mar 3. See details. With 2.1 mg deslorelin implants, oestrus can be suppressed for up to 27 months (Wright et al. Radiography, ultrasound, computer tomography, or cystoscopy might help to identify the cause of the incontinence. Certain amino acids, like L-arginine, are necessary to clear out ammonia build-up in the body, which can help the urinary tract. Dogs with brain or spinal cord disease may either dribble urine or be unable to pass urine. It has been hypothesized that the increase in these gonadotropins has either a direct negative impact on the urethral closure pressure or results in decreased bladder function.11,12. If you notice your dog urinating while sleeping or resting, they may have urinary incontinence. They may do additional testing to gain information, such as:. A careful history is essential when discussing UI with pet owners. The good news is that dedication and physical therapy can help your dog recover over time. . It can also soothe any irritation in your pet's urinary tract if infected and has a mild diuretic effect. In some females, a combination of estrogen therapy and phenylpropanolamine, for controlling incontinence, may be more effective. Radiographic image (right lateral view) of the sphincter after placement around the urethra of a dog (B). In larger breedsdogs with an expected adult weight >15 kgthere is a decreased risk of UI with every month delay in OVH. The dose and frequency needed for each animal tend to vary widely and may need to be increased over time to maintain continence (Table 1). Reichler IM, Hubler M, Jochle W, et al. Estrogen supplementation is also an available option, where your vet may prescribe estrogen-based medications such as estriol. Continence was maintained for up to 2 years in 4 of 4 dogs.18 In a recent review, 27 of 27 dogs had significantly improved continence scores after placement of the sphincter, with only 2 dogs having complications involving partial urethral obstruction.19 Surgical placement of an artificial urethral sphincter appears to have good success in male dogs that fail medical therapy. Incontinence in young animals is often caused by a birth defect known as ectopic ureter(s). Urethral Sphincter Mechanism Incompetence in Dogs: An Update. Colposuspension is a procedure in which the lateral vaginal walls are attached to the prepubic tendon, thus drawing the bladder neck and proximal urethra further into the abdomen. Sometimes, males may benefit from testosterone injections, but this is less common. Dribbling pee can occur due to a urinary tract infection (UTI). Diethylstilbestrol (DES) is a synthetic, nonsteroidal estrogen first synthesized in 1938. Hutchins RG et al. This is particularly important in males because functional obstruction and overflow incontinence may be more common than previously thought. Fluid inside the cuff can be adjusted by the veterinarian to achieve a level of pressure that maintains continence during bladder filling but does not lead to obstruction when the bladder and abdomen contract. It appears that the obstruction can involve either the smooth or skeletal muscle of the urethra or a combination. Urethral Sphincter Mechanism Incompetence in 163 Neutered Female Dogs: Diagnosis, Treatment, and Relationship of Weight and Age at Neuter to Development of Disease. Both are affected after a severe spinal cord injury, as damaged nerves can't control full bladders. Medical therapy for acquired urinary incontinence in dogs. It is orally bioavailable and reaches peak plasma concentrations in 1 hr in dogs; it has an elimination half-life of 24 hr because of enterohepatic recirculation. Bladder leaks are not an uncommon occurrence in older dogs. The artificial urethral sphincter is a silicone cuff that is placed around the urethra. In: Holt P (Ed): Reeves L, Adin C, McLoughlin M, Ham K, Chew D. Outcome after placement of an artificial urethral sphincter in 27 dogs. The good news is that making a few lifestyle, diet, and supplement changes can help alleviate or prevent incontinence in dogs. Evaluation of the prevalence of urinary incontinence in spayed female dogs: 566 cases (2003-2008). This might occur with ectopic ureters. Energetic pups will love discovering the world on their walks and we love to accompany them! Dogs with genuine urinary or urethral incontinence often pee while resting or sleeping with no obvious triggers. The dog should also have its blood pressure monitored after 2 to 4 weeks on the medication. In healthy dogs, intra-abdominal pressure transmits to the bladder and proximal urethra. Located in: Wrightstown, New Jersey, United States. No studies have evaluated them as first-line treatment options. In animals with a caudally positioned or pelvic bladder, the proximal urethra is not within the abdominal cavity, and this pressure is not exerted on the urethra. The tests performed to evaluate a pet with incontinence depend upon the age of the pet and clinical signs. Middle-aged to older spayed female dogs are prone to what is referred to as spay incontinence. This is a form of incontinence commonly caused by lower estrogen levels, which can lead to a loss of muscle tone in the urethra. Causes of urinary incontinence in dogs can be divided in congenital and acquired causes. Incontinence can be confused with diseases and infections that cause a pet to urinate frequently. The proposed predispositions to incontinence that follows neutering including gender, breed, body weight, obesity, tail docking, spaying technique (ovariectomy and ovariohysterectomy) and. One example is fibrocartilaginous embolism, or FCE. As a result, even though the dog drinks a lot of water, they can still become dehydrated. Congenital causes can be ectopic ureters, congenital urethral sphincter mechanism incompetence, persistent urachus, bladder diverticula, hypoplasia of the bladder, prostate, or urethra, and hypospadia. PPA has also been used safely in cats with UI, although there are little data available regarding its efficacy. 2018 Jan/Feb;54(1):22-29. doi: 10.5326/JAAHA-MS-6524. Before The mechanisms behind UI in dogs are multilayered and poorly understood. Pet Services All Pet Care Services Pet Pharmacy . Blood work might help to identify underlying diseases. The absence of testosterone may be caused by the neutering procedure. 1-Agonists are likely the most commonly used UI therapy in veterinary medicine. Breeds that are more prone to incontinence include: Most pet owners will notice their dog leaking urine while asleep or on the bed resting. Urinary incontinence is when your dog involuntarily loses control of their bladder. Urinary tract disorders and bladder infections are just a few possible causes. Acquired urinary incontinence in bitches: its incidence and relationship to neutering practices. Hormone-responsive incontinence can occur months to years after a pet is neutered. Female Dogs. An official website of the United States government. Keeping your dog fit and as active as possible may not specifically help incontinence, but it can help their overall well-being and bodily functioning. The decline in estrogen levels after neutering in female dogs may cause a decrease in the vasculature of the urethra and its supporting tissues, which is an important part of maintaining a closed urethra. Yes and no several smaller breeds are predisposed to arthritis, too. Estrogen therapy has been used to treat incontinence for decades. If your dogs leaking urine frequently due to fear or anxiety, help them by identifying the type of anxiety they're experiencing and potential triggers. 2. WebMD does not provide medical advice, diagnosis or treatment. Injectable urethral bulking agents, particularly bovine crosslinked collagen, have been used to increase resting urethral pressure in dogs with UI. Some dogs exhibit worsening clinical signs when stressed or anxious, and these patients may benefit from trazadone, fluoxetine, or other anxiolytic medication. In addition, some preparations are very costly and others are not available in North America. It enhances glandular function, impacts collagen strength, and increases the number and sensitivity of -receptors in the smooth muscle of the urethra. Median duration of continence without additional medical therapy ranged from 8 months to 2 years. Would you like email updates of new search results? Here are some ways testosterone can impact your dog's behavior and health. 2005 - 2023 WebMD LLC. The https:// ensures that you are connecting to the Peterson KL, Lee JA, Hovda LR. Holt P. Urinary incontinence. Treatment of testosterone-responsive incontinence in neutered male dogs. Unlike female dogs, male dogs have no increased risk of incontinence due to their body weight or neutering. Exclusive offers, a heads up on new things, and sightings of FOTP in the wild. Young dogs that have never been continent or have been difficult to housetrain should be evaluated for congenital abnormalities, such as ectopic ureter(s). Dog Incontinence: Its Causes and How You Can Cope, Do Not Sell or Share My Personal Information, Damage or injuries to the urethra or bladder muscles, Aging, which will result in reduced production of testosterone, even if the dog is not neutered. In this case, the urethral closure is constantly overwhelmed. PMC The median duration of continence without additional medical therapy ranged from 8 months to 2 years.11, Other surgical therapies for UI focus on increasing the transmission of intra-abdominal pressure to the proximal urethra and improving stability and pressure within the urethra. In support of this theory, data from one study have shown that the administration of GnRH analogues to dogs with USMI can lead to improvement of continence.5, In animal models, estrogen has trophic effects on the vasculature and tissue matrix of the lower urinary tract and its support structures. Sontas HB, Dokuzeylu B, Turna O, Ekici H. Estrogen-induced myelotoxicity in dogs: A review. While there are a multitude of reasons to eliminate testosterone from your male dog, there are some instances where testosterone is advised as a treatment for certain health conditions. Less than 50% of male dogs respond to medical therapy, and the most successful treatment is phenylpropanolamine. Then, you can make changes to avoid these triggers. Testosterone cypionate was used in a recent study for urethral sphincter mechanism incompetence in 11 male dogs. If the veterinarian suspects that the . 8600 Rockville Pike Byron JK, Chew DJ, McLoughlin ML. All rights reserved. Claeys S, de Leval J, Hamaide A. Transobturator vaginal tape inside out for treatment of urethral sphincter mechanism incompetence: preliminary results in 7 female dogs. 11 Testosterone cypionate at 0.5-3 mg/kg/month for male dogs was also noted as a treatment in a patent application. FIGURE 2. This condition is treated with antimuscarinic drugs such as oxybutynin and imiprimine. "Urinary incontinence after spaying occurred in 9.7 percent of bitches. Again, context is everything. Testosterone may be given to male dogs with urinary incontinence. The absence of testosterone may be caused by the neutering procedure. Congenital urethral sphincter mechanism incompetence can occur in combination with other malformations or alone. Another home remedy for incontinence worth exploring is corn silk supplements. Dogs with diabetes also drink more water and can exhibit extreme thirst. Delivery: Estimated between Fri, Mar 3 and Tue, Mar 7 to 23917. For instance, ectopic ureters can appear later in life because of the urethral closure pressure decreasing with age. However, it is less effective than phenylpropanolamine. In addition, purebred dogs are more likely to suffer from involuntary leaks than their crossbred counterparts, as line breeding can cause more genetic problems. In spayed female dogs, this is acceptable; however, in intact females and in males, further evaluation for other urinary tract disorders, particularly urethral functional obstruction and overflow incontinence, is warranted. A variety of home remedies for dog incontinence can be very helpful in the fight against urinary incontinence. Male dogs should be evaluated for urine retention and functional urethral obstruction. Holt PE. Bloodwork is indicated if the patient has a low urine-specific gravity, particularly in the face of dehydration. Male Hormone Replacement: Testosterone shots are a possible treatment for male dogs with urinary incontinence. However, if dogs suffer from urinary incontinence, they are also more likely to develop UTIs. Evaluation of long-term effects of endoscopic injection of collagen into the urethral submucosa for treatment of urethral sphincter incompetence in female dogs: 40 cases (1993-2000). The risks of delaying spay surgery, such as increased chance of mammary carcinoma, and benefits, like a lower risk of UI, should be openly discussed with the owner and tailored to the individual. The surgical placement of an artificial adjustable hydraulic urethral sphincter (Figure 2) around the urethra has been studied in female dogs and anecdotally used in males. Although many materials have been investigated, the theory behind all injectable bulking agents is to increase the stretch in the sphincter muscle fibers, leading to an increased resting closure pressure in the urethra. Reversion of feminization in male dogs following removal of estrogenic testicular . Hormone-responsive incontinence occurs in neutered dogs of both sexes but most commonly in female dogs. 1996). In addition to the obvious urine in unusual places and the persistent urine smell, your dog may display other symptoms as well. Similar to colposuspension, this increases transmission of intra-abdominal pressure increases to the urethra as well as the bladder and bladder neck, preventing a negative pressure gradient into the outflow tract. Dogs with low estrogen levels, obesity, and larger breed size can experience bladder sphincter and valve laxity, leading to urine leakage, especially while they sleep. Epub 2017 Nov 13. Vet Rec. Unfortunately skunk spray is pretty common in the US and Canada, so if your dogs come off worse for wear, dont panic, heres what you need to get rid of that awful smell. If you spot these symptoms, consider taking your dog to the vet. For example, dogs with separation anxiety may pee in the house while their owners are gone, or a dog with noise phobia might pee during a thunderstorm. Images courtesy of Mary McLoughlin, DVM, MS, DACVS, The Ohio State University. See details. In older dogs, bladder leaks are a common occurrence, the urethral muscles are simply weaker than they used to be. Specific treatment of an underlying disease or condition with surgery or medications may resolve incontinence. While urinary incontinence can happen to any dog, it is more likely in certain types. Dogs that do not respond to appropriate medical therapy should be evaluated for other lower urinary tract disease via imaging, including abdominal ultrasound and/or contrast radiography. Urinary incontinence (UI), a common problem encountered in small animal practice, can result from congenital anatomic abnormalities, urine retention and overflow incontinence, or sphincter incompetence. The device allows the dog to urinate normally while maintaining continence. Some practitioners avoid the use of estrogen compounds because of the potential for irreversible myelosuppression seen in dogs treated with estrogen compounds for mismating or to induce estrus.8,9 While this is a potential toxicosis, the doses associated with bone marrow suppression are generally at least 10 times higher than those recommended for management of UI. Are large breeds at greater risk? The dog is able to control the release of urine due to muscles that are at the base of the urinary bladder. A good general guideline is to perform an indirect systolic blood pressure on any patient before treatment with PPA and repeat the evaluation after 1 to 2 weeks of therapy. In this case series, we report the effect of testosterone cypionate, given at a median dose of 1.5 mg/kg intramuscularly every 4 wk, in eight male dogs with USMI. Dog incontinence is a common issue, and a dog that can't hold pee or is leaking urine all over the house is tricky for a pet parent to navigate. These tests can help determine the root cause and best treatment plans for your dog. Copyright 2023 Today's Veterinary Practice Web DesignbyPHOS Creative. Another important factor in maintaining continence is bladder position. In otherwise healthy dogs with normal blood pressure, PPA rarely induced hypertension at recommended doses.3,4 However, in patients with conditions such as chronic kidney disease, hyperadrenocorticism, and protein-losing nephropathy, it should be used with extreme caution and blood pressure should be regularly monitored. It is well known that UI is most common in dogs that are spayed or neutered; however, the exact mechanism and relationship to estrogen and testosterone decline is unclear. So let's look at some of the causes and solutions for dogs who can't hold their pee. In women, UI is often caused by detrusor hyperreflexia, or overactive bladder. However, these drugs can also have side effects on the bone marrow, so we monitor . 2001), but recent studies have suggested an average of 10.2 5.1 months (2.1-23.3 months) with the use of 4.7-mg implants (Maenhoudt et al. It is common to evaluate incontinent pets for the presence of a bladder infection. Mandigers RJ, Nell T. Treatment of bitches with acquired urinary incontinence with oestriol.
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