Raising a new puppy is a big undertaking, and potty training especially, can be stressful. When your pup finally gets it and is no longer having accidents in the house, you feel like you’ve checked off a pretty big box.
But what happens when you continue to see urinary issues, or new ones emerge, especially in your adult or senior pup?
We know that house-soiling is a top frustration for pet owners, and is even a top reason for pets to be relinquished to shelters. It’s clearly a big deal-breaker and really strains the bond folks share with their pets.
In this article, we’re going to review some common reasons why both dogs and cats can have inappropriate urination issues. This will include not just urinary tract infections, but also behavioral problems like stress, incontinence, metabolic issues like kidney disease, and others.
A Sudden Need to Pee (In the House): Urinary Tract Infections
The urinary tract infection is the most common illness most pet owners think of when their pup or kitty is inappropriately urinating in the house--even if an infection is not truly the cause.
The basis for a urinary tract infection in many pets is somewhat simple. UTI’s are caused by environmental contamination of the urinary tract by bacteria. This can include bacteria already present on the skin, like Staph and Strep bacteria, or bacteria we can find in fecal material or otherwise outdoors, like E. coli and Klebsiella.
Many folks are understandably concerned when I mention the environment as part of the cause. After all, we all do our best to keep the litter box and house clean. But one major difference between cleanliness in people and cleanliness in pets is self-grooming. What do pups or kitties do after doing their business? They lick back there to clean up.
Self-grooming can inadvertently cause cross-contamination of the urinary tract with fecal material. Also, dogs that squat particularly low to the ground when urinating can expose the urinary tract to dirt, which can contain remnants of past dogs’ fecal leavings.
Lastly for risk factors, some lady pups can have what is termed a “hooded” or “recessed” vulva. This means that the vulva is somewhat sandwiched down underneath folds of skin in the groin area. These extra folds and recessed tissue can harbor bacterial overgrowth, which can seed up the urinary tract. This is often the cause of Staph or Strep infections where a pup’s own skin bacteria are part of the problem.
Signs of a UTI are most often highlighted by the following characteristics:
-Frequent need to go out (sometimes every 10-15 minutes) with very little urine being produced each time (this is termed pollakiuria). This may be perceived as an urgent need.
-Some dogs may appear uncomfortable while urinating, like they are straining to pee each time.
-Blood may or may not be present.
While these signs may not always be there all together, at least one is usually present and I often use these characteristics when differentiating from another urinary issue.
In general, female dogs and cats are far more risk-prone to developing UTI’s because their urinary tract is shorter and wider, allowing bacteria to more easily colonize the bladder. However, we do sometimes see infections in males, especially older cats and dogs with less robust immune systems.
If you see signs in your pup or kitty consistent with a urinary tract infection, it’s best to have her checked out by a veterinarian. Your veterinarian will typically run a urine sample, even if the problem has happened before, because we always have to base our treatment on as much evidence as possible each time.
Empirical antibiotic therapy in most cases helps to resolve UTI’s, but if your pooch or fluffy furball has had repeated infections, your vet may advise culturing the urine to see if there is a chance of bacterial resistance. Cultures can also help to verify the success of treatment.
Is there any way to prevent UTI’s? For pets that don’t have a high level of risk for recurrence, there really isn’t much to do. Some pets will get a UTI only once or twice in their lifetime. But the good news is, these are often simple to treat.
For pets who seem to be at risk for contracting repeated infections, it’s important to check the positioning of the urinary tract. Is the vulva recessed or sandwiched under folds of skin? In overweight pets, losing weight can be helpful, but for pets that simply have a conformational issue making them prone to recurrent infections, a vulvoplasty surgery is possible.
Surgery not an option right now? A conservative route is to consider a cranberry supplement, like Cranberry Plus Echinacea. In people, some research has shown that cranberry juice can help prevent UTI’s. Through action of proanthocyanidins, cranberry can help prevent adherence of bacteria to the bladder wall.
Now, there are also studies that don’t support these findings, so the data is mixed, but anecdotally, I have encountered pet parents who feel a cranberry supplement really does help, and continuing one certainly does not hurt.
Between a Rock and a Hard Place: Bladder Stones
Bladder stones are rock-like formations of minerals that can form secondary to a couple of different causes. Risk factors include urinary tract infections, pH of the urine outside of the neutral range (meaning the urine is either too acidic or too basic), genetic predisposition, and diet.
The two main types of bladder stones we see are struvite and calcium oxalate. Struvite stones in dogs classically form due to an altered pH in the urine caused by certain bacterial infections. In cats however, these stones can form without any pre-existing infection.
Calcium oxalate stones typically form in more acidic urine pH and have a complex causality. The urine has to be high in calcium, citrates, and oxalates. These can come from dietary sources as some foods like spinach, sweet potatoes, and really high levels of vitamin C contain oxalates. However, individual dogs may have altered metabolism that lead to these components reaching high levels in the urine.
There are two other stone types, cystine and urate, but these are relatively rare to see. Regardless of cause or type, bladder stones cause irritation of the bladder wall, leading to UTI-like signs with frequent urination and straining. Stones also have the ability to cause a blockage of the urethra, preventing a pet from urinating altogether, which can be life-threatening.
Bladder stones can be diagnosed using either ultrasound or x-rays. Your vet might have a suspicion for them if a urinary tract infection has been treated for but the urinary signs remain unchanged.
Bladder stones can be addressed in two ways. While anesthesia risks have to be considered, surgical removal is actually the fastest method and ensures all stones and mineral grit material are removed. The bladder is pretty forgiving and heals quickly. Quick surgical intervention also reduces the risk of stone obstruction while waiting on other methods.
The second method is to dissolve the stones with a diet. Hill’s, Royal Canin, and Purina each have prescription diets specifically formulated to dissolve struvite stones. They can also prevent stone formation by keeping the urine within the narrow neutral pH needed. The only problem with this method is that calcium oxalate stones can be prevented with a diet, but cannot be dissolved with one. Thus, it’s a 50/50 shot as to whether the diet will work as a treatment.
LIthotripsy, which involves using shock waves to break up stones into small enough components that can be dissolved more easily or passed in the urine, can work well, but is not a widely available technology for most local veterinary clinics.
Once stones are gone, a prescription diet may be recommended to prevent their return. If it’s thought that struvite stones may have formed secondary to a UTI, addressing future UTI’s in a timely manner will be paramount for prevention.
Sit. Stay. Now Don’t Pee: Behavior
We’re going to move on next to behavioral causes of inappropriate urination in dogs, and this starts with puppies.
I can’t count how many times a new puppy parent will bring their cute little 10 week old pooch to me insisting he must have a UTI because he’s not only peeing in the house, but going every 30 minutes.
While it’s not impossible for a young puppy to have a UTI, I would argue that it’s far less common than a new pup parent simply needing to understand puppy behavior, potty training, and having some extra patience.
My expectations for puppies are that by about 12 weeks, they should be able to hold it for at least 8 hours overnight in their crate or pen. During the day however, puppies can be so active that they may have to go frequently. And be careful about restricting water. I do agree with limiting water before bedtime, but puppies should have ready access to water when active and playing, especially outside.
Potty training takes time, persistence, repetition, and sometimes help from a good in-home trainer. I start to get concerned if by 5 months we’re still having house-training issues, especially if we’re seeing soiling in the crate or pen. Your veterinarian can be a good resource for advice on potty training and should be able to refer you to a good in-home trainer who can work with you on more challenging issues.
When Holding It’s Just Not an Option: Incontinence
True incontinence can be difficult to differentiate from other conditions where pets are simply drinking excessive amounts of water and overfilling their bladder. Thus, incontinence can be over-diagnosed.
The main hallmark of true incontinence is urinary dribbling, especially where a pet appears to be unaware. Parents may often see urine just dribbling out while a pup is out for a walk. Or, you may notice that the doggie bed has some wet spots suggesting your pooch leaked while sleeping.
If your pup is having accidents but is consciously posturing to urinate and seems aware of the act, true incontinence is less likely.
Urethral Sphincter Mechanism Incompetence
Urethral sphincter mechanism incompetence (USMI) is an incontinence condition that can be seen at any age, but can have an onset as early as 3 years. According to American Veterinarian, it can affect as many as 30% of dogs.
Causes of USMI are likely varied. According to a 2018 article in the Journal of the American Animal Hospital Association, multiple studies on this topic have shown very variable associations with time of spaying and development of USMI. Causes likely also include variables like anatomic position of the bladder and breed inheritance.
Treatment often focuses on medication that either increases stimulation of receptors on one of the urinary sphincter muscles, or supplementation with an estrogen compound that also upregulates these receptors in cases where low estrogen levels after spaying may be related. Your veterinarian would be the best judge of whether or not these medications would be appropriate.
A ureter is a tube that connects each kidney, which actually produces urine, to the bladder. The purpose of the bladder is to then store urine until it’s full, then it sends a signal to the brain that we need to pee.
An ectopic ureter is an anatomic abnormality, where one or both ureters bypass the bladder and merge directly to the urethra. This prevents storage and sorting and leads to urine that is constantly leaking out as it is produced by the kidneys.
This is unfortunately a condition that an affected pet is born with. The hallmark sign leading to concern is when a young puppy is responding well to training, but continues to have accidents constantly and is unaware that the accidents are occuring.
Unfortunately, this condition is very challenging to treat and has extremely variable outcomes. Surgical correction of the abnormality is necessary for at least some improvement, but according to the American College of Veterinary Surgeons, a range of 25%-70% of female dogs will still have incontinence issues even with surgical correction and medical therapy. On the bright side, 70-80% of male dogs can be successfully managed with surgery.
When Kidneys Fail: Acute and Chronic Kidney Disease
Kidney disease is one of the most common causes in older pets especially for seeing urinary issues. As kidneys fail, they lose their ability to concentrate urine, one of their main functions. Concentration of urine simply means that the kidneys reabsorb water and electrolytes needed by the body, leaving urine as a more concentrated waste product.
When the kidneys lose this ability, far more water is lost, which then requires replacement, leading to an excessive need to drink more. This is vastly oversimplifying the process, but an easy way to think about it.
Typically with kidney disease, because pets drink a lot of water, they urinate a large amount at a time. And while it’s not a 100% rule, this most often can help us consider a UTI less likely, where we usually see small, frequent urination with straining. And while they can have an increased urgency because their bladder is so full and thus may not make it outside in time, pets with kidney disease do typically posture to urinate and are aware when they have an accident. This helps us to separate this disease from incontinence. At least most of the time.
Kidney disease is either acute or chronic in nature. Acute causes are typically caused by toxins, like antifreeze or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Chronic kidney disease is far more complicated and caused by a variety of factors. This can include genetic predisposition, immune mediated disease, chronic bacterial infections, and high blood pressure, among others.
While early treatment and intervention can make a big difference, and can even save a pet’s life, acute kidney injury often develops into chronic disease because of some degree of irreversible damage that occurs.
If you suspect your pet could be suffering from kidney disease, it’s extremely important to have her checked by your veterinarian. Bloodwork is used to check for build up of certain waste products in the bloodstream and electrolyte abnormalities caused by kidney dysfunction. In conjunction with these findings, a urine sample can confirm kidney disease with a low urine concentration.
Treating kidney disease is complex and depends on the circumstances. Sometimes, hospitalization is required in the short term, but there are strategies for home management to keep chronic kidney disease pets at a good quality of life for as long as possible.
Those Crazy Hormones: Endocrine Diseases
Endocrine simply refers to body systems that utilize hormones. There are three endocrine diseases in dogs that can cause excessive urination.
Hyperadrenocorticism, or Cushing’s Disease, involves the adrenal glands and overproduction of certain steroid hormones with cortisol being the primary one.
In addition to excessive thirst and urination, pup parents may also see increased appetite and excessive panting. Over time, dogs with Cushing’s disease will also typically develop a thin hair coat and pot-bellied appearance.
Diagnosing Cushing’s Disease requires testing by your veterinarian. A urine test can help to rule it out as a cause of the signs you’re seeing in your pup, but there are two blood tests that are more definitive. An ultrasound can also be used to see if one or both of the adrenal glands are enlarged.
Treatment often depends on how affected a pup is. Some pups have mild cases that can be managed without therapy. But if a pooch is excessively urinating, having accidents at home, and having issues with his skin, treatment will make him and his parents much happier. The only catch is that the medication to treat Cushing’s is expensive and so is the necessary testing to ensure the proper dosage.
Most folks are familiar with what diabetes is on some level. In dogs, the disease follows more what Type I Diabetes is in people, where the pancreas for whatever reason is no longer producing sufficient insulin. In pets, this can often happen after a severe pancreatitis or secondary to chronic recurrent pancreatitis.
In cats, this disease is different as it is more like Type II in people, which is caused by insulin resistance and is often triggered by obesity.
Whichever type, the process is similar. Insulin is needed by the body to take glucose, the most simple sugar, to cells where it’s needed for multiple processes. If insulin is either not being produced or can’t be utilized properly, all the circulating glucose reaches levels so high in the blood that it spills over into the urine.
When glucose is in the urine, it acts as an osmotic, drawing more water with it. This is what leads to the excessive urination and subsequent need to drink a whole bunch.
Many pup parents will notice a gradual increase in thirst and urination, but over a short period of time, maybe a couple of weeks. When changes like this occur, it’s very important to have a pet checked out by a veterinarian.
Diagnosing diabetes is relatively simple. A urine sample with any glucose present at all is suggestive. A high blood glucose level in conjunction gives you your diagnosis.
Treating diabetes with insulin injections is necessary for pets, as there are no oral medications shown to work yet for this disease. Treating Diabetes thus is challenging and requires dedication. Glucose is necessary for the body, so without treatment, the body will use fat instead, which produces a toxic byproduct called a ketone that makes a pet very sick and they can even die from the disease.
Because diabetes is complicated, we won’t cover further details here. If your pet is diagnosed with diabetes, an in-depth conversation with your vet is best, to help set expectations and make sure no details are overlooked.
Cat Particulars...Because Cats are Particular
We’ll now cover a couple of more cat specific causes of urinary woes. Cats do share a couple of conditions with dogs, like urinary tract infections, bladder stones, diabetes mellitus and kidney disease. The other conditions, like ectopic ureters, and Cushing’s disease, are very rare in cats.
Cats are well known for behavioral causes of inappropriate urination especially as related to stress. The trouble is, it can sometimes be difficult to know what the underlying stressor is.
Feline idiopathic cystitis is a poorly understood condition due to how many factors may be involved. But the main gist is that the bladder has a protective lining of components called glycoproteins. When a cat is stressed or anxious, this lining can become broken, exposing the bladder and allowing it to become inflamed.
Cats with this condition most often exhibit signs common with a UTI, like frequent urination and straining. Blood is often seen in the urine secondary to inflammation. Some cats will continue to use their box, but many may choose other places throughout the house, especially cool surfaces like hardwood or tile floors.
In male cats, this condition can lead to a life-threatening urinary obstruction. If your cat starts to show signs consistent with a UTI or cystitis, and he doesn’t appear to be producing urine, it’s extremely important to take him to a veterinarian immediately.
Treating non-obstructive cases is aimed at keeping the kitty calm and pain free. A medication that relaxes the urinary tract is often prescribed in conjunction with pain medication. Identifying the stressor is also important. This might be a change like a new pet, a new baby, moving to a new home or even just changing where the litterbox is located.
Here are some other preventative tips for this condition to consider:
-Make sure to have one litter box more than the number of cats in the home (i.e. 3 litterboxes for two cats)
-Keep a litterbox on each level of the home
-Utilize calming pheromone products like Feliway, which can passively reduce a cat’s stress, whatever the true cause.
-For indoor cats, provide more sources of stimulation, like window perches and toys. It may also be helpful to use an indoor hunting cat feeder, which involves hiding small portions of dry food around the house, and having your kitty hunt for them.
Making Those Urinary Woes Go
As you’ve read, urinary problems in pets are quite varied and cannot be diagnosed completely on what you’re seeing alone. That’s why it’s most important to see your veterinarian if you notice any changes in your pet’s urinary habits.
Collecting a urine sample and checking bloodwork can go a long way to pinpointing most of the more common causes. Fortunately most of these causes can also be managed and a couple can even be cured. Working with your vet is the best way to sort through urinary issues to keep your pet healthy and to keep the bond with your pet strong.