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A certain amount of muscle strength in the urethral sphincter is needed in order to prevent urine leakage.
After a female dog is spayed, the strength of the urethral sphincter decreases in the year following surgery — and it often continues to weaken with age. Approximately 20 percent of spayed female dogs will develop incontinence within three years of being spayed.
Larger dogs are more likely to develop spay incontinence than smaller dogs. And canines who are spayed before their first heat have a lower incidence of spay incontinence, but spaying before 3 months of age appears to increase the incidence of its development.
Urethral sphincter strength can be improved with medication — some 50 to 60 percent of incontinent spayed female dogs will respond to estrogen therapy, which works to increase the sensitivity of the closure receptors in the urethra.
Estriol (Incurin) is a new, natural estrogen therapy option that will be available to veterinarians this fall. Although other estrogen formulations have been used for spay incontinence, estriol is the only FDA-approved estrogen for the condition. (FDA approval ensures drug safety and effectiveness, as well as quality and consistent manufacturing and monitoring processes.)
Another course of treatment is phenylpropanolamine (PPA), which is a nonhormonal medication that directly stimulates closure receptors in the urethra. About 85 to 90 percent of spayed female dogs will show an excellent response to PPA. The FDA has also recently approved a PPA product called Proin for the treatment of spay incontinence.
If incontinence fails to respond to either estrogen or PPA alone, it is recommended that both therapies be used simultaneously, since they often work better together.
Medication works for most dogs with spay incontinence, but when it fails or a dog experiences adverse side effects from the medications, there are other procedures that can be considered. These include collagen or bulking injections around the urethral sphincter, surgical implantation of a urethral occluder and certain bladder and urethral tacking surgeries.
While some of these therapies have proven successful, these techniques will not necessarily provide lifelong continence, and a combination of surgical and medical options are often used jointly for the best outcome.
Dr. Donna Spector is a board-certified internal medicine specialist who practices in the northern Chicago area. She also owns a consulting business that focuses on bringing specialty veterinary care to underserviced regions, providing consultations directly to pet owners and their veterinarians.
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