Felis ISSN 2398-2950

Urinary incontinence

Contributor(s): Ellie Mardell, Penny Watson

Introduction

  • Relatively uncommon.
  • Lack of voluntary control over flow of urine.
  • Cause: neurogenic disease, congenital anatomic abnormality, bladder hypercontractility, urethral incompetence, partial urethral obstruction, bladder neck or urethral neoplasia, paradoxic incontinence (with urethral obstruction, eg urolith and full bladder, urine can leak past obstruction).
  • Diagnosis: needs to be differentiated from dysuria, polyuria, pollikiuria, abnormal urination behavior Indoor toileting Indoor marking.
  • Prognosis: depends on underlying cause.

Pathogenesis

Etiology

Neurogenic disease

  • Upper motor neuron disease (spastic neuropathic bladder, little or no urine leaked) (lesions proximal to sacrum, cauda equina and peripheral nerves).
  • Lower motor neuron disease (flaccid neuropathic bladder with overflow) (lesion of sacral spinal cord segments or bilaterally affected peripheral nerves).
  • Feline dysautonomia (Key-Gaskell syndrome Feline dysautonomia).
  • FeLV Feline leukemia virus disease - associated incontinence (neurogenic infection).

Congenital anatomic abnormality

  • Ectopic ureter(s) Ureter: ectopic.
  • Female pseudohermaphroditism.
  • Patent urachus Persistent urachus.
  • Ureterocele.
  • Hypoplastic bladder.
  • Congenital paralysis (Manx cats Manx).
  • Urethral sphincter mechanism incontinence (uncommon in cats).

Acquired urinary tract disease

  • Inflammatory or infiltrative disease of bladder, prostate (rare) or urethra causing detrusor instability, sphincter incompetence and/or (partial) obstruction.
  • Sphincter mechanism incompetence (uncommon in cats).
  • Uncommon complication of perineal urethrostomy Urethrostomy, common complication of pre-pubic urethrostomy.
  • Ureterovaginal fistula.
  • Paradoxical incontinence with urethral obstruction.
  • Partial urethral obstruction (urolith, stricture, neoplasia).
  • Detrusor muscle damage due to overstretch, eg post-obstruction.

Predisposing factors

General

Specific

  • Dietary (urolithiasis).

Pathophysiology

  • Urinary incontinence is dependent on a bladder that is able to both store urine effectively and contract efficiently enough during the voiding phase, and urethral competence.
  • Normal urethral function is a combination of normal urethral length and elasticity, a normal smooth muscle in the proximal urethra, normal skeletal muscle further distally and an intra-abdominal bladder neck. The hypogastric nerve (sympathetic) causes contraction of the bladder neck and urethral smooth muscle and the pudendal nerve (somatic) causes contraction of urethral skeletal muscle, thus retaining urine within the bladder.

Increased urethral pressure

  • Structural abnormality causing (partial) obstruction, such as prostatic disease, inflammatory or infiltrative disease, urethral plug, urolith, neoplasia, stricture, polyp or a periurethral mass   →   incontinence when intravesical pressure exceeds urethral pressure   →   increased residual urine volume (>0.5ml/kg) and possible bladder overstretch also causing incontinence.
  • Functional abnormality (reflex dyssynergia or urethral spasm): sympathetic or somatic neurological abnormality   →   inability of urethra to relax   →   incontinence when intravesical pressure exceeds urethral pressure.

Decreased urethral pressure

  • Urethral sphincter mechanism incompetence.
  • Complication of perineal or pre-pubic urethrostomy.
  • Inflammatory or infiltrative disease of the urethra.
  • Lower motor neuron disease (post-trauma) (L1-L4 sympathetic innervation of smooth muscle in proximal urethra; L7-S3 innervation of urethral skeletal muscle in distal half or urethral in females and post-prostatic urethra in male cats).
  • Pudendal denervation (post-trauma).
  • Dysautonomia.

'Urge' incontinence

  • Inflammatory lesions of bladder and/or urethra   →   detrusor muscle instability   →   'urge' incontinence with a small bladder.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Pisu M C & Veronesi M C (2014) Effectiveness of deslorelin acetate subcutaneous inplantation in a domestic queen with after-spaying urinary incontinence. J Fel Med Surg 16 (4), 366-368 PubMed.
  • King G J & Johnson E H (2000) Hypospadias in a Himalayan cat. JSAP 41 (11), 508-510 PubMed.
  • Baines S J, Speakman A J, Williams J M et al (1999) Genitourinary dysplasia in a cat. JSAP 40 (6), 286-290 PubMed.
  • Barsanti J A, Downer R (1984) Urinary incontinence in cats. JAAHA 20 (6), 979-982 VetMedResource.

Other sources of information

  • Holt P E (1994) Feline Urinary Incontinence. In: Bonagura J (Ed) Kirk's Current Veterinary Therapy XII; Small Animal Practice. Philadelphia, W B Saunders, pp 373-382.


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