Bladder problems in dogs

Chronic Bladder Infection in Rottweiller

Question: Hi Dr. Mike, I`m a new subscriber and I have two questions regarding "Onyx" my 12 year old female, spayed Rottweiller. She`s basically in good health, some arthritis pain for which she takes Rimadyl 100mg. once a day, but otherwise healthy. Anyway, she`s had a stubborn urinary tract infection off and on for about two months. First she was on Clavimox, then Cephalexin, now Baytril. It cultured out to be E.Coli bacteria. Each time, she`s better for a week or so, then it returns. She had a bladder cancer test that came back negative, x-rays and ultrasound also showed nothing, and a blood test was normal. Anyway, our vet seems to think it returns due to Onyx licking herself, but I`m a little skeptical of this- because of her arthritis, she doesn`t usually stretch that far, you know. Are there other ways to become reinfected, possibly from eating something or from some kidney abnormality? My second question is this, I check Onyx`s urine occasionally with a multi-stick and the PH is usually 7.5. I`ve read where around 6 is better to prevent bacteria from growing so I`ve been giving her cranberry extract and a little methionine to try and accomplish this. I thought maybe these were a little hard on her stomach so I give her about 1/8th of a Maalox tablet at the same time. So, since Maalox is supposed to reduce stomach acid, is it defeating the purpose of the methionine and cranberry or are stomach acid and urine PH two different things? Well, thanks for your advice, I really like your website and I`m glad to be a subscriber. Velvet

Answer: Velvet;

When bladder infections keep coming back over and over again, there is usually a problem that is interfering with the bladder`s ability to fight off infection. The most common contributing problems are bladder stones, anatomic defects allowing urine pooling, hyperadrenocorticism, diabetes mellitus, kidney infection and bladder cancer. In some cases, antibiotics are not used long enough to eliminate the infection and it never really goes away but this is probably not an especially common cause of bladder infections that appear to be recurring over and over. We think that obesity is a factor in some cases of recurrent bladder infections. If Onyx is overweight, weight reduction might help the bladder infection and the arthritis problems but it helps with the arthritis more consistently than the bladder infections. Once in a while we see dogs with skin disease and recurrent cystitis, so I don`t think your vet`s theory about licking the vaginal area leading to some cases of chronic cystitis is off base but you may be correct that it is not a factor in Onyx`s case.

Diabetes is usually easy to detect through urinalysis or blood work and is probably unlikely since those tests have been done. Hyperadrenocorticism often causes mild rises in blood sugar and elevations in serum alkaline phosphatase, which can be hints it is present from normal blood work. It takes specific tests for this condition to rule it out, though. It is probably worth trying to rule out this condition when bladder infections are frequent in a patient over 9 years of age. You might want to ask your vet about this. If there are no other symptoms of the disorder, such as increased drinking and urination, loss of hair (especially if it is symmetrical on both sides), a pendulous appearing abdomen or increased appetite. Checking for vaginal tumors or changes in the anatomy of the vaginal area would be a good idea. Dogs may have vaginal tumors that do not change the external appearance at all. It is possible for dogs to have bladder stones that do not show up on X-rays but it would probably be unusual to have stone formation that was not visible with X-rays and ultrasound. Kidney infections can be difficult to detect but may be detectable with ultrasound examination in some patients. In some dogs there are defects that are visible when contrast dyes are used to enhance the ability to see the urinary tract through X-rays. Exploratory surgery is an option for evaluation of the bladder, if nothing can be found with other test procedures. The bladder cancer test is pretty good for ruling out bladder cancer but is not absolutely accurate.

There are some dogs who have normal urinary tracts, no sign of kidney infection, no detectable underlying diseases and no observable anatomic defects that might lead to urine pooling. In these patients it is sometimes necessary just to use continuous antibiotic therapy to control the problems. It is often possible to use antibiotics at a reduced dosage (like once a day for an antibiotic that is usually used twice daily) when using them chronically. It can be helpful to acidify the urine. The most consistently successful way to do that is with the special diets made for that purpose, such as Hill`s c/d (tm) or Purina`s UR (tm). I do not know if there is an interference between Maalox (tm) and cranberry juice or d-l methionine but I suspect that this isn`t a major problem.

You and your vet have been working through the possible causes of this problem in a logical manner so I hope that you are rewarded with an answer soon.

Mike Richards, DVM 3/10/2001

Bladder Mass in Wire Haired Fox Terrier- Should Surgery be Done?

Question: I have a 12 1/2 year old female wire fox terrier. The following is an imaging consultant report: History. chronic hematuria. Oxalate crystalluria. Culture negative. Treated with urinary acidifiers and diet change. Ultrasound: abdomen: there was a polypoid mural mass of the urinary bladder at the vertex. This mass contained mineralized area and extended into the bladder lumen. Several small calculi were also seen with the bladder. Both kidneys were small in size (4.2 cm in length) and had mineralization at the corticomedullary junction. There was a small mass in the tail of the spleen. This mass measured approximately 1.7 cm in diameter. The remainder of the examination was unremarkable. Conclusions: urinary bladder mural mass. Urinary calculi. Renal mineralization. Small splenic mass. Differentials for the urinary bladder mass include neoplasia and polypoid cystitis. The splenic mass is either neoplasia or hyperplasia. Biopsy of either lesion would be needed for definitive diagnosis.

In your opinion, what is the most likely outcome if we choose surgery- meaning do you have statistics on how many of these operations are successful and what is the quality of life for the dog which is our primary concern. How long does this breed of dog usually live without medical concerns. She has vision problems plus severe arthritis of the spine but judging by her behavior is not currently in pain. I know this is long but we are desperate to reach a decision on what to do. We have seen our local vet plus we took her to UC Davis. Also, we have spent $800 so far and the operation will be approximately $2000 plus costs of chemo or radiation, whatever is called for. So what it boils down to is what quality of life and for how long can we expect if we go ahead with the surgery. Would really appreciate your thoughts on this. Thanks in advance. I promise I`ll never send such a long message again. Pat

Answer: Patricia;

I think that the success of surgery has to be looked at in two ways. The first is from a diagnostic standpoint. Identifying whether the mass in the trigone area of the bladder is a tumor or a polypoid may require surgery. It is possible, in many instances, to differentiate between these conditions using a suction biopsy technique, in which a large bore urinary catheter (regular polypropylene urinary catheters are usually used) is passed to the level of the tumor and then suction applied to it using a 10 to 12cc syringe. Whatever is sucked into the catheter is sent to the pathologist for review. If a transitional cell carcinoma is identified from the suctioned biopsy it is considered to be diagnostic. It is harder to diagnose other bladder conditions using this method. That is OK, though, because TCCs of the trigone are very difficult to successfully remove, so knowing that was the problem would make it easier to decide for or against surgery.

Polypoid cystitis can regress without surgery if the primary cause can be identified and treated (bladder infection, bladder stones, etc.). Since there are bladder stones (uroliths) present, surgery would potentially provide both immediate comfort and long term resolution of the problem, though. I do not know of any successful medical treatment for calcium oxalate stones, which it is reasonable to presume are present until a stone can be obtained for analysis. Sometimes it is even possible to suction out a stone to analyze using the suction biopsy technique, so that would be another potential benefit of that procedure, although it can`t be counted on.

I think that you have an estimate for a worst case scenario, involving the surgery and follow-up care. There is at least a reasonable chance that this is not a bladder cancer, in which case the cost of surgery and subsequent treatment would be less.

You do have to figure in over-all health in decision making. Twelve years of age is about the beginning of the time that we see dogs of this size dying of natural causes, but many smaller breed dogs will live to be fifteen years or more in age and often have good quality lives the majority of that time. Surgery won`t make her young again, but it could relieve a lot of current discomfort and that is a worthwhile goal, unless her other problems are severe enough that you were considering euthanasia prior to this latest problem.

Hope that helps some. I am sorry for the delay in responding. There is no problem with long questions, especially when they present important data, as you did.

Mike Richards, DVM 11/4/2000

Persistent Bladder Infections in Older Dogs-Using Antibiotics

Question: Hi, again, Dr. Richards,

This is in regard to earlier e-mails re: my 11-1/2 lab with the persistent UTI. Fortunately, she came through her amikacin/gentamicin treatment unscathed. The bleeding in her urinary tract stopped, but the most recent culture shows she now has a drug-resistant (except for tetracycline) staph infection in her bladder. So she`s now on oral tetracycline- we are going to the internal medicine specialist tomorrow for a follow-up ultrasound to rule out stones and bladder cancer (again). I have two questions:

1. Why is it that every time we culture her urine a new bacteria shows up? So far we`ve had E. coli (sensitive to nitrofurantoin and amikacin), Psuedomonas (sensitive to Cipro and amikacin) and now staph (sensitive to tetracycline only). Is it likely that all 3 have been there all this time (now going on 8 months)? Or does the constant treatment with antibiotics make it easier for new species resistant to the drugs then in use to colonize? Is there any way to keep this from happening by combining antibiotics that are likely to kill everything?

2. How many hours a day do normal elderly dogs sleep? My dogs are 13 and 11-1/2. I know that lethargy is one sign of illness, but it`s hard to figure out if that`s what`s going on with the older ones since they seem to sleep so much.

Thanks. Carol

Answer: Carol;

I was not able to find a reference that listed the average time that older dogs sleep. Actually, I didn`t even find a reference that lists the average time that a dog sleeps during the day, at all. I will keep looking for this, since I don`t keep my physiology texts at home and they may have the information. Older dogs do sleep a lot, though.

E. coli, Pseudomonas and Staph are all bacteria that have a hard time invading the bladder on their own. They usually require a breakdown in the bladder`s defensive mechanisms or the body`s immune system. This can be many things. In older dogs, it is important to rule out hyperadrenocorticism (HAC, Cushing`s disease) and diabetes mellitus as potential underlying contributors to the recurrent bladder infections. Diabetes is usually easily ruled out due to the repeat urinalysis testing. HAC can be much harder to rule out. Bladder stones and bladder cancers can be contributing factors. It is a good idea to try again to rule these out, given the history of the problem at this time. After that, the work-ups become more complicated.

Older dogs may have neurologic problems that make it difficult to empty the bladder and that can lead to recurrent bladder infections. These problems include disc disease, cauda equina syndrome and spinal tumors. Older dogs may have liver disease that makes antibody production deficient, or immune compromise for other reasons. Kidney infections can sometimes be the source of the bacteria that keeps causing recurrent bladder infections. Usually, though, this will be the same bacteria, over and over again.

In some dogs, it is necessary to use antibiotics long term to suppress bladder infections that the dog can not control. The usual recommendation is to use about half the recommended dosage and to use it at night, on the theory that the antibiotic will be retained in the bladder longer at that time. It is usually possible to find an antibiotic that is likely to work to suppress most of the secondary invaders. It is easier if they have been similar, such as all gram-negative bacteria (E. coli, Pseudomonas) or gram-positive ( Staphylococcus), but fluoroquinolones may work for both, the cephalosporins may work for both and there are others. When you reach this point it is important to remember that the antibiotic is helping the body to fight the bacteria and that even if there is partial resistance, that may not matter. So often, an antibiotic that doesn`t look like it would work, based solely on culture and sensitivity testing, may work. It is better to start with single antibiotics and go to combinations only when that has been proven not to work.

Hope this helps some.

Mike Richards, DVM 9/15/2000

Excessive Dog Urination after Bladder Stone Surgery

Question: our 16 year old neutered kerry blue male developed bladder stones at 7 years, subsequently treated with a urostomy. About one month ago developed excessive urination, including recurrrent urination in house. Does not appear to be related to a bladder stone, as the stream seems normal. Urinalysis showed sg of 1.014, culture showed 20k staph, bun and creatinine were normal. 10 day trial of quinalone of no help. Does not appear to be incontinence as he can control his bladder when walking, and is not wetting himself. We`re currently attempting to fluid restrict, as the vet feels it may be psychogenic polydipsia. Would appreciate any input tnx.

Answer: TNX- It sounds more like there is a cause of increased production of urine, rather than an increased need to urinate with normal urine production. The most common causes of increased urine production in older dogs are kidney insufficiency, diabetes mellitus, and hyperadrenocorticism (Cushing`s disease). There are other possible causes of increased drinking and urinating, including diabetes insipidus, hypothyroidism, hypercalcemia, and liver disease. The urine specific gravity is not too helpful in this case, since several of these conditions would be expected to have a specific gravity in this range. A general blood chemistry examination might be helpful in differentiating between them. If that didn`t help, specific testing for the conditions that require it, such as hyperadrenocorticism and hypothyroidism might be necessary.

I would be really hesitant to restrict fluids without having ruled out most of the above conditions, since it could cause problems with some of them.

I hope that you already have a better idea of what is going on by now, but if not, it would be a good idea to keep looking for a cause of this problem.

Mike Richards, DVM 8/29/2000

Urinary Crystals after Bladder Stone Removal in Corgi

Question: Doctor, Our little corgi had some bladder stones taken out about six months ago. You may remember the case she was bleeding excessively for 10 days after surgery. Well anyway we have her urine checked every month for crystals and this time when we took her in , she didn`t have crystals in her urine but the white cell count was up and they think she has some irritation or a bladder infection. We have tried her on Baytril, Calvomox, and a few others but she always gets diarrhea from them. They said to let her rest a few days to clear up the diarrhea, while they pick their brains as to what we could use to help her without so many problems. Do you have any ideas as to what may help clear up this bladder infection or irritation without giving her diarrhea. Any advice would be much appreciated. She seems a little uncomfortable this last week and a little jumpy.

Connie

Answer: Connie;

If increased white blood cells are the only abnormality on a urinalysis using a dipstick testing technique, I have some suspicions about the value of this particular test. On the other hand, since there is a history of bladder stones and signs of discomfort, it does seem like a good idea to try to figure out if there is a problem and to treat it, if necessary.

The best test to perform at this point would probably be a urine culture and sensitivity, withdrawing the urine from the bladder by cystocentesis. This is the process of inserting a needle into the bladder by passing it through the skin and muscles layer and then into the bladder. This is the best way to obtain a sample for urine culture. If it is possible to get a culture of a bacterial agent, this will help in selecting an antibiotic that would work but perhaps cause less problems with diarrhea. This test sounds scary, but it is usually easy to obtain urine in this manner and there is very little risk associated with it. Most dogs will allow us to withdraw urine without struggle and without sedation.

It is also a good idea to examine the urine from the bladder using the same testing techniques as are used for free catch urine samples. If there are crystals in urine that is voided but not in urine that is withdrawn directly from the bladder, the crystals may be forming after the urine is voided. If there is no blood in the urine withdrawn from the bladder but blood in voided urine, the problem may be lower in the urinary tract. This is also true for increased white blood cells.

If diarrhea occurs when any antibiotic is given it may be necessary just to treat the diarrhea. This is usually possible using diphenoxylate and atropine (Lomotil Rx) or loperamide (Immodium AD Rx). We do not have too much problem with diarrhea when using Baytril (Rx), so I am wondering if you will be able to find an antibiotic that doesn`t lead to this problem.

Video: Home Remedies for Bladder Infection In Dogs

Good luck with this.

Mike Richards, DVM 4/15/2000

Antibiotic Therapy Failure in Treating Bladder Infection in Boxer

Question: Dear VetInfo, I`m writing to you from Buenos Aires, Argentina. I read your page and I understand that in order to ask a question I have to be a subscriber. I`m planning to be in the Miami this month, and call you to subscribe. I would like to know if you could please provide the following inquiry to Dr Michael Richards. I don`t expect an answer until after my subscription is in, but he might be able to have something ready by the time I become a subscriber.

I have a situation with one of the five Boxers I have which is driving my husband, my vet and I absolutely crazy.

Pericles, a 1.5 year old male Boxer, has been found to have the bacteria "Escherichiacoli". We have made several cultures of urine, isolating the bug and running antibiotic sensitivity testings. We are running out of antibiotics, and the bacteria still there. We have given Pericles antibiotics for different periods of time, anything from 7 to 20 days period. After 5 to 7 days of the last intake of antibiotics, the blood shows up again. The results indicate the bacteria still there. By the way, when running each culture we have taken into consideration the fact of not having Pericles taking any medicine, and allowing the sufficient time after the last antibiotics were given (at least 10 to 15 days).

We have done x-rays of the bladder and everything shows to be fine. We have also done an echography which doesn`t show us anything abnormal either.

We would greatly appreciate any information you could prepare for us in relation to the above mentioned matter.

Best regards, Lorena

Answer: Dear Lorena;

Video: How to Tell if a Dog Has a Bladder Infection

There are several possible problems that might lead to repeated failure of antibiotic therapy for cystitis or lower urinary tract infection (since it is necessary to consider prostatitis and urethritis as well).

The most common reasons are probably bladder stones and anatomical defects in the bladder. Sometimes bladder stones don`t show up well on X-rays. We have been surprised to find them on exploratory surgeries for persistent bladder problems on a couple of occasions after having failed to see them X-rays. Anatomical problems, such as diverticuli in the bladder, provide a safe haven for bacteria to escape the effects of antibiotics, in some dogs, and the result is a recurrent infection that appears not to respond to antibiotic therapy. It is probably possible to diagnose many of the anatomical defects using contrast X-rays (dye studies) but it sometimes takes a specialist`s help in reading the films. Visualization of the bladder using endoscopy is a possibility in some practices in the U.S., but not many. That would be a good choice if it was an option, though.

Sometimes the signs of cystitis are occurring because of infections or problems in the kidneys. In this case, it can take longer for antibiotics to work and in some cases they simply won`t -- such as pyelonephritis (sort of an abscess of the kidney).

I have read of a couple of cases in which male dogs had a rudimentary uterus that became infected and led to signs of recurrent urinary tract infection. These are very resistant to antibiotic therapy, too.

Sometimes the problem really is antibiotic resistance. There was a paper in the Journal of Small Animal Practice (1997) by Farca, et. al., on the use of Tris EDTA in combination with antibiotics to treat resistant cystitis. The authors used local irrigation with tris-EDTA and various antibiotics.

If you try the tris-EDTA and it doesn`t work then the next best options are special X-ray studies or exploratory surgery, which allows visualization of the bladder and the opportunity to take biopsy samples if nothing is seen on exam.

Good luck with this problem.

Mike Richards, DVM 8/7/99

Persistent Bladder Infection with Frequent Urination and Blood in Urine

Question: Dr. Mike,

Video: Dog Bladder Infection Signs and Treatment

A friend has a female (spayed) 7 year old mixed breed dog that can`t seem to get rid of a bladder infection. She`s had 20 days of antibiotic treatment and seemed much better, but is again experiencing frequent urination with blood present. She doesn`t seem to feel bad, but there is obviously a problem. Could this be something other than an infection, like bladder stones. My friend also mentioned that the dog`s (Tinsel) urine is killing the grass, which is a new development.

Aanswr: Melissa

Video: Expressing bladder of a paralyzed dog

Your friend`s dog should be checked for other problems. Bladder stones are most likely but bladder cancer, Cushing`s disease and several other problems can lead to persistent urinary tract infections. Sometimes, but not often, there are just highly resistant bacteria and in those cases it helps to have a urine culture and sensitivity done to be sure that an antibiotic is being used that will kill the infection. Sensitivity testing is a way of checking to see if different antibiotics have the ability to kill the specific bacteria that grows on culture.

Mike Richards, DVM 7/31/99

Bladder Infection in Shih-Tzu

Q: Our five-year-old Shih-Tzu had a bladder infection several months ago and was treated successfully with an antibiotic. We also changed her food to more accurately meet her acid content needs. Five days ago, she developed another bladder infection and our vet performed x-rays but found no stones in her bladder. He put her on a more potent antibiotic but her condition has not changed. There is still blood in her urine, she is very lethargic, eating little and drinking water. Our vet thought we would see a change in her by the second day into the antibiotic but she appears to be on the decline and I fear we may lose her. Do you have any idea as to what this may be? Our vet is very capable and caring but he`s not an expert on Shih-Tzus. Please help. Sincerely, Shelley

A: Shelly, Anytime that I have a dog with signs of cystitis that is not responsive to antibiotics the first thing I think of is bladder stones. There are occasional bacterial infections that are resistant to antibiotic treatment but most of the time there is another problem when a dog is on antibiotics and blood continues to show in the urine. Cancer is another possible problem and there can be blood in the urine from non-bladder sources, such as kidney damage or a systemic bleeding disorder. I`m sure your vet has or will consider all of these possibilities but it is important to keep communicating and letting him know if treatment is working. Not all bladder stones show up on X-rays and bladder tumors are very hard to see on X-rays, too. Sometimes it is necessary to do exploratory surgery to rule out these problems.

I hope you are seeing improvement by now, but if not, keep working with your vet to sort through the possible problems. Mike Richards, DVM

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