BOWEL AND BLADDER FUNCTION IN THE D.M. DOG.

Author Ann Cooper
acooper@direct.ca

Although Bowel and Bladder problems are not normally seen early in the course of Degenerative Myelopathy, they do become a concern as the disease progresses and nerves controlling the muscles of these functions are impaired. It is possible to successfully manage B and B function to avoid the accidents that can make both the dog's and owner's life miserable.
It does take some initial time and determination to set up and follow an effective routine. However, once established, it takes far less time, effort, money and distress than dealing with the alternative consequences of poop and pee in the house, urinary tract infection's, skin breakdown and the potential health complications of kidney damage.

I am not a Vet. I base this information on my own 18month journey with my dog, Raffi, into the world of D.M. and my 20 years working in Rehab. with people who are dealing with neurological disorders such as Multiple Sclerosis and Spinal Cord injury. Also, other owners of DM dogs have shared their own experiences. So please if you have any concerns about your own dog, ask your Vet to show you the best techniques for her/him.

BLADDER.
Problem: As the nerves controlling the muscles of the bladder and sphincter become affected the bladder gradually looses its "tone", its elasticity and ability to contract to force the urine out. It also looses the ability to open the exit sphincter. The bladder cannot empty normally. It becomes over-filled and distended. Pressure rises to the point where it is forced to dribble out past the closed sphincter. Or any unexpected pressure over the bladder area can cause a flood. Urine also backs up the urethras towards the kidneys. Since the bladder doesn't fully empty, there is retention of stale urine and a prime site for infection.
The results can be: Discomfort or pain of an over filled bladder
Scalding of the skin and urine burns.
Urinary tract infection
Kidney damage

Compounding the Problem: A D.M. dog often does not drink enough water. This leads to dehydration and also concentration of urine which in turn increases the risk of Bladder infection and skin scalding and breakdown, so any management of bladder control must include controlling fluid intake as well as output.

Solutions:

1. Control fluid intake
2. Manually express the bladder

1.Controlling fluid intake: The obvious is to always have fresh water close by. However, even then, some dogs don't initiate drinking. If that is the case mix one to two cups of water with each meal, more if the food is dry. Also give a "treat" of one to two cups of water twice a day, flavoured with very diluted low salt chicken broth, or whatever it takes to encourage drinking.
Stop giving fluids two or three hours before bedtime.

If recurring Bladder infections are a problem try giving Cranberry juice or Cranberry extract to acidify the urine, and also increase fluid intake. Get Veterinary help for the infections. The dog will need more frequent potty trips until the infection is cleared up.

2. Manually expressing the bladder: The goal is to stop the bladder from ever getting completely full and therefore avoid accidents. Adding hand pressure over the bladder will increase the pressure enough to trigger the sphincter to open. You have probably already found this by accident as you lifted your dog with a hand under the tummy!! The trick, then, is to use this technique to empty it at a time and place of your own choosing It needs to be done first thing in the morning, at least every four hours during the day and last thing before bedtime. With this routine most dogs can go through the night without accidents and without discomfort. It can be done with the dog standing, or in a cart or in a sling. Take the dog to an acceptable "Potty spot". Encourage him/her to use whatever control is still available by giving the "go pee" command or whatever the dog associates with the act.

Male Dogs: Slip a hand palm up under the belly and slide it towards the genital area. You will feel the round globe of the full bladder under your hand. Apply a gentle but sustained pressure until the flow starts. In early stages it will be sufficient to just start the flow. As the bladder weakens you will need to maintain and gently build the pressure towards the rear to keep the flow going until the bladder is empty. Sometimes you will need to empty, let him sniff around for a minute or two and do it again until he is completely empty.[Males have a habit of reserving some for territorial marking!]
Female dogs: It is a little harder to find the bladder and to stay clear of the flow in the ladies. Stand behind her with your feet apart, straddling her hips. The flow will come between your feet. In the early stages reach a hand, palm up, under her tummy and slide it back until your wrist stops against the hipbone. Do the same thing with your other hand if you want to do a two handed lift. Now gently lift her so that her own weight presses her bladder onto your hands. As the flow starts her legs will probably bend up in a reflex into a squat position, and will go back down as she finishes the flow.
N.B. Some people find it easier on their back to sling a folded towel under her belly to lift. In the early stages this is often effective, but you may need to change as the bladder weakens more. In later stages the bladder becomes more flaccid and abdominal muscles are softer. The pressure needs to be more directional and controlled. Use the same stance as before. Slide one hand under just behind the rib cage, where the soft tummy starts. Apply pressure there as you place the other hand over the bladder area just in front of the hips [as you did in the early stages.] As you lift apply pressure with the "bladder hand" up and back towards the root of the tail. You may need to hold the pressure there for a few seconds before it triggers a flow.
I actually find it easier to use my forearm in front of the rib cage, as it is stronger than my hand for a sustained lift. Raffi is late stage and I sometimes need to squat right over her and actually press her up against me to get enough pressure to start the flow. You really need to be aware of your own body posture and back protection techniques, i.e. keep your back flat and use your legs to squat and lift, not your back.

BOWEL.
Problem: Voluntary control of the sphincter muscle is lost. The dog may or may not have the sensation that they need to "go", but in any case cannot control it. Once the rectum is full, a reflex pushes the stool out.
Solution: We can stimulate the bowel to empty on a regular basis so that it never gets so full that it has to empty itself at an inconvenient time or place.
Method : It is very important to establish a regular routine so that the dog's digestive system can accommodate to the timing of the procedure.
Feed at the same time each day. Feed preferably twice per day, breakfast and supper time. Choose times to do the bowel stimulation that are convenient enough to you, that they can be done at the same each day. Again the preference is for twice per day, first thing in the morning and last thing at night.
Get surgical gloves from any pharmacy [you can wash them in hot soapy water and reuse]
The dog can be standing, or in a cart or in a sling. There will probably be a reflex squatting action and the dog may not have the muscle strength to maintain him/her self in the squat position so will probably need some kind of support to avoid falling over while defecating.
Put one hand or forearm under the belly for support and to steady the dog. Talk gently and reassuringly; this is a new experience for the dog. It wont hurt but it must feel strange. Use the index finger of the gloved hand [you can use a little Vaseline on it at first] push the finger gently into the anus. You will feel considerable resistance to begin with. Just keep a steady pressure and twist the finger a little until the reflex contraction lets go. You will probably feel the stool just inside. If you do not feel anything in the first 1 to 2 inches s/he is not ready to go, try again in an hour.
In the early stages this, initial, stimulation will be enough to start and complete the defecation. Later you will need to gently stroke just inside the top of the anus to keep the stool moving until you cannot feel any more stool there. You will probably know how much is usual for your dog.
You can't do any harm as long as you are using a clean gloved index finger, are gentle, slow and don't go in more than 1 to2 inches.
If your dog is not able to tolerate this, or you find doing it and supporting the dog too hard, it is possible to do the stimulation with the dog lying on it's side. It takes more time and you may need to have the dog backed up against a wall so that you can give a little steady, gentle pressure against the abdomen to help with the "push".

At first this may seem too gross to contemplate. In fact it becomes so routine that I don't even think about it any longer. It is worth it to me to keep Raffi comfortable and clean and to not have unexpected "surprises" to clean up around the house.

With two Bowel movements a day there should be no accidents and no problem lasting through the night. The only exception to this is if the dog gets diarrhoea.

To avoid this:
Watch what they eat and drink while out of the home.[Garbage mouth??]
Use clean water and food bowls [Stainless Steel are easy to keep clean]
Change any diet and meds gradually.
Watch the toys they chew, some have sharp, gut-irritating debris.

Good luck, and free to call me for clarification or with other suggestions.
Ann Cooper
acooper@direct.ca

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