Common Conditions – Lower Urinary Tract Disorders of the Dog
To start with, conditions of the urinary system in both dogs and cats are very common, and form a significant percentage of my own clinical cases. Diseases of the bladder and urethra are related to several factors – genetic, nutritional, bacterial/fungal and neoplastic. Because the cat and dog differ significantly in these conditions, metabolic tendencies and nutrient requirements, it’s important to separate the two species and afflictions they experience. Next time, we’ll look at the unique issues facing domestic cats, and then at renal disease, a large topic in itself. In this article I will start this series by talking about lower urinary tract conditions in dogs.
As an overview; many of the conditions discussed here will require veterinary care, as they are painful and potentially serious, even fatal. Mild UTI may be cleared up at home if the owner truly knows how to assess the severity – more often than not, this isn’t the case and the animal really should be seen. That said, herbs can play an important role in management/recovery and in many cases, dietary manipulation will be essential. When the two are combined, the results can be dramatic, but this is often a longterm strategy, and the veterinarian is essential for handling acute issues.
In my practise, the conditions I see most often with dogs, are infections (sometimes recurrent), incontinence, a variety of uroliths, and bladder cancer.
Urinary Tract Infection/Cystitis
Many of us have personally experienced a bladder infection/UTI and know too well the pain and misery of it. So, too, UTI in dogs can often be a painful and miserable experience. Symptoms of a urinary tract infection may be subtle or dramatic, depending on the severity of the infection and the animal’s disposition (some will register pain easily, others seem to ignore even major discomfort). Typically, they include the following:
Straining to pass urine
Blood in urine
Licking the area
Increased frequency of urination
Soiling in the house\strong unusual odour
Signs of pain such as whining, panting, inappetence
Weightloss (in chronic, lowgrade cases)
Any one, or combination of these symptoms can arise suddenly, but in many cases are missed by the owner until the infection has gone on awhile. The appearance of any of the above should be a redflag to the alert owner, that the animal may be in considerable discomfort – and, if the infection spreads to the kidney, (pyelonephritis), or if struvite stones develop – quite possibly in danger.
Once you see symptoms, the next step is always to have a veterinary evaluation. Your vet will start with a urinalysis, which will detect the presence of white blood cells in the urine, indicating infection. From there, a urine culture will offer more information as to which type of bacteria are present. This is the most precise way of determining which antibiotics to use; whether we like it or not, an immediate course of antibiotics is truly necessary to alleviate suffering. Some veterinarians may also prescribe “empirically” – meaning they will skip the culture and simply prescribe what their own experiences suggest is most likely the cause. The plus side of this is you can spare your dog the ordeal of cytocentesis , the most accurate means of obtaining an uncontaminated culture – performed by inserting a needle directly into the animal’s bladder. The drawback is, and this is common in my own experiences – potentially using an antibiotic that is less than powerful against the specific bacterial strain. Too often I see dogs who have been on multiple rounds of antibiotics, and the UTI persists – with each new drug the immune system (and this innate ability to fight the bacteria) is weakened. It is up to the owner, of course, and the vet to decide which route to follow.
With my own dog’s rather nasty UTI a few years ago, I decided not to opt for cytocentesis, but try one round of antibiotics. When his UTI returned a couple of weeks after we had completed it, I was able to entirely clear it with herbs. But at the beginning, seeing my dog suddenly passing blood was not something I felt I could wait on. Many owners feel the same, but do not have the herbal knowledge to follow the antibiotics with herbs, and so enter onto the merry-go-round, of multiple infections and rounds of medication. This is frustrating to see, as I do feel most infections of this nature can indeed be effectively dealt with naturally, once a diagnosis and initial relief has been attained.
With UTI (or bacterial cystitis) the bacteria needs to enter the urethra and make its way into the bladder – a short journey in the female, and thus UTI is more common in bitches. Older, intact male dogs, however, are prone to bacterial infections of the prostate. The most common bacterial strain dogs are treated for empirically is e.coli, but there are others: “E. coli, Staphylococcus, and Proteus spp. account for more than half of all cases of bacterial infections of the lower urinary tract. Less common bacteria include Streptococcus, Klebsiella, Enterobacter, Pseudomonas, and Corynebacterium spp.”(1)
Popular Alternative Approaches
So, conventional veterinary treatment most often starts with antibiotics. The vet will take a urine culture and base the medication of choice accordingly – which can be the end of the issue. In other cases, however, the owner finds herself in a cycle of repeatedly trying different antibiotics, with the vicious circle emerging – the infection is not cleared up, but the immune system of the dog is weakened as the gut lining is adversely affected by the ongoing antibiotics. Often it is at this point the owner will turn to an online “natural” dog group or search for sites that offer alternative options. Many of these are useful, but it always depends on the case. Briefly, these are the popular approaches to UTI, whether chronic or acute.
Apple cider vinegar
Now, I will often hear from owners who employed one or more of these strategies and experienced great relief – owners who will say these measures were a resounding success. And for me, that’s great to hear. There are also many who work with all of the above and don’t see the lasting results they hoped for – perhaps the symptoms seem relieved but there is still evidence of alkaline urine, pus and blood cells upon analysis – so the infection is less severe but still present. Perhaps the dog clears up for a while and then the infection returns. Perhaps the cranberry, acv and probiotic didn’t do much at all. To understand why these measures may not be the firstline defense against an active UTI – or may be thought of as supporting a herbal protocol, rather than sufficient on their own – we need to look at what they do. All these measures have both value and limitation; cranberry, which is indeed a good supplement to add as a part of a strategy to prevent recurrence, is often used as a sole or first-line defense against active infection, without the more powerful actions of a urinary tract antiseptic such as uva-ursi. Cranberry has been shown to help with the removal of bacteria adhering to the bladder walls, which supports antimicrobial and diuretic herbs – so it definitely has a place here…. but it is not tremendously powerful alone, against active infection. (Note: the juice contains fructose and should never be used with dogs.) I often use cranberry with recurrent infection, and it can help with an active infection alongside herbs, but it is not a powerful single defense against a raging, painful UTI. (2) It should also not be used longterm in a stone-forming dog, due to the high oxalate content.
D-mannose is a type of carbohydrate that has been shown, in clinical trials with humans, to help prevent recurrent UTI, only if caused by e.coli; since e.coli is the most common pathogen to cause urinary tract infection in the dog, it’s reasonable to think of using it in any case of recurrent or resistant infection.(3)
VitaminC, while it can certainly acidify urine, can also go too far and acidify the ph to such an extent that we run the risk of calcium oxalate crystals developing (if used longterm). I may use Vitamin C short term in dogs who cannot tolerate an increase in dietary protein (which will also acidify urinary ph) or Uva-ursi, or who are already consuming high protein diets. High dose C, or an unbuffered variety, may irritate stomach lining or cause diarrhea in some dogs. If you do use it, think about 200 mgs EsterC for a small dog, 500 for a medium/large breed and up to 1000 for a large/giant – but check the ph with Chemstrips (available at most pharmacies) and don’t over-acidify. Acidification of the urine is not the ideal tactic for managing UTI and it should not be done to excess, or for too long. In addition, acidic urine nullifies the efficacy of the herb Uva-ursi, which is such a potent ally against UTI. I prefer not to acidify urine, but to utilize herbs and clear the infection, hence VitaminC is not usually one of my own choices with canine UTI.
Colloidal silver is fraught with potential dangers, including poor absorption of antibiotics and thyroxine, (4) and apple cider vinegar, in my experience, does little on its own, at all for an active, painful infection.
Probiotics can be helpful with a wide range of canine conditions and for the most part, I encourage people to use them. Aside from their role in restoring balance to the gut after antibiotics, probiotics can support digestion throughout life, and in turn the immune system. Probiotics play a role in reducing the inflammation that can lead to hyperpermeability (leaky gut) and can help reduce the recurrence of UTI. There are a wide variety of types available, and I encourage people to do their research and decide which strain is right for their dogs.
My own approach with UTI, is to first, adjust the diet- if indicated – which in this case means a careful evaluation to ensure all essential nutrients are well supplied, and may also include raising protein levels. So much of what we might see with infection, especially chronic infection, will relate to what a dog is fed on a regular basis. Both commercial and home prepared diets carry potential drawbacks; commercial diets may not be well absorbed, or the dog may not be fed enough of them to cover all nutrient requirements. Home prepared diets that rely on variety and guesswork in formulation are almost certainly low in multiple essential nutrients. Chronic low intake of various nutrients can negatively impact the immune system, and contribute to inflammation, so my first step in addressing chronic/recurring UTI is to assess the diet. Protein may be raised to help bring urinary ph, into the neutral zone (about 6.5 – 7) but not to overly acidify, as discussed above. In addition, simply adding meats willy-nilly to any diet can pose problems over time. I make sure that VitaminD, zinc, other essentials, which are often low in home made raw or cooked recipes, are well supplied, by foods or supplementation..In all cases of UTI, it’s important to keep the dog well hydrated, so encouraging water consumption can be important with the dog who doesn’t drink a lot of water. Typically, a kibble fed dog will drink more than one on a home prepared diet, but it’s good to observe water intake and encourage drinking by adding a little broth or stock to water – just make sure you dump out the water regularly and don’t let bacteria form in the bowl.
Herbally, we can think about the following therapeutic goals, and find herbs that supply them and are suited to the individual case.
1) Fight infection with antimicrobials (in this case, urinary tract disinfectants) – Echinacea, Uva ursi, Oregon grape root, Monarda, Usnea
2) Soothe the area and relieve inflammation/pain – demulcent and vulnerary herbs – Marshmallow leaf and root, Slippery elm, Corn silk, Plantain, Licorice root
3) Astringe/tonify the bladder and urethra – Agrimony, Goldenrod, Horsetail, Yarrow
4) Ease pain and associated tension – analgesics, anti-spasmodics – Hydrangea, Crampbark, California poppy
5) Dilute urine to assist flushing bacteria – diuretics – Dandelion Leaf, Cleaver’s herb
6) Support immune function longterm – Echinacea, Astragalus, Cordyceps, other fungi
Formulas for Urinary Tract Infection
Formulation for UTI should combine the actions listed above, but with a view to the type of infection and stage it is at, as well. An acute infection will benefit from more anti-microbial, more pain relief and demulcency, in most cases, then a lingering, low grade type. It’s wise not to give Uva ursi longterm, I may have an owner stop after 7 days or go as long as 14, depending on the case – for longer term use other herbs with antimicrobial action can be considered. I’ve had good success with Usnea, Oregon grape, Monarda, Elecampane, and Thyme. Pairing any of these herbs with Agrimony and Mallow leaf steers the formula to the bladder and I’ve cleared up not only canine UTI, but many human cases without uva ursi (and many more with, but there are options).
Echinacea and uva -ursi, the classic pairing, is often where I start my formula building. This is a great combination of urinary tract antiseptic and immune boosting, and can be very effective on its own; the addition of a demulcent like mallow, and an antispasmodic, analgesic like Crampbark can ease the discomfort considerably, and a diuretic round the formula by helping flush bacteria(this is where cranberry lends some aid, too).. I use alcohol tincture in any animal who is in good overall health, and I dose fairly high, short term. Glycerites can be used in sensitive animals, animals with liver disease (although I actually prefer water-based preparations here) and for longer term usage- I simply dose them at a higher level.
For Acute UTI with Pain
Animals with acute, painful UTI should always be seen by a vet – but there can be occasions whereby one can’t access care so easily – camping trips,holidays for example, people in isolated living situations. This formula can really help, but it is still imperative to have your dog seen as soon as possible. I also use this, or similar, for dogs who have been treated with antibiotics but the infection returns. In those cases, I generally add one part Goldenseal as well.
Echinacea – 2 parts
Uva ursi – 2parts
Crampbark – 2 parts
Marshmallow – 2 part
California poppy– 1 part
Corydalis – 1 part
In alcohol tincture, I generally give ¼ ml 4 times daily for a small dog, under 30 pounds: ½ ml for a dog 30 – 60 lbs and ¾ for a large dog, 60 – 100 lbs. You could give as much as 1 ml 4x daily for a giantbreed. I generally increase by 30 – 50% with glycerites.
For chronic UTI with bleeding
Agrimony – 2 parts
Oregon grape – 2 parts
Goldenseal – 1 part
Monarda – 1 part
Hydrangea – 1 part
St.John’s wort– 1 part
Mix dried sifted herb together and infuse 2 teaspoons in one cup boiling water, at least 2 hours and preferably four. Strain and ladle over food (small meals, protein-centered) 3-4 times daily. Consider ¼ cup for a small dog, 3-4 times daily; ½ cup for a medium dog and as much as two cups for a large/giant breed, in divided doses. I have also combined all in a tincture blend and given throughout the day, added to small meals.
Mild UTI in a senior dog
Goldenrod- 2 parts
Bidens – 2 parts
Echinacea – 1 part
Cornsilk – 1 part
Hydrangea – 1 part
California poppy – 1 part (if there is trouble sleeping)
I really prefer glycerite or infusion with older dogs, and I have given this formulation in many ways, including infusion/decoction, glycrite and sometimes a combination of the two. What I like here is the gentle support – uva ursi may be a little harsh for older dogs (even if a geriatric bloodwork had been done recently, things change quickly in seniors) and alcohol tincture, while probably ok, may irritate stomach lining… plus, if this is lingering infection as we often see with seniors, then it will be preferable to avoid alcohol.
If additional immune support is called for, I often like astragalus, but a number of herbs could be used and should be chosen, and fatty acids (Omega 3 from fish body oil, in the dog, is the ideal choice) can ease inflammation throughout the body and support healing. As with anything given longterm, select according to the whole history and constitutional type of the dog.
The Materia Medica at the end of this article should give some more ideas, but my bottom line is this:
1) Optimize the diet, especially if feeding a low grade kibble or an unsupplemented, ad hoc home made diet..add fish body oil with VitaminE, and/or a source of GLA (gamma-linoleic acid) from evening primrose or borage oil. Higher protein may help acidify urine, but the goal is to ower alkalinity, not create very acidic urine. Chemstrips will give you precise feedback about this and other aspects of your dog’s urine, and are well worth the investment..
2) Use a herbal formulation that covers multiple actions, and dose it correctly, with acute cases receiving tincture and infusion both, and longterm, difficult-to-resolve cases both infusion and glycerite.
3) Consider probiotics, cranberry and D-mannose, as adjunct therapy to the herbs, in specific scenarios, not as a panacea for all UTI
Another common condition in dogs is urolithiasis, or bladder stones. There are several types of stones, but the most common are calcium oxalates, struvites and ammonia urates; recent studies show the incidence of struvites at 39%, oxalates at 41% and urates at 10% or lower (other stones, such as silica and cystine, account for the balance). Bladder stones can be not only intensely painful, but in some cases completely block the urethra and lead to a ruptured bladder. In all cases, uroliths must be taken seriously. And in all cases, dietary intervention is a top priority. Conventional veterinary therapy involves prescription diets, antibiotics, and sometimes surgery. The prescription foods are controversial, but in many cases it’s preferable to utilize them until a correctly formulated recipe can be located using fresh whole foods. These diets usually manage the conditions well enough, but the ingredients used are not nourishing in a holistic way, so we might see an ingredient label that looks like this:
“Brewers Rice, Corn Starch, Pork Fat, Egg Product, Powdered Cellulose, Chicken Liver Flavor, Flaxseed, Lactic Acid, Potassium Citrate, Soybean Oil, Calcium Carbonate, L-Lysine, Iodized Salt, Choline Chloride, vitamins (Vitamin E Supplement, Niacin Supplement, Thiamine Mononitrate, Vitamin A Supplement, Calcium Pantothenate, Biotin, Vitamin B12 Supplement, Pyridoxine Hydrochloride, Riboflavin Supplement, Folic Acid , Vitamin D3 Supplement),” (5)
It’s easy to see that these diets are formulated to manage the condition and nutrient requirements, but the ingredients chosen are questionable(to put it mildly) for a carnivore…or, really,any species. A nutritionist with experience in these conditions can formulate a fresh food recipe that will not only manage the stones, but support the health of the whole dog, but that is not always easy for the average owner to locate. A home made diet absolutely has to be formulated with the some skill in nutrient manipulation, but using whole meats, poultry, grains as indicated, vegetables and so on. With struvites associated with infection, the goal is to clear the infection as well as dissolve the uroliths and then prevent recurrence; with oxalates and urates, dietary intervention is key. While we can’t dissolve oxalates with diet, dietary management is still key,as it is with urates. It’s important to note too, that a dog can have more than one type of urolith at the same time – again, surgical removal and analysis is really the only way to know for certain.
Dogs of any breed, mix, age, or sex can develop uroliths – but, there are some predisposing factors. Some breeds with a high incidence include the Miniature Schnauzer, Shih Tzu, Bichons Frise, American Cocker Spaniels and the Lhasa Apso. Dalmatians and English Bulldogs are at very high risk for urate stones.
Diagnosis: because herbal and especially nutritional therapy differs greatly form one type of stone to another, correct ID of the stone is crucial. Surgical removal is the most accurate, but a skilled veterinarian may be able to take a very good guess based on X-rays, for example.
Symptoms of bladder stones are similar to that of UTI but may be more severe – or, some cases are totally asymptomatic, and the stone is only discovered when an Xray or examination for another condition is performed. Typical symptoms include blood in the urine, straining to pass urine, licking the genitals, evidence of pain, cloudy urine.
With all uroliths, the rate of recurrence once the stones have been removed is high and the dog should be monitored carefully. In all cases, too, it is important to encourage adequate water intake and ensure the dog has frequent opportunity to urinate.
Here is what I do with both herbs and diet, for all three.
Again -the presence of struvite crystals, without concurrent infection is not a cause for alarm. Struvite crystals are present in around 45% of dogs without stones or infection. “Struvite crystals are commonly seen in canine and feline urine. Struvite crystalluria in dogs is not a problem unless there is a concurrent bacterial urinary tract infection with a urease-producing microbe. Without an infection, struvite crystals in dogs are not associated with struvite urolith formation.” (6)
When struvite crystals develop into stones, as may happen with prolonged, untreated infection – more aggressive measures are indicated.
Standard veterinary measures with diagnosed struvite stones is based on the health of the dog, the severity of the case and other factors, which may include breed tendencies. In any case where it is possible, the protocol is to promote dissolution of the stones using nutritional therapy; this consists of a prescription diet that is low protein, high sodium(to encourage drinking) and restricted in mineral content. Holistic vets sharply disagree with this approach and will usually use a higher protein diet to bring the urinary ph into range, along with limited carbs and somewhat restricted mineral intake. I concur, theoretically anyway, with the latter approach; that said, it can be challenging for the owner to manage on their own, and that is one drawback of a home made diet in this case. If a veterinary prescription diet is used, it’s my opinion this is a short term measure only. Therapeutic goal is to dissolve the struvites and then manage the urinary tract health of the dog proactively from there on in.
Herbs that Help
Therapeutic goals in managing a dog with struvite uroliths include:
Eliminate infection and control recurrence
Tonify the bladder (astringents, bladder tonics)
Support dissolution of stones (anti-lithics)
Maintain a neutral urinary ph
With struvite stones, several herbs can provide much assistance with the process of dissolving the urolith. If there is active infection, the herbs for UTI are all relevant; if not (or in addition) the class of herbs knowns as “antilithics” can provide great support. Anti-lithic simply refers to the action of reducing “gravel” or stones and crystals; a few of the more commonly used examples are Gravel Root(Eupatorium purpureum) Stone Root(Collinsonia canadensis) Hydrangea (Hydrangea arborescens) Wild Carrot(Daucus carota) and Craeteva (Crataeva nurvala). The formulas I put together are similar to the UTI blends, but with some anti-lithic support added to the mix. How much and which one to use is always case-dependent, but these are a few ideas.
Collinsonia canadensis, also known as Stoneroot
Formula for Struvite Uroliths
One part each of the following (in glycerite) :
Stoneroot (Collinsonia Canadensis)
Marshmallow Leaf and Root(Althea officinalis)
Crampbark (Viburnum opulus)
Bidens (Bidens frondosa)
Alternately, use Gravelroot in place of (or along with) the Stoneroot, Cornsilk in place of or alongside the Mallow, Wild Yam in place of the Crampbark and Goldenrod or Yarrow in place of Bidens. Yes, there are nuances (and some significant ones) of difference here, but the core idea is to use an antilithic, a demulcent, an antispasmodic and an astringent. I have used myriad combinations of these herbs and – alongside dietary adjustments – always seen significant improvement.
Calcium oxalate stones are another common type of urolith in dogs, and can be more difficult to manage than struvites, in many cases. Several factors predispose dogs to developing oxalates; genetics are chief amongst them. Unlike struvites, these stones cannot be dissolved and must be surgically removed. Dietary measures are essential and differ from our approach with struvites. Briefly, dietary management of oxalates entails the following:
Restriction of high oxalate foods
Monitor mineral intake – calcium, magnesium, and phosphorus
Avoid Vitamin C supplements or giving VitmainD3 above requirement levels
Encourage drinking – hydration is key
Bcomplex, Vitamin E and fish oil can all be useful
Avoid herbs with high mineral, Vitamin C or oxalate content
Calcium Oxalate stones cannot be dissolved as we may be able to do with struvites and urates; they need to be surgically removed. For this reason I don’t make use of antilithics in the same way as with struvites; my focus is adding some herbs with anti-lithic action alongside soothing demulcents like marshmallow root and leaf, and gentle diuretics such as dandelion leaf, and working with diet to minimize risk of recurrence. With dandelion, I prefer glycerite – dandelion leaf contains about 100 mgs of calcium per cup, not all of which will even be bioavailable for the dog, but I prefer to be careful especially with small dogs. It’s critical to be mindful of mineral content with dogs who have calcium oxalate stones.
I often use Stoneroot with Cornsilk and/or Marshmallow(root), a little dandelion and something along the lines of Kava kava(Piper methysticum) to help with pain. Stoneroot is another herb not made a lot of use of in veterinary circles and I love working with it; it’s actually one of my staple herbs. Craetava, also knowns as Varuna in Ayrurvedic medicine,(Crataeva nurvala) is not a herb I encounter in many places, in my herbal meanderings, it was brought to my attention by Susan Wynn and Barbara Fougeres in their book Veterinary Herbal Medicine. I include it here as a potential antilithic as well as restorative to the bladder.
So, a formula for Oxalates (assuming dietary management is in place) could look like this:
Stoneroot – 2 parts
Cornsilk- 1 part
Dandelion – ½ part
Hydrangea- ½ part
I’d use glycerite or alcohol tincture here as indicated by the dog’s overall profile (age, health, digestion) or an infusion would also be great, if the dog will accept it.
With this formula, I might think about adding a mallow root infusion separately, especially during times when pain or straining was evident.
To sum up, always place oxalate content of foods and herbs at the centre of your therapy for calcium oxalate stones in dogs. High oxalate foods we should limit for dogs include sweet potato, dark green leafy vegetables, beets, sesame seeds, quinoa. Herbs high in oxalates include turmeric, cinnamon, coriander, fennel seed and dried ginger. Lamb’s quarters (Chenopodium album) Wood sorrel (Oxalis acetosella) Sheep sorrel and common sorrel (Rumex acetosa) are exceedingly high as well.
A full list of oxalate content (foods)can be found here: http://www.denvernephrology.com/wp-content/uploads/2012/12/Oxalate2008.pdf
Urate stones are a type of urolith composed of uric acid, and associated with a derangement in purine metabolism. Purines are an organic compound found in both plant and anima tissue; as they break down in the process of digestion, they form uric acid. Urate stones cannot be identified via radiographs, so an ultra sound is needed for diagnosis; however, some breeds are very affected, with Dalmatians at the top of the list ( as many as 30% of males will develop urates) but Black Russian terriers, English Bulldogs and Parson Russell terriers are also at -risk breeds. Dogs can also develop urate stones in relation to a condition called portosystemic shunt – any dog with a shunt should be fed a preventive diet and monitored for stones throughout life.
“A portosystemic shunt (PSS) or liver shunt is a condition where the normal flow of blood, to and through the liver, is markedly reduced or absent. Normally, blood returning from the puppy’s digestive tract is routed to the liver through the portal vein. The blood flows through the liver and then exits the liver and joins the venous blood flowing back to the heart. A liver shunt is a blood vessel that connects the portal vein with the main systemic blood stream. This causes the blood to bypass the liver. Without adequate blood flow to the liver, the puppy’s body cannot thrive. “ (7)
Management is dietary, with a low-purine diet of utmost importance. This can be a challenge for the average owner, and so many dogs with these stones end up longterm on a prescription diet. Home made diets can be raw or cooked but must feature low purine foods as well as meet nutrient requirements such as calcium, VitaminD, linoleic acid. Foods high in purines – liver, sardines, kidney – should never be fed and the diet should be built around foods on the low end of purine content. Herbal protocol is the same as with oxalates.
Incontinence is such a common complaint, and not always limited to senior dogs. Sometimes it manifests as a steady, constant dribbling – other times a flooding while asleep, or the problem may be cyclical – with the dog being fine for a few days and then an “accident” in the house – any way it manifests, it’s unpleasant for human and dog alike. There can be a range of causes, incontinence may be related to a number of conditions, and any effective herbal therapy will start with a correct determination of cause. Some of the more common causes include:
-Urinary tract infection (and the problem clears when the infection is treated)
-Spinal cord problems
-Polydipsia ( dog is drinking excessively, perhaps related to high sodium food, or to a condition like diabetes)
-Neurological problems (CCD, canine cognitive dysfunction)
– Behavioural (hyper-excitement, fear)
-Hormonal changes – so-called “spay incontinence” or a weakened sphincter related to low estrogen
When your dog starts to dribble/leak urine, the first step is to have your veterinarian assess him or her – check kidney function, thyroid, check for UTI – in general rule out these causes. If, as is often the case, the diagnosis is spay incontinence, you can help pinpoint any contributing factors by carefully observing your dog – keeping a journal if need be, to determine the pattern. And thus tip you off to possible contributing factors. If your dog has, for example, nerve damage or osteoarthritis, these issues may be contributing factors and you will need to address them along with working on the bladder directly. Neurological problems associated with advanced age can be addressed with diet, herbs and veterinary medications as well. Too often, I see mature and senior females with simple incontinence related to spaying, placed on Propalin or stilbesterol when natural measures can help so much.
So, what can be done for spay incontinence? First, it’s important to understand what this condition is and how the dog is physically affected. Bitches who have been spayed will often start to lose bladder/sphincter tone when hormone production is impaired. And so it seems that using phystoestrogenic herbs would be the best way to address the problem at it’s root, but in practise this doesn’t turn out to be the case. The standard veterinary approach is usually either the drugs Proin or Propalin, which carry some truly terrifying side effects :
“The most commonly reported side effects for dogs taking Propalin, which mimic the results of excessive stimulation of the sympathetic nervous system include: anorexia, aggressive behaviour, restlessness, irritability, tremors, tachycardia, cardiac arrhythmia, hypertension, and urinary retention. “(8), or estrogen, in the form of stilbesterol. Both these approaches do help, but in the case of stilbesterol there is also a risk of thrombocytopenia, among other things:
“Treated dogs are susceptible to bone marrow suppression from estrogen, typified by early thrombocytopenia and potentially fatal aplastic anemia. Hematopoietic toxicity is rarely seen in cats. Other adverse effects seen in dogs include alopecia, cystic ovaries, cystic endometrial hyperplasia, pyometra, prolonged estrus, and infertility.” (9)
Clearly, there are drawbacks to both of these approaches, although I have on occasion used stilbesterol with geriatric females who were completely incontinent or when herbal measures were not offering the level of support we needed. But I’ve also seen on numerous occasions, early administration of herbs either slow the beginnings of incontinence considerably, or completely prevent its development. It’s a good idea to start an older female on these herbs before the problem starts – once it has, you need a few weeks to see improvement and those weeks can be difficult. If you can use a diaper, feed smaller meals (more nutrient dense/lower volume overall) and limit water before bedtime, that can help. Naturally, avoid diuretic herbs during this time!
The mechanism behind loss of tone is hormonal, so many ask why not use so-called estrogenic herbs such as Red Clover (Trifolium pratense) and approach the problem that way. In practise I have found that phytoestrogenic herbs alone exert a relatively mild in effect, whereas working directly on the muscle/bladder tone and health provides more dramatic results. In addition, many herbs with demonstrated estrogenic actions should not be fed either generically nor longterm. The diet can and should be supplemented with appropriate herbs and foods with demonstrated phytoestrogenic actions; while soy is not an appropriate food for dogs, I like to include lentils and chickpeas in small amounts in home made diets, and ground flax is an excellent source of lignan, with ground sesame seeds also providing some. Keeping the intestinal tract healthy will aid absorption of plant compounds such as isoflavones and lignans, that offer some estrogenic action.
In short – my approach is to support bladder tone and add *some*estrogenic herbs and foods as indicated. Dogs are carnivores and prone to digestive sensitivities when fed a lot of plant matter, so each case needs to be individually evaluated.
One formula for spay incontinence might look like this; glycerite is ideal for longterm use.
One part each:
I like to shake this formula up from time to time; other herbs to consider include Cornsilk, Bidens, Couch grass, Plantain and Crataeva. Avoid diuretics, overly warming herbs and don’t use the Clover if your dog has any kind of bleeding disorder. I have personally found evening primrose oil very useful in these cases as well. Susan Wynn likes Vitex for females and saw palmetto for males, but I treat all prostate disorders somewhat differently and may or may not include Vitex in a formulation. NOTE: incontinence related to prostate issues will be covered in another article!
Bladder tumours in dogs account for about 2% of all reported neoplasias. The most common type is TCC, or transitional cell carcinoma, and as with human cancers, early detection is key. Breeds at risk include Scottish terriers, West Highland White terriers, Beagles and Shetland Sheepdogs. Females are more frequently afflicted than males and toxin exposure is a risk for any breed.
“Exposure to topical insecticides and herbicides, obesity, cyclophosphamide administration and particular types of breed are believed to be the probable risk factors. In a vast majority of studies, female predilection has been found to be a predominant factor.”
The majority of dogs with TCC are treated with NSAIDS and chemotherapy (piroxicam is a drug of choice with or without chemotherapy, but there are others). In one study, survival time with NSAIDS alone was 195 days while NSAIDS and chemotherapy gave about 300 days. Recently, the chemotherapy drug vinblastine has been shown to put about 35% of dogs with TCC into remission. Whatever treatment an owner decides to utilize, will greatly influence the herbal protocol; as with all cancers, a high fat, moderate protein and lower carbohydrate diet is considered beneficial, but not every dog does well especially digestively, with this approach. Diet, herbs according to the case are always important with cancer but vary greatly according to the case. With bladder cancer, we can think about adding demulcents and antispasmodics to ease discomfort and bring some anti-inflammatory actions to the area. Marshmallow root and leaf, Crampbark, and Hydrangea are all useful.. I like to add Agrimony, Potentilla or Shepherd’s Purse if there is bleeding and any number of nervines if there is anxiety. I covered a fair bit about cancer, both nutrition and herbal support, in my canine cancer article, and much of that information is applicable here. Home made diet(if well formulated) with higher fat, a high presence of Omega3 fatty acids, minimal carbohydrates but always some in the form of fresh vegetables, legumes, and seeds such as quinoa and buckwheat; mushroom polysaccharides, herbs to support the immune system, control inflammation, support pathways of elimination and of course, support the specific organ or system affected.
In the case of bladder cancer, a full history is necessary to address nutritional problems, issues related to veterinary treatment, and other potential contraindications, but we can look to utilizing herbs with affinity for the urinary tract,that soothe, reduce inflammation and help stop bleeding as part of the overall protocol.
Urinary Tract Materia Medica
There is a lot of crossover with herbs; listing them under primary actions is just to give an idea of how I might use them in formula I have seen a wide variety of combinations “work” especially with UTI, but it’s important to consider length of time you will use the herb, oxalate and purine content if using with uroliths, and energetics. This list is just to give some general ideas and an overview of the classics.
Bearberry -(Arctostaphylos uva-ursi) a profoundly important herb to know for urinary tract isues with dogs
Uva Ursi (Arctostapholys uva-ursi) A potent antimicrobial, Uva ursi is probably THE urinary tract disinfectant of choice. Arbutin needs an alkaline environment to be effective so it’s best to use uva- ursi without urinary acidifiers. Limit to 7 -14 days usage, depending on amount used.
Oregon grape (Mahonia aquafolium) Almost all my formulas for UTI contain Oregon grape -especially the lingering kind we so often see with canines. Both antimicrobial and hepatic, Oregon grape adds to the spectrum of infection-fighters and is very safe for dogs.
Usnea (Usnea barbata) Usnic acid is a potent antibiotic compound ,and while much of usnea’s popular usage focuses on respiratory infection, I’ve included it in many UTI formulas for dogs. There is a little controversy regarding the safety of longterm/high dose use of Usnea, with some reports of liver toxicity related to isolated, high dose usnic acid, not the whole lichen – in my view, the same is true of Tylenol, and it is nowhere near as useful medicinally as usnea. I often use echinacea and usnea together, or if there is autoimmune disease, usnea is the choice (with monarda and Oregon grape). To be extra safe, don’t use with known liver disease or for more than 7 days. I also tend to reserve usnea for more severe infections.
Monarda (Monarda spp) Not always a plant we see listed in classic urinary herbs, but Monarda has been very helpful in my house (we grow it and always have a good supply) probably in part due to the thymol content, antibacterial compound associated with them. Monarda is also relaxing, which can help a lot with tension associated with pain and straining to urinate. Very safe and very helpful.
Hydrangea (Hydrangea arborescens) antimicrobial, anti-inflammatory, antilithic – really a specific for UTI and struvite stones.
Echinacea (Echinacea angustifolia, purpurea) Echinacea’s immunostimulant actions are more than well documented and often called for with infection. Many people believe that you need to superdose Echinacea and it is only useful at the start of an infection – I use moderate doses all through the UTI and into recovery, and see excellent results. I am often able to clear infection that multiple rounds of antibiotics did not, with echinacea, as part of the formula. As with humans, Echinacea is contraindicated for dogs with auto-immune disease.
Astragalus (Astragalus membranaceus) generally included in immune support for chronic UTI and with cancer. Especially good for seniors and dogs with internalized stress and heart disease. I don’t use astragalus if fever is present, but then if there’s a fever I recommend immediate veterinary care.
Agrimony (Agrimonia eupatorium) Agrimony is a premier urinary tract astringent without side effects, and is added to formulas for UTI, some uroliths and incontinence. While some authors comment that agrimony can be interchanged with any rose-family astringent herb, I feel there is an affinity here for the urinary tract and so generally prefer agrimony in my formulations. You could of course try potentilla etc as well.
Goldenrod (Solidago canadensis) Solidago is underused in veterinary herbalism and that’s a shame. Wonderful with UTI, struvites, even bladder cancer, Goldenrod is astringent, anti microbial and anti-inflammatory…one of our most important urinary tract herbs, along with many other applications.
Horsetail (Equisetum arvense) Horsetail is astringent, diuretic and anti-hemorrhagic – useful in UTI, but also a very rich source of silicon, so my preference is not to use with silica uroliths and use in formulation only with incontinence, due to some diuretic effects.
Yarrow (Achillea Millefolium) It’s hard to know where to place Yarrow in a list like this – actions include antibacterial, astringent, antispasmodic, anti-inflammatory and diuretic. My only reservation with yarrow for dogs is a higher than usual incidence of allergic reaction, and so I use it internally only after a skintest. Otherwise, generally a go-to herb for UTI and may be useful with spay incontinence as well.
Dandelion (Taraxacum officinale) Dandelion leaf is a standard addition to many urinary tract formulas, it is more diuretic than the root, so helps flush urine and the unwanted bacteria out, without the potassium depletion of veterinary drugs such as Lasix. I prefer it to Cleaver’s with UTI, but might mix with Cleaver’s if a need for more lymphatic support arises.
Marshmallow (Althea officinalis) The ultimate demulcent, I like marshmallow root and leaf both in my formulations for urinary tract infection. Soothing, anti -inflammatory, mildly immune stimulating, I like to use glycerite or alcohol tincture of the leaf in formula and give cold infusion of the root separately.
Corn Silk (Zea mays) Demulcent, mildly diuretic and anti-lithic, Cornsilk is both safe and effective with uroliths and UTI , as well as in formulas for general bladder health.
Gravel Root (Eupatorium purpurea) This is one of the go-to herbs with bladder stones, and I do make use of it, but only after careful assessment of the case. Not sure if this is a “dog thing”, because several of my distinguished herbal friends make extensive use of Gravel root with human stones, but I have several times observed this herb involved in cases where stones were expelled more quickly than is safe or certainly, comfortable for the dog (and these cases did include antispasmodics). I use Gravel root less than Stoneroot , or in formulation, chiefly because I have never seen this effect with Stoneroot.
Stoneroot (Collinsonia canadensis) I think it was about 8 years ago I started to work with Stoneroot in a number of applications, impressed and intrigued by the wide variety of actions and applications I was reading..even thought some herbalists give mixed reviews. I was looking to work with a herb that could be used like Gravelroot, but perhaps a little gentler, after three separate stories (2 involving Dalmatians) involving Gravelroot and painful, difficult passing of stones…and this has turned out to be it. I may start off with just Collinsonia and add Gravelroot over time if we don’t see results, but most of the time it’s amazingly effective. One of my own can’t-be-without herbs, for this and other uses.
Licorice (Glycyrrhiza glabra) With UTI, the main actions we seek from licorice are its ability to significantly reduce inflammation and also the cooling demulcency it adds. There are multiple contraindications for licorice, including hypertension, liver or gallbladder disease and some types of renal failure. When in doubt with a dog, don’t use licorice. Wonderful for easing inflammation if it’s the right herb, but by no means the only choice for this action.
St.John’s wort (Hypericum perforatum) included here to help with pain and anxiety in dogs who may also have some spinal cord issues or arthritis, or are constitutionally excitable and reactive.
Kava Kava (Piper methysticum) Especially for anxious dogs who cannot relax and lick the area compulsively, and where there is likely pain.
California poppy ( Eschscholzia californica ) probably my favorite, combined with crampbark, for pain with uroliths and/or UTI. Calming and gentle, the right dose can help an uncomfortable dog sleep, but not so deeply they pass urine.
CrampBark (Viburnum opulus) I use viburnum in any formula where there is evidence of pain, and alongside antilithics to help prevent spasmodic expulsion of stones too large to pass the urethra.
Corydalis (Corydalis yanhuso) – Lesley Tierra writes that “corydalis is the most valued herb for pain in Chinese medicine”(11) . Now,many herbs provide analgesic actions, I have just worked mostly with Corydalis in fairly acute cases,and seen it’s efficacy. Using the same formulation, but adding ½ to 1 part Corydalis, provided noticeable relief to both cats and dogs with discomfort due to uroliths and infection(as well as other causes). I’ve used higher doses in a simple formula for injured animals and never seen unwanted effects at all (including cats).
Next time, I’ll look at feline lower urinary tract disease, differences between cats and dogs with these conditions, and an overview of canine and feline renal disease and management.
- Merck Veterinary Manual, http://www.merckvetmanual.com/pethealth/dog_disorders_and_diseases/kidney_and_urinary_tract_disorders_of_dogs/infectious_diseases_of_the_urinary_system_in_dogs.html
5. Hill’s u/d http://www.hillspet.com/en/us/products/pd-canine-ud-dry
6. Merck Veterinary Manual(online): http://www.merckvetmanual.com/pethealth/dog_disorders_and_diseases/kidney_and_urinary_tract_disorders_of_dogs/infectious_diseases_of_the_urinary_system_in_dogs.html
7. Liver shunt description: http://www.peteducation.com/article.cfm?c=2+2103&aid=3605|
8. “The most commonly reported side effects for dogs taking Propalin, which mimic the results of excessive stimulation of the sympathetic nervous system include: anorexia, aggressive behaviour, restlessness, irritability, tremors, tachycardia, cardiac arrhythmia, hypertension, and urinary retention.” In my practise I have seen this reaction (some combination of symptoms on countless occasions) http://www.merckvetmanual.com/mvm/pharmacology/systemic_pharmacotherapeutics_of_the_urinary_system/urinary_incontinence.html
9.Merck Veterinary Manual
- Healing with the Herbs of life, Lesley Tierra
Small Animal Clinical Nutrition, 5th edition
Veterinary Herbal Medicine, Susan G. Wynn DVM, and Barbara Fougeres, DVM
Medical Herbalism, David Hoffman
Herbal Therapy and Supplements, David Winston
Combining Western Herbs and Chinese Medicine, Jeremy Ross
Christopher Hobbs on Usnea barbata
Healing with the Herbs of Life, Lesley Tierra