Is this normal? I ask myself this question all day every day. As a veterinarian, I can’t ask my patient what is wrong. Where does it hurt? Are you nauseous? I end up being more of a detective than a doctor. Some of the most confusing cases involve clinical signs that could be medical or behavioral. And is this behavior normal? Things like eating grass, rubbing a face on the furniture or urinating/defecating in inappropriate places. Since your pet cannot talk to me, I need to spend a lot of time asking questions and running tests to help rule out hundreds of possibilities.
One of the most common medical-versus-behavioral issues is urinating or defecating in inappropriate places. That innocent little puddle on the kitchen floor can be caused by a plethora of conflicting reasons, including the issue being normal. How could urinating on the floor be normal? Animals use urine to mark their territory. They will urinate over the top of another animal’s urine. They will urinate around the property multiple times throughout the day.
And not just males. Females will mark with urine as well. Submission and excitement urination are also normal behaviors. This is usually done by young dogs eager to show how well they submit by rolling over to expose their belly, whining, and urinating for you when you get home or when they are meeting new people. Do not get upset or raise your voice as this might make the situation worse. Until they outgrow this, the best thing to do is to keep all excitement to a minimum when first seeing your pet for the day.
Sit or crouch on the ground to be more at their height and ask your pet to come to you. Keep your voice low and calming and move slowly. If you are introducing someone new to your pet, have them move slowly and get low to the ground. Having a treat ready will help as well. Get the dog to come to you or your friends. Keep all noises and excitement to a minimum.
Behavioral inappropriate urination/defecation can actually just be normal behaviors that need to be differentiated through a very thorough complete history at the veterinary visit.
Is your pet spayed? Having a pet go into heat can look like they are urinating bloody, infected urine. Most people will think there has been a breach of the house-training rules. Did he "forget?” Is he mad at me? Of course, housebreaking rules may be "forgotten," but I rarely find this to be the primary reason.
So why would your pet "forget?” Perhaps, your pet cannot access the area for elimination. Are the doors open? Is a dominant cat restricting access to the litterbox? Is the litter clean? Where is the food and your pet's bed? If food or bed is placed too close to the toilet, your pet may not use the bathroom there.
A clearer behavioral issue is separation anxiety. Defecating and urinating all over the house, couches torn up, door jams, chewing and scratching, window screens torn out, howling and barking—these are not normal behaviors. These pets are frantic to escape the house. These serious signs can start soon after they are left alone.
This disorder will need a multifocal treatment plan. The first step is to do a medical workup to make sure this is only a behavioral problem. There are supplements to help calm the anxiety—from herb to Prozac. Practice leaving for a few minutes and work your way up to longer times. Finding a good trainer to come to the house is key, as well as family dedication and participation. Doggie daycare with active socialization is also helpful.
In older animals, urinary and fecal incontinence and/or inappropriate urination/defecation are almost always medical. They don't "forget" their house-training, but they do become senile and will show other signs of geriatric dementia. These signs can include your pet wandering and staring at walls, not sure how to get out of a room, not being able to find the food and water dish, "forgetting" where to go to the bathroom, whining and crying for no apparent reason, anxiety, changes in sleep cycle, confusion, and a decrease in interactions with the family. Cognitive disorders can be treated with supplements, diet changes, good exercise and medications to help make more neuro pathways.
Another common medical issue is arthritis. It may be too far for our pets to get to the "bathroom" area without pain. Take your older pet to the veterinarian to discuss possible arthritic pain and treatments. What comes with arthritis is vertebral spondylosis. Large dogs with arthritis often have arthritis along the vertebral column from the neck down the back to the tail. As the bony vertebrae begin to fuse together, they can pinch a nerve. This is like having that feeling of stabbing pain near the backbone and down the leg.
There can also be a tingling and burning sensation. This pinching can also cause nerve damage that affects the rectal sphincter. Urine and feces can then just "fall" out. Acupuncture and herbal supplements can be a huge help with this condition.
Walk in the area where your pets use the bathroom. Are there stairs to climb? Are there items in the way making it hard to maneuver? Cats also get arthritis and can find it painful to get in and out of a tall box. Cats also control each other through body language and you may not be aware that there is an internal issue. They will often block access to the food and water and the litterbox. It is important to have as many boxes as cats. They can’t guard multiple boxes at the same time.
Other medical issues in older pets include cancer, kidney failure, diabetes, neurologic disorders, and hormone responsive incontinence. Young and old patients can have diabetes, bladder/kidney infections, poisoning, and kidney and bladder stones.
These are a lot of issues to wade through. This is why we ask so many questions and run more tests than many people expected. Coming to the clinic prepared with some answers (and hopefully some urine sample) makes our job easier and your visit faster.
Here are the most important questions we will ask: Is your pet a male or female? Is your pet spayed or neutered? What do you feed your pet? How old is your pet? Is your pet drinking more water than normal? Urinating more than usual? Does your pet have diarrhea? Has your dog been on preventatives and checked recently for heartworm and tick diseases? Does your pet leak urine while sleeping? (This is very important).
The next step is to run some tests. The first and foremost is the urinalysis. We run the exact same tests your doctor runs for you. To run a urinalysis, it is best to use urine less than 24 hours old. It can be kept in the fridge until it is time to bring into the clinic to be tested. It will be checked for red blood cells, bacteria, crystals pH, and glucose (sugar). This test will tell me if there is a bladder infection, cancer, diabetes, and bladder stones. If I see cells in the urine that should not be there, it will be time to run more tests to find out where these abnormal cells came from. For example, blood in the urine could mean there is a bladder infection, but it can also mean cancer, bladder stones, heartworm or tick disease, prostate disease or kidney disease/failure.
Whew!! This is a lot! And we still aren't done. Once I see what is swimming around in the bladder, I need to take an x-ray or do an ultrasound to check for tumors, stones, and arthritis.
If I suspect cancer or poisoning (such as antifreeze), I will run bloodwork. We also always check for heartworm and tick diseases, which cause unstoppable bleeding.
So, that innocent puddle in the kitchen is no longer innocent. It may be a simple bladder infection needing antibiotics, or it could be an older dog showing early signs of dementia. The treatments being vastly different. I have found acupuncture and supplements to be a great help to my older patients that need a little help navigating through old age.
I hope this answers some questions regarding inappropriate urination (and why your appointment is taking so long).
Dr. Lisa Silk is the owner and primary veterinarian at Isla Veterinary Clinic. Send feedback to drlisa222@gmail.com