Geriatric care

Fecal Incontinence in Dogs

Posted on in Geriatric care, Non-surgical Therapy, Nutrition 82 Comments

Faecal Incontinence in Old Dogs

 

Incontinence in dogs: a common complaint I hear from the owners of old dogs is fecal incontinence – normal looking bowel movement or stool “accidents” that get left somewhere in the house by a dog who knows better, and who didn’t do it on purpose.  Often the owner finds them where the dog sleeps, or they see them come out when the dog first struggles to stand after a nap.  But is this really dog incontinence?

What Causes Incontinence in Dogs?

 

In most cases, this is not true incontinence.  True incontinence in dogs stems from a lack of anal sphincter control, and I think in most cases that is only a small part of the problem.

I know this picture has nothing to do with the article, but really... who wants to see a picture of a geriatric dog straining to defecate?

I know this picture has nothing to do with incontinence in dogs, but really… who wants to see a picture of a geriatric dog straining to defecate?

This problem seems to almost exclusively affect dogs with very weak or debilitated hind ends.  These dogs have difficulty standing, and most importantly, they have difficulty assuming a proper “defecation posture”. Although these dogs may have a weaker than normal sphincter, in most cases it is still strong enough to prevent incontinence as long as the colon is not overfull.

However, because these dogs lack the strength to comfortably squat and defecate, they do what I refer to as the “walk & drop” – rather than crouch, they keep stepping forward while defecating.

Presumably, because defecating is so awkward and potentially uncomfortable for these dogs, they never fully evacuate their colon; they seem to defecate just enough to relieve any immediate urge, but not much more.  As a result, they spend most of their day with a mostly full colon.

Sometimes this catches up with them when they sleep, when a mostly full colon becomes an over full colon.  Combine that with the reduced muscle tone of a deep sleep and suddenly you have the recipe for a soiled bed.  Alternatively, as they engage their abdominal muscles to stand, pressure in the abdomen increases, causing them to have an accident while first getting up from a nap.

 What can I do to help?

 

Sometimes increasing the amount of non-digestible fibre in the diet helps (1 ice cream scoop of canned pumpkin with each meal for a large sized dog).  There are prescription medications available that improve colon motility, but I’ve not found them particularly effective.  Giving plenty of opportunity to defecate outside before bedtime is definitely helpful.

Another random picture that has nothing to do with the article.

Another random picture that has nothing to do with incontinence in dogs.

The treatment with which I have seen the best results is to address the underlying lower back pain – increase the dog’s comfort and hind end strength so that it can hold a better defecation posture and therefore better evacuate its colon.  Using combined acupuncture and manual therapy (CAMT), as well as a comprehensive arthritis treatment protocol, yields the best results.  Manual therapy is an umbrella term for chiropractic and/or physiotherapy style adjustments and mobilizations, as well as massage techniques. This protocol has an excellent prognosis for improving quality of life, and in most cases reduced the number of “accidents” as well.

Having said that, by the time the dog is at the “walk & drop” stage, they are usually quite debilitated, and the more advanced a condition is, the harder it is to turn around.  But by being aware of earlier signs and responding when you first see them, the chance of preventing this problem in the first place is much better.

 Some of the more common earlier signs include:
  • Hesitation or reduced ability to jump up (e.g.: into the car)
  • Body shakes that don’t reach from head to tail
  • Stiffness or difficulty standing (e.g.: pulling from front legs instead of pushing from the back)
  • Fatiguing earlier on walks
  • Stumbling or scuffing hind feet
  • Altered head, back or tail posture

 

What about urinary incontinence?

 

Although that is a blog topic unto itself, lower back pain is a common cause of dogs leaking urine in their sleep. Treating that underlying pain often resolves urine leakage issues. Resolving back pain can be a effective treatment for both urinary and fecal incontinence, but is also an important goal unto itself.  Less pain is a good thing.


Why Exercise Reduces Pain

Posted on in Geriatric care, Non-surgical Therapy, Prevention, Uncategorized 2 Comments

relaxed acu dog

Dysafferentation

(don’t worry, that’s the biggest word in this article)

and the Gate Control Theory of Pain

 

The brain is bombarded with tens of thousands of pieces of information every second, information about body movement, input from the sense organs (eyes, ears, nose, etc.), from the internal organs, from thermal and chemical detectors… the list goes on and on.  88% of this information belongs to our subconscious; we are unaware of it.  Everything else, everything we sense, ponder, feel, and experience is only 12% of what the brain is processing at any given moment.  The combined input from our peripheral nervous system, both conscious and unconscious, is called afferent flow.

Not surprisingly, the brain needs to sort this information.  It filters, prioritizes and responds to what it has learned.  Once it has finished sorting, it transmits a response called efferent flow.  In approximate terms, for every 10 bits of afferent information the brain receives, it responds with 1 bit of efferent information.

Part of this sorting and prioritizing happens at the spinal cord level, before signals even reach the brain.  Information about movement flows up one type of nerve, and information about pain flows up another.  If information about both movement and pain happen at the same time, the two signals compete with each other to see who actually gets to project up the spinal cord to the brain.  This is known as the Gate Control Theory of Pain.

Because nerve fibres that convey information about body position are faster than the ones that convey information about pain, they usually win the battle to project up the spinal cord to the brain.  Therefore, the more information the brain receives about changes in body position, the less information it receives about pain.

dogs of the dogocolypse

The Four Dogs of the Apocalypse: Gluttony, Hyperactivity, Barking, and Stick Chewing

This is why you rub your leg after banging your shin; the sensation of skin being touched outpaces the sensation of pain and reduces the amount of discomfort perceived by the brain.  Similarly, this is why people who have an illness or injury might not feel too bad when they are up and moving about, but then once they just lie immobile in bed at night, they really notice their aches and pains.

The same goes for arthritic pets.  If all they do is lie on a blanket, then there is little information travelling to the brain to compete with the sensation of pain.  Dysafferentation is the word used to describe this imbalance in which the brain receives a large amount of afferent flow relating to pain, and little information about movement.  This triggers a downward spiral: reduced movement allows the perception of more pain, which makes the patient reluctant to move, which allows the perception of more pain, which makes the patient reluctant to move….

We’re used to the notion that “practise makes perfect”, that the more we repeat an action, the better we get at it, whether it’s catching a ball or balancing on a narrow beam.  This occurs because the nervous system is constantly rewiring itself for greater efficiency.  The problem is, this phenomenon happens at both a conscious and unconscious level.  In the same way that the nervous system can learn to catch a ball more efficiently, it can become more efficient at slouching, or at having a seizure, or at experiencing pain.  The more pain you feel, the easier it becomes to feel that pain.  This goes back to the downward spiral described in the paragraph above.

Both chiropractic adjustments and acupuncture needles trigger neurologic responses that help reduce dysafferentation, as well as provide temporary relief and the comfort needed to start moving, but the best way to prevent dysafferentation is to remain active.  Encourage your arthritic dog to participate in controlled exercise.  Distract them with activity.  Circulate that joint fluid to disperse inflammatory mediators.  Prescription pain control might be needed – whatever it takes to maintain activity.  The longer they keep active, the happier they will be and the longer their arthritic joints will last.

As was mentioned before in a previous blog on exercising old dogs, any exercise that doesn’t flare them up afterward was good for them.  If you are unsure of how much your dog is capable of doing, consult a professional with experience in developing rehabilitation exercise programs.


Exercise for old dogs – how much is too much?

Posted on in Geriatric care, Non-surgical Therapy, Prevention, weight control 1 Comment

 

Exercise for Old Dogs:

The longer they keep moving, the longer they will last

 

A common question is “How much is too much exercise for an old dog?”  We know that too much exercise has the potential to flare arthritic joints, that older dogs tire sooner, that they are more prone to injury, and all this needs to be respected.

But as much as we don’t want to over exercise an older dog, under exercising them is even worse.  Once a dog becomes inactive, their health and quality of life quickly drops.  Better to have an older dog take anti-inflammatory medication and lead an active life, than have it remain drug free but spend its time sleeping on the couch, too sore to enjoy the simplest outing.

There are many reasons why the health of under exercised patients declines so quickly, too many to cover in one blog, but here is a partial list:

Fiver might not be a geriatric, but she definitely needs regular exercise, not only to keep her sanity but also to keep her gluteals tone (she has had bilateral knee surgery).

Dysafferentation: This will get explained in more detail in a later blog, but the bottom line is that if the brain receives signals about body movement, it becomes less aware of pain.  Active dogs feel less pain.

Muscle mass/tone: Geriatrics tend to lose muscle tone and bulk. Inactive pets also lose muscle tone and bulk. Inactive geriatrics lose muscling the fastest of all. Exercise is the best way to maintain muscle mass (use it or lose it).  Good muscling reduces arthritic pain by providing stability to the joint.

Feeding the Cartilage:  Nutrients are transferred from the blood stream into the joint fluid.  Circulating joint fluid carries these nutrients to the joint cartilage.  Joint fluid is circulated every time the joint bears weight.  Lying around results in reduced nutrition reaching the cartilage, which accelerates cartilage degeneration and secondary arthritic change.

Neurologic benefits:  Again, the notion of “use it or lose it” applies.  Nerves need regular stimulation in order to remain healthy, the sort of stimulation that exercise provides.  Exercise helps maintain co-ordination and strength in the limbs, as well as the mental stimulation needed to combat dementia.

Weight control: As we’ve already seen (click here), increased fat results in increased pain.  The more active a geriatric is, the easier it is to prevent excessive weight gain.

 But how much exercise is too much?

 

The answer to that question varies from patient to patient but here are a few thumb rules that you can apply:

  • Keep sessions short and frequent – older dogs tire easily.
  • If the exercise session doesn’t contribute to stiffness afterward, then it was good for your dog’s health.
  • If the stiffness gets worse with certain types of exercise, avoid those types of exercise.
  • Casual walk on level or mildly challenging ground are best.  Rough-housing and sudden exertional activities (e.g. jumping down, hard braking etc.) are not as good.
  • Have your pet examined by someone experienced in detecting musculoskeletal pain, and let them help you devise an exercise program.

 

Again, too little exercise can do as much if not more harm than too much.  Any exercise that doesn’t increase pain and stiffness afterward was a good thing.