Non-surgical Therapy

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.


Severe Hind Leg Weakness in a Cat – Non-Surgical Treatment

Posted on in animal acupuncture, Case Reports, Non-surgical Therapy, veterinary acupuncture, Veterinary Chiropractic Comments Off on Severe Hind Leg Weakness in a Cat – Non-Surgical Treatment

Severe Hind Leg Weakness
Before and After videos of Sally the Cat

 

Sally presented with a history of severe hind leg weakness that prevented her from walking.  Her condition had not changed in the last six months.  She was treated using a combination of chiropractic, acupuncture and physiotherapy techniques. The video below is a good demonstration of how well hind leg weakness patients can respond to non-surgical therapy.

The decision on whether a case of hind end weakness will respond to non-surgical treatment depends on several factors, including the degree of neurologic impairment, how rapidly the condition is progressing, and the amount of concurrent pain that is present. Some cases are clearly surgical, but this one was not.


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.