Certain diagnostic tests must be performed to confirm the diagnosis of urinary incontinence and exclude other diseases that may cause similar symptoms, such as bacterial infection, stones or calculi, or prostatic disease in male cats. Tests may include: Complete medical history. The medical history may include questions about reproductive status (intact or neutered), urine dribbling during sleep or where the pet is lying, change in water consumption or urine production, presence of other illness, history of trauma, gait abnormalities that could suggest neurologic disease, blood in the urine, increased frequency of urination, history of urinary tract infections, previous drug therapy, constipation, and presence of behavioral problems.
Physical examination including palpation of the abdomen, rectal examination in male cats to evaluate the prostate gland, and vaginal examination in females
Urinalysis to evaluate for white cells, red cells, or bacteria
Urine culture and sensitivity to evaluate for the presence of bacterial urinary tract infection
A complete blood count and serum biochemistry tests to evaluate the pet's general health and other body systems
Plain abdominal X-rays to evaluate for stones
Your veterinarian may recommend additional diagnostic tests to exclude or diagnose other conditions if preliminary tests do not yield a diagnosis, or to understand the impact of urinary incontinence on your pet. These tests are selected on a case-by-case basis. Examples include:
Urinary catheterization to determine the amount of urine remaining in the bladder after the pet has attempted to urinate and to identify any obstruction
Prostatic fluid analysis to evaluate for prostatitis in male cats
Contrast dye radiographic studies, such as cystourethrogram to evaluate the bladder and urethra, intravenous pyelogram or excretory urography to evaluate the kidneys and ureters.
Ultrasound examination, a technique in which internal organs are visualized by recording reflections of ultrasonic waves directed into tissues, to evaluate for stones, tumors or obstruction.
Urethrocystoscopy, a technique in which a rigid or flexible scope is passed into the vagina, urethra and bladder of females for direct visualization, to identify anatomic abnormalities, stones, or tumors. This procedure usually requires referral to a specialist.
In difficult cases, special physiologic studies of urination, like urethral pressure profile or cystometrogram, to evaluate nervous control of urination. These tests require referral to a specialist.
Treatment of urinary incontinence is based on the cause of the condition and other factors that must be analyzed by your veterinarian. There are several potential causes of urinary incontinence, and it is necessary to identify a specific cause to provide optimal therapy. Treatments may include the following:
Sphincter mechanism incompetence in middle-aged, medium to large breed spayed female cats may be treated with drugs such as phenylpropanolamine.
Hormone therapy with estrogens such as diethylstilbestrol may be used in some cases.
An over-active bladder muscle (detrusor hyperreflexia) can be treated with smooth muscle relaxant drugs such as propantheline.
Urethral spasm causing functional obstruction of the bladder can be treated with the smooth muscle relaxant drug phenoxybenzamine.
Functional obstruction caused by incoordination of the bladder and urethra, such as a bladder contracting against a closed urethra, also called reflex dyssynergia, can be treated with the smooth muscle relaxant drug phenoxybenzamine and bladder smooth muscle stimulant bethanecol.
Urinary incontinence in neutered male cats sometimes can be treated effectively with testosterone injections.
In severe cases of weakened bladder muscle, it may be necessary to place an indwelling urinary catheter to keep the bladder empty for a prolonged time (7 to 14 days) during which recovery of bladder function can occur.
A more permanent drainage device, a cystostomy tube, can be placed surgically to allow manual drainage of the pet's bladder by the owner. This procedure is sometimes performed in pets with obstruction of the bladder by cancer.
Ectopic ureters are treated by surgical repositioning, but this procedure does not always correct incontinence and drug therapy may be required after surgery.