Bladder and Bowel Management in Dogs With Spinal Cord Injury

Abstract

Spinal cord injury in companion dogs can lead to urinary and fecal incontinence or retention, depending on the severity, and localization of the lesion along the canine nervous system. The bladder and gastrointestinal dysfunction caused by lesions of the autonomic system can be difficult to recognize, interpret and are easily overlooked. Nevertheless, it is crucial to maintain a high degree of awareness of the impact of micturition and defecation disturbances on the animal's condition, welfare and on the owner. The management of these disabilities is all the more challenging that the autonomic nervous system physiology is a complex topic. In this review, we propose to briefly remind the reader the physiology of micturition and defecation in dogs. We then present the bladder and gastrointestinal clinical signs associated with sacral lesions (i.e., the L7-S3 spinal cord segments and nerves) and supra-sacral lesions (i.e., cranial to the L7 spinal cord segment), largely in the context of intervertebral disc herniation. We summarize what is known about the natural recovery of urinary and fecal continence in dogs after spinal cord injury. In particular we review the incidence of urinary tract infection after injury. We finally explore the past and recent literature describing management of urinary and fecal dysfunction in the acute and chronic phase of spinal cord injury. This comprises medical therapies but importantly a number of surgical options, some known for decades such as sacral nerve stimulation, that might spark some interest in the field of spinal cord injury in companion dogs.

The Long-Term Clinical Course of Canine Degenerative Myelopathy and Therapeutic Potential of Curcumin

“…This study indicated that urinary and fecal incontinence was present in a high percentage of dogs with DM, which was similar to what was noted in patients with ALS [19]. The regulation of urination and defecation involves a complex neural control system in the brain, spinal cord, and peripheral autonomic neurons [20]. In dogs with DM, spinal cord lesions spread in ascending and descending orders from the caudal thoracic spinal cord [21], leading to the development of urinary and fecal incontinence.…”

Cranial thoracic myelopathies (T1-T6 vertebrae): Retrospective evaluation of the signalment, clinical presentation, and, presumptive or final diagnoses in 84 dogs

“…This was documented in three cases, however only two of those were presumed to be secondary to the cranial thoracic myelopathy, which were still ambulatory despite the urinary/faecal incontinence. A myelopathy in the area of interest of our study, from T1 to T6, could cause a supra-sacral (cranial to the L7 spinal cord segment) incontinence ( 55 ). This can occur due to the damage of the upper motor neuron pathways to the bladder and rectum, resulting in a retention urinary incontinence, due to increased sphincter tone, and faecal incontinence due to the inability to control defecation once the defecation reflex has been triggered ( 55 ).…”

An unusual case of intervertebral disc extrusion in a dog

“…The current approaches for dogs with acute thoracolumbar myelopathy due to compressive IVD extrusion have been recently reviewed 19–21 . Clinical examination (including testing nociception, which is a key factor in several reported grading systems) is critical in prognostication, where a loss of nociception indicates a worse prognosis for recovery than intact nociception.…”

“…12,13,15 The current approaches for dogs with acute thoracolumbar myelopathy due to compressive IVD extrusion have been recently reviewed. [19][20][21] Clinical examination (including testing nociception, which is a key factor in several reported grading systems) is critical in prognostication, where a loss of nociception indicates a worse prognosis for recovery than intact nociception. MRI is the preferred diagnostic modality, and, after localization of the compressive lesion, surgery is often (and, most will consent, preferably) performed shortly after.…”