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Urinary tract infections (UTIs) in dogs

All dogs can experience urinary tract infections (UTIs) from time to time, however these infections are particularly common in paralyzed dogs. Unfortunately, UTIs can be a reoccurring or chronic problem for paralyzed dogs that can see you in an endless cycle of vet visits, smelly pee, and antibiotics.

This summary is based on a review of the available literature, and discussions with veterinarians, leading medical researchers and scores of other paralyzed dog owners. We hope that the information and advice helps you and your dog but remember, this is not a substitute for a visit to the vet. UTIs can become serious and life threatening when left untreated. They need professional diagnosis, monitoring, and often treatment.

Causes

E. coli is the most common bacteria that causes bladder or urinary tract infections. In a study of paralyzed dogs, 75% of all positive cultures were due to E. coli. It is even more commonly the cause of UTIs in humans, with up to 90% of all infection due to this bacteria.

Once bacteria enters the urinary tract, they latch on to the lining of the urinary tract, grow, multiply, progress to the bladder and cause infection. Recent research has shown that the bacteria use hooks to attach to the body's cells and progress up to the bladder.
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Dogs who have suffered spinal cord injury have an increased risk of UTIs occurring. The main reason for this is the inability of paralyzed dogs to completely empty their bladder, allowing bacteria to remain, multiply and colonise the bladder. The other contributing factors for reoccurring UTIs in paralysed dogs can be the regular use of diapers as well as the fact that paralyzed dogs are more frequently catheterised while receiving treatment for other issues. Both of these can increase the chance of E. coli making its way into to the urethra. 
Picture
E. coli in urine clings to the body's cells (source: NewScientist.com)

Symptoms

Typically, one or more signs and symptoms will be present including fever, puss in the urine, sensitivity or signs of pain over kidneys and bladder, increased incontinence or leakage, increased spasticity, cloudy urine with foul smell, blood in the urine, lethargy, and change in difficulty in expressing or voiding urine.

Diagnosis can be more challenging in spinal cord‐injured dogs who are partially or totally incontinent and have reduced feeling. Furthermore, there is no standardized set of guidelines to define the clinical signs to diagnose a UTI in a paralyzed dog.

​Urine culture is the “gold standard” for diagnosis of UTI to ensure the right antibiotic is used. A sample may be collected by expressing a sample, however often the preference may be for a direct sample to be collected from the bladder using a syringe inserted through the abdomen. This is a common procedure and is not nearly as painful for your dog as it sounds!
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For paralyzed dogs with chronic UTIs, you will most likely have learned to see the signs of an infection taking hold. This is commonly reported as increased leakage, smelly urine, discomfort when expressing the bladder and even uncontrolled erections in males in response to the pain.

Treatment

Left untreated, UTIs can have serious complications, including septicemia and even death. This is why a visit to your vet is critical so that the infection can be appropriately managed. Antibiotics are the cornerstone of UTI therapy, and many animals with recurring UTIs are managed with repeated courses.

However, repeated use can lead resistant bacteria. This can be dangerous as chronic UTI from highly resistant bacteria have very limited treatment options. This has led to medicines specialists recommending that asymptomatic UTIs not be treated with antibiotics until absolutely necessary. 

The good news is that bacteria can be present in the urine without the painful and dangerous symptoms of a UTI being present. These cases of asymptomatic UTIs are common in paralyzed dogs and they are typically not treated with antibiotics. This approach promotes the importance for complimentary therapies to prevent and manage infections which we discuss further. .

Prevention

The research suggests that there are three key things that you can do to reduce the occurrence of UTIs, or manage the severity of infections and offset the need to use antibiotics.

Frequent and complete bladder expression 
Easier said than done, but this is the best way to prevent bacteria from colonising the bladder to problematic levels. See our guide for tips and advice on expressing a dogs bladder. 

Cranberry and Mannose D supplements 
Alternative preventative methods such as cranberry supplements and D-mannose have been well studied. The use of cranberry juice (or supplements) to prevent UTIs appears to be one of those rare home remedies that actually work. 

Research into both cranberry and D-mannose supplements have shown that they reduce the bacteria’s ability to hook onto the lining to the bladder and urinary tract, thereby reducing their ability to colonise the bladder. So, while these supplements will not kill off bacteria in the same way that antibiotics do, they do reduce the infection and keep the bacteria count low enough to remove the symptoms. 

We recommend the NOW supplement brand as they use high quality ingredients and we have had lots of positive feedback. One capsule per day does the trick. You can either provide as a capsule or open them up and mix the contents in with their regular food.
​Probiotics for dogs
The link between probiotics and bladder health is less proven than cranberry and mannose supplements, but is certainly worth a shot for those who need all the help they can get. 

References

  1. https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.14854
  2. https://www.healthline.com/health/d-mannose-for-uti#research
  3. https://www.europeanreview.org/wp/wp-content/uploads/2920-2925-D-mannose-a-promising-support-for-acute-urinary-tract-infections-in-women.-A-pilot-study.pdf
  4. https://www.msdvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-urinary-system/bacterial-urinary-tract-infections
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