Bladder and Bowel Management in Dogs With Spinal Cord Injury.

Nicolas Granger,Yvette S Nout-Lomas,Natasha J Olby

doi:10.3389/fvets.2020.583342

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.

Highlights

Spinal cord injury can cause irreversible locomotor and autonomic dysfunction including urinary and fecal incontinence
It seems that the focus of owners is regaining locomotion, and that urinary or fecal incontinence, Incontinence After Spinal Cord Injury whether persistent or temporary, are forgotten or “managed” dysfunctions that will either pass or will need to be accepted as permanent
The spinal patient might be especially susceptible to developing complications such as decubital ulcers and urinary tract infection because of the combination of neurogenic incontinence, recumbency [leading to reduced tissue perfusion and pressure >60 mmHg in risk zones such as scapula-humeral articulation, the greater trochanter and the thirteenth rib [44]] and reduced immunity after spinal cord injury [which is known to occur in people from decentralization of the autonomic nervous system [45]] potentially sustained by poor nutrition

Summary

INTRODUCTION

Spinal cord injury can cause irreversible locomotor and autonomic dysfunction including urinary and fecal incontinence. With intervertebral disc herniation causing compression within the T3-L3 spinal cord segments (upper motor neuron lesions) and when dogs have present (intact) deep pain sensation in the pelvic limbs, recovery of urination usually occurs concomitantly with return of motor function [5, 22, 23] and the prognosis for recovery of urinary continence is good [17]. The spinal patient might be especially susceptible to developing complications such as decubital ulcers and urinary tract infection because of the combination of neurogenic incontinence (leading to increased moisture on skin), recumbency [leading to reduced tissue perfusion and pressure >60 mmHg in risk zones such as scapula-humeral articulation, the greater trochanter and the thirteenth rib [44]] and reduced immunity after spinal cord injury [which is known to occur in people from decentralization of the autonomic nervous system [45]] potentially sustained by poor nutrition These factors have not been clearly studied and established as “risks” in dogs after spinal cord injury, they are in people and for the time being, it appears logical to consider these as such. The same group found no effect of cranberry extract given in the acute phase of spinal cord injury on the occurrence of bacteriuria in a randomized control trial in dogs [54]

Method

Method Recommendations

Findings

CONCLUSION