Not a week goes by without talking to a client who is dealing with a pet with persistent or recurring urinary tract infections (UTIs). It is one of the most common problems that we see in both dogs and cats. Unfortunately, most vets have gotten into a conditioned pattern to place the pet on a couple of weeks of antibiotics, which usually resolves the problem, until the next occurrence of the problem. This is not in the best interest of the pet.
Let’s take a look at the anatomy of the urinary tract which will help us understand a bit more about this common problem. The urinary system is divided into two portions, the upper urinary tract (kidneys and ureters) and the lower urinary tract (bladder and urethra). Most common UTIs involve the lower urinary tract.
The anatomy plays a major role in this recurring problem. By far, most UTIs occur in female dogs and cats. The simple reason is that females have shorter urethras. The urethra is the tube that goes from the urinary bladder into the vaginal vault. It allows urine to pass from the bladder to the outside. In females, the urethra is very short in length, whereas in males, due to the penis, the urethra is much longer.
Most UTIs or bladder infections occur when bacteria from the outside migrate into the vaginal vault, up the short urethra and into the bladder. We call this an ascending infection. Bacteria from the outside can originate from local fecal contamination, skin infections and poor hygiene. Yeast can be another microbe that can be involved since they often reside in the vaginal vault.
When bacteria migrate into the urinary bladder, we usually begin to see typical symptoms of a UTI or bladder infection. The symptoms usually include straining to urinate, frequent attempts to urinate and often painful urination, particularly in cats. If the infection persists, due to inflammation of the bladder wall, there will often be blood in the urine. This might be seen as flecks of blood in the urine or pinkish urine. When the bladder wall is inflamed, the nerves of the bladder send a message to the brain that the bladder is full. This gives the pet the urge to urinate frequently. The pet will go so frequently that it often passes very small amounts of urine at a time, another typical symptom. They will often go in inappropriate areas in the house.
If the pet is taken to the vet, the standard protocol is to do a physical exam on the pet, palpating the bladder and examining the vulva or penis. Then a urine sample is collected in order to do a urinalysis, which is the main lab test to diagnose a UTI. The urinalysis will likely show the presence of blood, white cells and bacteria. The vet will also be looking for other findings that might suggest that it is not a simple bacterial infection. This might include crystals or cells that could suggest a tumor in the bladder.
Often, the vet will opt to send the urine into the lab for a culture and sensitivity. This allows the vet to know what the bacteria are and what antibiotics they will respond to. This takes the guess work out of the equation. Once the culture and sensitivity are back, the vet will select an antibiotic that the bacteria are sensitive to and put the pet on the antibiotic for around 2 weeks. Most of the time, the symptoms are resolved by the time the antibiotics have finished.
If this happens once, then this is not a problem. However, if the problem recurs or persists, then it is paramount that the vet look deeper to find the source of the problem. There might be an atypical anatomical problem with the urinary system. Many dogs have inverted or recessed vulvas which allows a trough to form around the vulva. The trough collects urine and bacteria from the skin and feces will often set up a local infection around the vulva. In a short time, the bacteria will migrate up the urethra into the bladder and the symptoms start again. The way to deal with this is with good hygiene. The caretaker needs to clean the area around the vulva and put something on it that will kill the bacteria. Diluted apple cider vinegar with some colloidal silver or olive leaf extract works well.
If the vet does not find an anatomical deviation, she might decide to take an X-ray of the urinary bladder. This is done to look for bladder stones which might not be palpable on physical exam. If the vet finds large bladder stones, they may have to be removed surgically. If this happens, the vet will send the stones to the lab for analysis to try to develop a plan to keep them from recurring.
If all else fails, the vet might choose to do an ultrasound of the bladder, looking for masses growing from the bladder wall. If one is seen, the vet will likely place a needle into the mass to determine what type of tumor is involved. Treatment will be determined according to the cytological findings.
Like I mentioned, it is often rare to find UTIs in males. When we find a UTI in males, they are usually not the typical bacterial infection that has migrated up the urethra. The vet will palpate the bladder for stones (and X-rays) but will also take a look at the prostate. If the dog is an intact male, chances are the prostate is the source of the infection and needs to be treated accordingly. If the urinalysis determines that there is infection involved and there is no bladder stones, prostatitis or tumor, then there is a good possibility that the infection has descended from the kidneys. This is called a pyelonephritis, meaning the infection is involving the kidneys and the bacteria are following the urine downwards into the bladder. Kidney infections often are caused by infections from other parts of the body that have entered the blood stream and landed in the kidneys. This might originate from an abscessed tooth, badly infected mouth, anal sac infections and others.
For each cause of the UTI, there is a conventional treatment that usually involves antibiotics, other drugs, possible surgery and likely a preventative program, including prescription diets. As a holistic vet, I use natural remedies and alternative modalities to support the problems. Often, changing to a fresh raw diet, supplements that support the urinary system and immune system will help resolve the underlying problem and prevent the recurrence.