She can't go to the bathroom

Old Yeller Alert

A while back, I posted about Curly Sue having blood in her urine.  She turned out to have a bleeding disorder instead of a urinary problem.   Last week, she developed a urinary problem.   One day my receptionist asked me what the dose would be for a mild laxative. "They say that Curly Sue is straining to have a bowel movement."  I suggested some Metamucil, but also suggested that they be sure whe was urinating okay (even though female dogs rarely become obstructed -- their urethra is short, straight and stretchy, so it doesn't get stopped up very easily).

The next day, her owners called back and decided that they had been mistaken: she wasn't having trouble defecating, she was actually straining to urinate.    I wasn't too surprised by that, as the squatting and straining looks pretty similar.  Since female dogs rarely have blockages, I suspected that she had a bladder infection. When they told me that she was making frequent attempts to urinate, but producing very little, I was even more sure that cystitis (bladder inflammation) would be the problem.  However, as Sherlock Holmes once said, "It is a capital mistake to theorize in advance of the data."

When Curly Sue walked in, she was dripping urine in a steady trail of drops.  That does not go along with a bladder infection.  With the bladder infection, you feel you like really, really have to go, even though you just went and got emptied out.  If you just got emptied out, you wouldn't be dribbling.  If you're incontinent and can't stop dribbling, you wouldn't be having to strain.  Something doesn't jibe here.

She could have had  a stone lodged in the urethra, causing a partial blockage (rare though that is in females), but she didn't.

She could have reflex dyssynergia.  This is a weird neurological condition where your "squeezing-out" muscle and your "hold it in" muscle aren't in sync.  When the "squeeze" is on, the "hold it" should be off and vice versa.  In those dogs, when they strain to empty, their sphincter paradoxically shuts down and tries to hold it in.  When they quit trying to squeeze, the sphincter opens and they dribble.

She could have had that, but she didn't.  Her abdomen was tense, and when I ultrasounded her bladder, it was hugely full.  Then we found the big mass of tissue surrounding the neck of the bladder.  The ultrasound alone couldn't tell you exactly what it was, but it was a big mass that normal dogs don't have.  It proved to be cancerous and inoperable and the end of the trail.

Curly Sue had a long life, and dodged a big bullet in the summertime.  I guess all good things come to an end, but she will be greatly missed.

One more lesson in how hard it is to make the diagnosis over the telephone.

Comments

[urinary retention]

Urinary retention is the inability to empty the bladder. With chronic urinary retention, you may be able to urinate, but you have trouble starting a stream or emptying your bladder completely. You may urinate frequently; you may feel an urgent need to urinate but have little success when you get to the toilet; or you may feel you still have to go after you’ve finished urinating.

[urinary retention]

Urinary retention is the inability to empty the bladder. With chronic urinary retention, you may be able to urinate, but you have trouble starting a stream or emptying your bladder completely.