Research Review: lower back pain and urinary incontinence in dogs, are they linked?

New research published in February has investigated the possible link between lower back pain (LBP) and urinary incontinence (UI) in dogs (Lane and Hill, 2022), a link which has already been established in humans. In the human research, treatment of LBP with physiotherapy has shown to reduce UI symptoms (Ghaderi et al., 2016), with acupuncture and laser treatment also proving beneficial (Mackova et al., 2020; Shen et al., 2019; Sun et al., 2020). Canine UI patients are currently treated with long term medication so this research could give us another option.

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The Research

This trial only included patients with incontinence whilst sleeping, lying down, or straight after getting up from rest. The dogs were treated with acupuncture for a minimum of two treatments and some received laser therapy too. Manual therapy was included to the muscles of the lower back area, with the overall goal to resolve any areas of muscular pain. The researchers wanted to determine whether there was a change in the frequency or volume of the UI episodes after treatment.

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The Results

Of the 39 dogs included, all showed a lack of mobility in the lower back area, and as a physio this is a problem I see commonly in my patients. The results from the trial supported the theory that resolving lower back pain will help to reduce UI episodes, as treatment was successful in reducing the frequency of leakage overall. 74% of owners reported a decrease in the frequency of UI episodes and 69% reported a decrease in the volume of urine leaked. This data therefore suggests a link between lower back pain and urinary incontinence, and potentially suggests that UI is a previously unrecognised pain symptom.

Previous research has linked UI with difficulty getting into a normal urination stance which indicates underlying pain or reduced flexibility in the spine (De Bleser et al., 2011). This may be something you notice in your dog particularly as they get older or if they suffer with joint conditions affecting the spine or hindlimbs. The same research also linked UI and osteoarthritis (OA), OA in the lumbar vertebrae causes lower back pain and OA of the hind limbs predisposes dogs to secondary lower back pain, so you can see how this all correlates.

This new research has given us a great insight into a possible new approach in managing UI, however, more research is needed to support this theory and to investigate the long-term effects in different cases. As these dogs received a multi modal treatment, it would be helpful to isolate each treatment to see if they are effective in isolation.

If you have concerns about your own dog and would like to seek treatment, please speak to your vet or a veterinary physiotherapist who can advise you on the best options.

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References:

De Bleser, B., Brodbelt, D.C., Gregory, N.G. and Martinez, T.A (2011) ‘The association between acquired urinary sphincter mechanism incompetence in bitches and early spaying: a case control study’. Veterinary Journal, 187, 42–47.

Ghaderi, F., Mohammadi, K., Amir Sasan, R., Niko Kheslat, S. and Oskouei, A.E (2016) ‘Effects of stabilization exercises focusing on pelvic floor muscles on low back pain and urinary incontinence in women’. Urology, 93, 50–54.

Lane, D. and Hill, S. (2022) ‘The relationship between urethral sphincter mechanism incompetency and lower back pain: Positing a novel treatment for urinary incontinence in dogs’. Open Veterinary Journal, 12, 105-113.

Mackova, K., Van Daele, L., Page, A., Geraerts, I., Krofta, L. and Deprest, J (2020) ‘Laser therapy for urinary incontinence and pelvic organ prolapse: a systematic review’. BJOG International Journal of Obstetrics and Gynaecology, 127, 1338–1346.

Shen, J., Luo, R., Zhang, L., Li, Y., Ke, L. and Gao, Z (2019) ‘Using electroacupuncture with optimized acupoint positioning to predict the efficacy of sacral neuromodulation of refractory overactive bladder: a case report’. Medicine (Baltimore), 98.

Sun, Y., Liu, Y., Liu, S., Wang, W. and Liu, Z (2020) ‘Electroacupuncture for women with urgency predominant mixed urinary incontinence: secondary analysis of a randomized noninferiority trial’. World Journal of Urology, 38, 1035–1042.