New report refutes belief spaying causes urinary incontinence.

[cute_lil_fancy_pants]

J Small Anim Pract. 2012 Apr;53(4):198-204. doi: 10.1111/j.1748-5827.2011.01176.x. Epub 2012 Feb 21.
The effect of neutering on the risk of urinary incontinence in bitches - a systematic review.
Beauvais W, Cardwell JM, Brodbelt DC.
Source

Veterinary Epidemiology and Public Health Group, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA.

Abstract

An increased risk of urinary incontinence in bitches has often been associated with previous ovariohysterectomy but remains controversial. The objective of this study was to evaluate the strength of evidence for an association between neutering or age at neutering and urinary incontinence in bitches and to estimate the magnitude of any effect found. A systematic review of peer-reviewed original English analytic journal articles was conducted, based on Cochrane guidelines (Higgins and Green 2009) Of 1,853 records screened, seven studies were identified that examined the effect of neutering or age at neutering on the risk of urinary incontinence but four were judged to be at high risk of bias. Of the remaining three studies, which were at moderate risk of bias, there was some weak evidence that neutering, particularly before the age of three months, increases the risk of urinary incontinence. However, overall the evidence is not consistent nor strong enough to make firm recommendations on the effect of neutering or age at neutering on the risk of urinary incontinence.

Conclusion
The evidence for a causal relationship between neutering and
urinary incontinence is weak, although there is some evidence
of an association. There is some weak evidence that the risk of
urinary incontinence decreases as the age at spay increases, up to
12 months of age, after which there is no evidence of an effect
of age at spay. There was no direct evidence found in this review
that the occurrence or absence of oestrous before neutering plays
a role in the aetiology of urinary incontinence. This information
should be balanced with other available information on the risks
and benefits of neutering.
Further research on the association between urinary incontinence
and neutering should focus on recording age, breed and
tail docking as potential confounders. Occurrence of oestrous
before neutering should be recorded and studies should ideally
include dogs neutered at a wide range of ages. In addition, a reliable
definition of urinary incontinence should be used, and it
should be shown that dogs considered

[handydandyjake]

Interesting take on the issue, but the fact that only seven studies worldwide were assessed is pretty discrediting, given all the work that’s been done to try and figure out why the frequency of urinary incontinence is so high in spayed bitches. Less than 1% of intact females are incontinent, whereas 20% of spayed dogs are incontinent (Arnold S, Hubler M, Reichler I, Urinary incontinence in spayed bitches: new insights to the pathophysiology and options for medical treatment, 2009). And this article is trying to argue against those numbers, given that the studies that generated these numbers weren’t even assessed in their meta-analysis?

I’m working on an alternative treatment for incontinence now for my grad thesis under the hypothesis that the permanently elevated levels of LH and FSH as a result of spaying is what can cause incontinence (normally, estrogen controls levels of these hormones, but no ovaries = no estrogen = these hormones get out of control). Receptors for both LH and FSH have been found in the urethral tract, indicating a relationship between the two, but there are obviously still a lot of unanswered questions that the answers aren’t available for (Why female dogs and not male dogs? Why only some females and not all? What about cats?). Regardless, I’m conducting clinical trials with a vaccine that drops LH and FSH levels and although it’s just getting started, I’ve had success with it. This combined with success from using DES treatment and GnRH analogues makes this article’s argument not very plausible.

[irkenequine]

TWENTY PERCENT? 2-0 percent? Is that ONE study’s number or is that the commonly accepted one? No, it can’t be/I can’t believe that. That number is not only incorrect in personal opinion / professional experience but just SHOCKING.

[diffuse01]

Well, here’s all I can say: I spayed my female at 5 months old, before her first heat. She developed incontinence starting at around 15 months.

Tried Proin with terrible results, will never give it (or recommend it) to ANY dog of mine! So we just manage it… it’s decreased dramatically since switching her to a raw diet, interestingly. She can go a few weeks with no accidents whatsoever, then out of the blue have them daily for a few days, multiple times. Very strange.

I do wish I would’ve waited longer to spay her, especially after hearing numerous stories of the same thing happening to others. I know quite a few spayed females with incontinence. I know NO intact females with the problem (I show dogs, so I know of quite a few intact females).

It’s definitely an interesting “issue”, and I wish there were more options for treatment.

[Equibrit]

It is splendidly vague. How can you say that they “refuted” anything ?

[wendy]

that doesn’t “refute” anything- it mostly says there is no evidence available, but what little evidence there is supports the idea that there is a link between spaying before age 1 year and incontinence.

Considering how many dogs are out there ready to be studied it’s rather shameful that there isn’t any better evidence.

[grayarabpony]

[QUOTE=Equibrit;6399424]
It is splendidly vague. How can you say that they “refuted” anything ?[/QUOTE]

:lol:

How long did they follow the dogs? Any comparison with dogs not spayed?

My own personal experience (which may be an outlier), is with our JRT who was spayed at 9 months and started developing bladder infections (with heavy drinking and incontinence) at age 10 years. Prion (?) had no effect, but a low dose of estrogen (half a human dose 2X/week) prevented further bladder infections. She lived 10 more years.

[handydandyjake]

[QUOTE=irkenequine;6399149]
TWENTY PERCENT? 2-0 percent? Is that ONE study’s number or is that the commonly accepted one? No, it can’t be/I can’t believe that. That number is not only incorrect in personal opinion / professional experience but just SHOCKING.[/QUOTE]

Google (or check google scholar) ‘incidence of urinary incontinence in dogs’ and take a look. Ranges vary, but the commonly accepted terminology that articles report is that up to 20% of females develop incontinence post-ovariohysterectomy. So I apologize for my first post being misleading - there is of course no concrete percentage of dogs that develop it, especially considering that some breeds seem more predisposed to it than others, but the ‘up to 20%’ is widely used, cited, and accepted in scientific literature.

I’m recruiting incontinent dogs locally for the vaccine trial because all visits for the dogs have to be conducted at the campus vet school. I am having absolutely no problem recruiting dogs to meet the sample size I want, and I could enroll more if my grant budget allowed for it. So based on my experience, the ‘up to 20%’ isn’t shocking at all to me.

[wendy]

the study cited by the OP is a systematic review- they don’t do a “new” study, instead they search for all prior studies done on the topic and try to report a “composite conclusion” across all of the available studies. One reason for doing this kind of review is to evaluate the strength of the evidence supporting an idea or treatment, and the other is to see if conclusions are replicated across studies- any single study can easily come to an erroneous conclusion.
Usually they have strict criteria for study inclusion for systematic reviews, such as only well-designed studies without serious flaws will be examined; they don’t examine every single thing ever written on the topic.

[Equibrit]

http://www.ncbi.nlm.nih.gov/pubmed/11787155

“At the time of the enquiry the average age of the bitches was 6.5 years, and the average age at the time of surgery was 7.1 months. Urinary incontinence after spaying occurred in 9.7% of bitches. This incidence is approximately half that of spaying after the first oestrus. Urinary incontinence affected 12.5% of bitches that were of a large body weight (> 20 kg body weight) and 5.1% of bitches that were of a small body weight (< 20 kg body weight).”

[irkenequine]

Only dog I’ve ever had develop spay incontinence in my life of dog ownership is my 10 year old female who was spayed at 6 after coming into a shelter. She’s a health nightmare all around and Proin fixed the problem immediately. Family’s dog spayed at 6 months began developing incontinence, went to the vet–it was a stone. Removed, off Proin, back to normal.

I do believe spay incontinence occurs. I don’t think its a mythical thing. But 20% just blows my mind. I wonder WHO is defining the word and on what grounds–and I say this NOT having google scholar’d it yet. I will read those studies later when I’m off work. But doing at a shelter that turned over 10+ female spay surgeries a day (at 25+ quick and ‘dirty’ (metaphorical) surgeries a day) at 16 weeks…I can count on my hand the number of dogs that were having issues when they came back at 6 months/year for HW tests, and I saw most come back for multiple years (shelter offered it free w/ adoption.) Knew of ONE in those years that the shelter had to put on Proin. Perhaps my social group and I have had a lucky life run, incontinence of any form has just never been a massive or discussed common issue. I would say just personally reflecting 1 out of every 40 puppies adopted, the new owner’s personal vet (one specific one in the area) would have to write slips to the shelter explaining that the dog’s proof of spay would not be in until after the first heat. At my 6 doctor surgery clinic, and my roommate’s 5 doctor GP, all of our vets are pro young spay. So I certainly operate in a biased region/crowd/education base. I am happy to learn and hear the other side.

Though just personally if I’m picking the lesser evils please, give me spay incontinence over the 25% risk of mammary cancer I’ll have for waiting until 2 to spay any day. My and my only opinion.

[Houndhill]

Handydandyjake, very cool you are doing this for your thesis. I hope you will “leak” (!) us some results!

I totally do think the spay incontinence is breed/age dependent. So many spayed IWs I know have this, and with such a large animal, you can imagine the “lakes” caused by the leaks.

That, plus the increased incidence of osteosarcoma (a truly horrible thing to have) and other problems in spayed bitches of this breed, has made it a difficult decision as to whether to spay my older girls to avoid pyometra, etc. So far, I have elected to keep them intact for their health. I just watch like a hawk for signs of pyometra at the appropriate times.

I think you just have to assess the risks for your particular animal. IWs are extremely prone to bone cancer, it is one of the breeds most affected, whereas pyometra and mammary tumors, not so much, and potentially treatable although surgery might then be necessary.

Glad you are doing this research, good for you! We can only base our decisions upon the information we have, and our interpretation of it.

[handydandyjake]

I say this with nothing to back me up on it, but what I’ve noticed from my subset of animals and the people I’ve talked to around the state of Oregon is that incontinence seems to be more prevalent amongst purebreds than mutts, and I wonder if ‘hybrid vigor,’ if you will, does play a role as to whether a dog is destined for urinary incontinence or not, similar to the concept that dogs greater than 20kg are far more likely to be incontinent than dogs under 20kg.

Also, I just don’t know if incontinence is really linked to early spay. So many studies out there on the topic are in disagreement. Based on the philosophy behind my research project, age of spay theoretically doesn’t matter because LH and FSH are going to be sky-high post-spay regardless. Once I finish my data collection, I will be looking into whether age of spay is a factor since that is such a hot debate. Right now, the dogs I have enrolled have been all over the map as far as age of spay so I honestly don’t expect to see any correlations.

[handydandyjake]

[QUOTE=Houndhill;6399915]
Handydandyjake, very cool you are doing this for your thesis. I hope you will “leak” (!) us some results![/QUOTE]

Based on what I have so far, I’m expecting a 75-85% success rate with the vaccine I’m using (hope I didn’t just jinx myself, ha!). No treatment is always a perfect success, but my goal here is to provide a WAY safer, easier, and less expensive option that would be a far better first choice of treatment compared to Proin. I won’t have my work completed until winter-ish, but I’ll keep you all updated

[Houndhill]

Whether it is because IWs are large/giant or because they lack “Hybrid vigor”, they are certainly very prone to spayed bitch incontinence. Like you, I am not sure if the age at which they are spayed matters much, from what I have experienced personally and have known so many over the years. My bitches generally remain intact because they are shown in AKC conformation, and may be bred (or not).

The same factors (large/giant adult size, lack of hybrid vigor) that predispose IWs to spayed bitch incontinence may also predispose them to osteosarcoma. Additionally, their rapid growth rate may also contribute to their predisposition to osteosarcoma.

I do think their reproductive hormones are important to maintain for their health, if possible, and perhaps more so than in smaller/mixed breeds.

Anyway, again, kudos to you for doing this research.

[Houndhill]

Handydandyjake, do you think your vaccine would also be protective against the increased risk of osteosarcoma?

I would be much more likely to spay my bitches past breeding age, if so. I would get the gastropexy at the same time, and have two less things to worry about!

[TrotTrotPumpkn]

In my family’s small sample size it was 1/2. One doberman (mine) incontinent at 5 years. She suffered multiple and frequent bladder infections post spaying (not sure it is related) as well. She was either 4 or 6 months old when we spayed her…I can’t remember. My American Water Spaniel did not have issues, and lived into her mid-teens. My uncle had two female boxers and one became incontinent. All of these were spayed before a heat cycle.

So it feels to me like it is very common.

My dog does pretty well on one pill of Propalin (not sure if this is the same drug as others have mentioned) per day. [Looked it up it is Proin] We cannot miss once, however. She also sometimes has some residual dribbling issues, but the incontinence is different. She will pee and not even realize it until she wakes up or gets all embarrassed about it. She REALLY does not want to pee-herself.

Sorry for the novel. This is a really big issue in my life–managing a 73 lb incontinent dog who is only 6.

[Bluey]

Every one female dog we have had over the past 40 years, there have been a good dozen, have been spayed before 7 months old, but one that was at 6 years old.
That is from toy poodles to dobies, a rottie and saint bernard and assorted breeds and sizes inbetween.

We never had not one become incontinent, but all have been active farm and competition dogs, even the toy poodles.

Maybe exercise has something to do also?
Maybe we have been just lucky?

I know a few in our dog club with that problem, but very few.
Without data, I don’t know what % are spayed or when or what % is incontinent.

Let us know what your results seem to be.:yes:

[Simkie]

This is a very interesting discussion. I have thankfully never had a bitch with incontinence, but we generally spay late (if at all) because we show. My pet girl was spayed after her first heat only because we didn’t get around to it earlier and don’t find girls in heat to be a big deal.

If it is hormone related, perhaps the answer is to remove the uterus but leave the ovaries? That would remove the pregnancy risk and the in heat bleeding. I imagine the behavioral aspects of coming into heat would persist.

[supaflyskye]

hm.
My mutt was spayed at 6 months, and starting only a few weeks after that she started peeing in her sleep. She’s almost 18 months old now and still does it very occasionally(it’s happened maybe 5 or 6 times?). She always acts extremely upset when she notices it, so I don’t make a big deal about it and just try to make sure she goes out as much as possible.
I figured it was an effect from spaying, since she never once peed in her sleep during her first 6 months of life. It’s not too disruptive though, at least not at this point.