UTI’s that keep returning
When frequent bladder infection (UTI) occurs, it’s time to work with your vet. This article ranges in ideas for at home to strategies for vet discussions.
The information on this page was reviewed for correct medical information
by Dr. Natasha Olby Vet MB, PhD, MRCVS, DACVIM (Neurology)
Bladder bugs the good and the bad
Good bugs and bad bugs are all around us. Bugs live on the surfaces of objects, in our noses, inside our bodies. When the bad bugs (bacteria) out number the good, infection erupts. The bladder stays the healthiest when urine is regularly released so the bad bacteria can’t breed to reach an infectious level. Urinary tract infection (UTI) can occur when first learning how to fully express a paralyzed dog’s bladder. The urinalysis is a screening test to identify if an infection is present. This screening test does not identify the exact problem bacteria. Quite often a couple of weeks on a broad spectrum antibiotic targeting several kinds of bacteria will resolve the infection.
Why UTIs can come back
So why do some dogs keep having frequent bladder infection (UTI)? There may be a missed underlying cause such as stones, diabetes or a tumor. When a relapse happens weeks after stopping of the antibiotic, a new approach is needed to detect the problem and implement treatment. The same bacterium may be the culprit in the repeat UTI because the wrong antibiotic, the dose and length of use were not correct. A clone of the original bacterium with a different requirement to kill it is needed. A reinfected bladder may mean an altogether different bacterium is involved. For example, introduction of new bacteria could have happened during a cathing procedure. Often the case is the original bladder infection was due to multiple bacteria strains. One or more may not have been a match for the selected antibiotic and they survived to multiply.
Super imposed bladder graphic: reprinted with permission by the copyright owner, Hill’s Pet Nutrition, from the Atlas of Veterinary Clinical Anatomy.
Black/white pencil sketch: Canine Intervertebral Disc Disease. by Patricia Luttgen, DVM, ACVIM (Neurology). Ann Blackstone illustrator. 1993. p4.
Harmless strains of E. coli are part of the natural make up of intestines and provide a benefit of producing vitamin K2. Other strains can cause urinary tract infection. A strain is a genetic subtype of a micro-organism. A strain can have unique characteristics that may for example have the ability to resist certain antibiotics.
- THINGS YOU CAN DISCUSS WITH YOUR VET
It is near impossible to collect urine at home without contamination with a mid-stream catch with short-legged dogs. With persistent UTI’s the better idea is cystocentesis. A needle is inserted directly into the bladder avoiding any contamination. The most accurate urinalysis results are derived from a quick analysis not more than 60 minutes after collection.
Urinalysis vs. Urine Culture and Sensitivity Test
A urinalysis is often done in 30-40 mins in the vet clinic giving the vet information about presence of bacteria and the need for antibiotics. What a urinalysis does not reveal is which bacteria are present and which antibiotic would actually target them. Often vets choose a shotgun approach with a broad spectrum antibiotic.
When there are frequent bladder infection UTI’s, it is time to take a sample to send out to a lab where the bacteria will be grown over the course of days and different antibiotics tested, a Urine Culture and Sensitivity Test. Resistant UTIs can be blamed on multiple species of bacteria growing in the bladder and some may be drug resistant explaining why they are so hard to treat and the need for a more involved treatment plan. One to two weeks after the course of antibiotics is completed, take another Urine Culture and Sensitivity Test to make sure the UTI is completely cleared up. More information to understand UTIs: http://www.marvistavet.com/urinary-tract-infection.pml
Do another urinalysis before the antibiotic is finished to know early on if the antibiotic is doing the job or not. Some recommend a urine culture 7-10 days from the start of the antibiotic to know if the antibiotic is the correct one. The antibiotic should clear up bacteria within the first 48 hours so by the last few days of the prescription the urine should show NO indication of infection. A repeat urine culture 2 to 3 days after the completion of antibiotic therapy as final proof all bacteria were killed.
With repeated UTIs a second opinion/consultation with a specialist in small animal internal medicine is warranted for their specialist training in a higher degree of tenacious detective work. The vet will review medication history for immune suppressive drugs like steroids. The specialist will want blood tests and also specific tests to rule out Cushing’s Disease. Give a hands on exam for abnormalities via a rectal exam such as enlarged prostate gland in male dogs or a infection in the sheath. For females, search for infection in the skin fold covering the vulva. Ultrasound to reveal stones, tumors, polyps. A last step may be a urethogram or pyelogram with xrays or CT to look at the sections of urinary tract that is not shown with ultrasound. Find a specialist: http://find.vetspecialists.com/
Using an antibiotic as a prophylactic
If the UTI will not clear up or keeps recurring, it is time for a discussion with your vet on whether it is appropriate to use low dose long term antibiotic therapy. Another option is the full dose that is a correctly matched antibiotic as a pulse therapy one week each month in conjunction with periodic urine cultures. Dr. Natasha Olby Vet MB, PhD DACVIM (Neurology) at NCU reports with the tough continuing infections, the infection is treated with an appropriate specific antibiotic and dose.
At the completion of the two-week antibiotic course, a low antibiotic dose given at night would be continued ad infinitum.
If a UTI is present when dietary treatment starts, the antibiotic should be continued throughout treatment. Dissolving stones may release more bacteria. Choice of antibiotic should be based on the results of urine culture and sensitivity test. Grauer, Gregory. Struvite Urolithiasis http://files.brief.vet/migration/article/18801/struvite-urolithiasis-18801-article.pdf
- THINGS YOU CAN DO AT HOME
Keep water available at all times. If feeding dry kibble, reconstitute it by soaking overnight in the fridge. Use equal parts liquid as kibble for each soaked meal. Water in-take is a total of moisture in food and what the dog drinks on their own. Dogs normally take in about 20 to 40 milliliters per pound of body weight per day or about 3 to 4 cups of water per day for a 20 pound dog. Water intake is also dependent on the activity level of the dog and how hot the weather is. Cool weather and sleeping longer would make a dog less thirsty. Because the Dachshund breed has a high incidence of heart problems avoid pushing fluids by tempting with low fat/low salt broths unless specifically directed by your vet.
The longer urine stays in the bladder the more chance for bacteria to grow and multiply. Consider a regular schedule of expressing or letting the dog outside to potty every 4-6 hours during the day.
There may be obvious indicators of UTIs such as foul odor to the urine, bloody urine, pain and increased frequency of urination. However, not all UTI’s will show observable signs. In general pH testing is not followed as an indicator for UTIs.
Wiping in the wrong direction can place bacteria nearer the entrance of the urethra making female dogs more susceptible to infections. There is a question if use of anti-bacteria wipes and their over killing of both the good and the bad bacteria is warranted. Thought is the immune system may become ineffective and contribute to the development of resistant bacteria. Clean your dog with simple non-scented baby wipes or soap and water cleansing if necessary.
Cranberry, probiotics and supplements will not get rid of an existing UTI. Supplements, however, “maybe might” help prevent bacteria adherence to the bladder wall if the cranberry product contains sufficient quantity of proanthocyanidin (PACs). Cranberry’s proanthocyanidin’s are known to only work with the strain of E. coli bacteria that makes velcro like fringe attachments to the bladder wall. Not all E. coli make a fringe. There are other bacteria that also cause UTIs. A good expressing technique and regular scheduled potty times will help to contribute to a healthy bladder. NOTE: A complete and well designed clinical trial study is needed to scientifically verify the question of whether cranberry is a wise expenditure of consumer’s money vs. popular beliefs.
Four Protective garment
Bacteria have a very short pathway into the bladder when scooting on the floor or sitting on the ground especially for females. Butt protection “panties” can help keep this area clean. Click the graphic to learn more about the 4 DIY protective garment.
Support Group and internet information
When looking for internet information, it is important to qualify the source so that you are not reading urban myths and incorrect information. Look for websites or groups associated with creditable entities. There is a lot of good information on the internet just be careful in selecting your source of information. Check for support groups on Yahoo. Often pet parents dealing with recurrent UTIs can give you good support and home care tips. You might find UTI discussions in a group dedicated to a disease such as Cushings.
- ADDITIONAL READINGS
Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease Antimicrobial Use Guidelines for Treatment of Urinary Tract Disease http://www.hindawi.com/journals/vmi/2011/263768/
Hot Literature: Antibiotic guidelines for dogs and cats with urinary tract disease
Bacterial Urinary Tract Infections http://www.merckmanuals.com/vet/pharmacology/systemic_pharmacotherapeutics_of_the_urinary_system/bacterial_urinary_tract_infections.html
Larry G. Adams, DVM, PhD, DACVIM. Diagnosing and managing recurrent urinary tract infections (Proceedings). October 31, 2010
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