Urinary Incontinence in Dogs

Unfortunately some dogs are prone to bladder leakage or not being able to hold their bladder for long periods of time. This is called urinary incontinence. Large breed, female dogs are especially likely to experience urinary incontinence after being spayed because they no longer produce certain hormones. Some male dogs can also develop urinary incontinence; it’s just not as likely. There are a few treatment options available for your pet, but unfortunately the availability of some through VetRxDirect is changing. Please read further about this recent issue and the other possible treatments for urinary incontinence in dogs.

Hormone-dependent urinary incontinence in female dogs:

The urinary sphincter is a part of a dog’s urinary tract and tightens to form a closure when a dog is not urinating. This is what makes a dog able to hold their bladder and to not have any leakage. Spaying a female dog means removing their ovaries and most likely their uterus too. These organs are responsible for producing estrogen and progestin hormones. Sometimes, this decrease in estrogen over time can cause a female dog to become incontinent, or not be able to fully close their urinary sphincter. There are also instances where intact (not spayed) female dogs can experience urinary incontinence related to a decline in estrogen with age.

Hormone-dependent urinary incontinence in male dogs:

Male dogs may also develop urinary incontinence, and it can be caused by being neutered. The neutering process involves removing the testicles, which are responsible for producing the male hormone, testosterone. Testosterone, like estrogen, helps control the urinary sphincter and provides the dog with bladder control. Just like female dogs, male dogs who are not neutered may also develop urinary incontinence due to a decline in testosterone.

Treatment for urinary incontinence in dogs:

There are many other causes of urinary incontinence in dogs, ranging from nerve-related, physical abnormalities, and urinary tract infections. This is why it is important to go through all testing for your dog to find the cause of their urinary incontinence. For dogs with hormone-dependent urinary incontinence, the treatment options can be broken down into two categories: hormone replacement and adrenergic agonists. Below is a short list of possible treatment options for urinary incontinence in dogs, but it does not include all possible treatment options. Each dog requires a specific therapy determined by your dog’s veterinarian.

Male Hormone Replacement: Testosterone shots are a possible treatment for male dogs with urinary incontinence. Testosterone will cause the urinary sphincter to tighten and regain control again. Testosterone shots are usually given through your veterinarian, and they are not available through VetRxDirect.

Incurin (estriol) for urinary incontinence in dogs

Incurin is Available at VetRxDirect Pet Pharmacy

Female Hormone Replacement: Female dogs have two options for hormone replacement: estriol and diethylstilbestrol. Incurin is the brand name product for estriol for dogs, available through VetRxDirect, and it is given to replace estrogen levels. Diethylstilbestrol, commonly known as DES, is a synthetic drug which mimics the body’s natural estrogen, estradiol. There are no manufactured products containing DES, but it is compounded by pharmacies, including VetRxDirect. Diethylstilbestrol is usually given daily for 7-10 days and then reduced to a weekly dose. Both Incurin and DES work by acting as estrogen on the urinary sphincter, causing it to tighten and regain control over urination.

Adrenergic Agonists: Adrenergic agonists can be effective for both male and female dogs. Adrenergic agonists resemble epinephrine or adrenaline and cause the urinary sphincter to tighten, preventing leakage and controlling the bladder. There are several adrenergic agonist drugs available but only phenylpropanolamine has a veterinary approved product, called Proin.

Others: There are many other possible treatments for urinary incontinence due to non-hormonal causes. Your veterinarian will best know which medication is right for your dog based on the cause and potential side effects.

VetRxDirect’s discontinuation of Proin sales:

Phenylpropanolamine, the active ingredient in Proin, can be a precursor to methamphetamine production, so it’s sales and use are controlled under the Combat Methamphetamine Epidemic Act of 2005. Most regulatory bodies have tightened the control over the sales of Proin over the years because of its use to create meth. Due to continual changes in state reporting and monitoring of controlled substances, such as Proin, VetRxDirect has made the difficult choice to discontinue selling Proin. The decision was made by weighing the risks versus the benefits of selling Proin. VetRxDirect would like to support the Combat Methamphetamine Epidemic Act of 2005 in reducing the availability of methamphetamine ingredients in the United States to decrease drug addiction and abuse. This decision unfortunately affects our dedicated customers who have purchased Proin and seen benefits in their dog; however, Proin may still be purchased from licensed veterinarians. VetRxDirect has other treatment options to consider as listed above. We apologize for any inconvenience this decision may cause, and we hope to be a continued trusted source for your pet’s medications.

VetRxDirect is a PCAB Accredited Compounding Pet Pharmacy

VetRxDirect’s compounding pharmacy is proud to hold the Pharmacy Compounding Accreditation Board’s Seal of Accreditation.

Pharmacy Compounding Accreditation Board's Seal of Accreditation

VetRxDirect is an Accredited Pet Pharmacy

While all compounding pharmacies are required to meet the requirements set by their respective state boards of pharmacy, PCAB Accredited™ denotes a more stringent and comprehensive standard which serves as an assurance that our compounding pharmacy has been tested against the profession’s most rigorous standards.

PCAB Accreditation requires a pharmacy:

  • Agree to the PCAB rules and terms of accreditation.
  • Abide by the PCAB Principles of Compounding.
  • Meet or exceed all PCAB quality standards.
  • Pass an extensive on-site inspection.
  • Use only high quality chemicals and equipment.
  • Ensure that compounding pharmacists and technicians receive continuing education and training in compounding.
  • Employ a system of continuous quality improvement.

PCAB criteria was established by a Standards Committee of compounding pharmacists and nationally-recognized experts in the compounding pharmacy profession.

To earn our designation as a  PCAB Accredited™ compounding pharmacy, VetRxDirect completed an extensive application and submission process, documenting our education, training, licensures, policies and procedures. Our documentation was reviewed by PCAB. Next, we had to pass an extensive on-site inspection. Only when this stringent evaluation was completed and we were judged to have met all criteria, did the PCAB officially grant us the PCAB Seal of Accreditation.

VetRxDirect is honored to receive the PCAB Seal of Accreditation. We feel it confirms our commitment to providing safe, personalized solutions that meet the medical needs of the pets we serve.

You can find more information on specific drugs by visiting VetRxDirect, or by reading our blog posts on Cisapride or Urinary Incontinence which includes information on DES.

VetRxDirect looks forward to helping you obtain needed medications for your pet, whatever the form.

Thank you,


Incurin: New FDA Approved Drug for Urinary Incontinence

Veterinarians know urinary incontinence or involuntary urine leakage is a common problem encountered in dogs. You may notice incontinence occurring at routine times, including when your dog is sleeping, or at less predictable times up to several times per day.

You should be aware of several potential causes to this problem. Questions regarding the timing and age of onset of the incontinence will help your pet’s veterinarian determine if the condition may have existed prior to or shortly after birth, shortly after being spayed, or if another reason is causing the incontinence. A thorough physical evaluation by the veterinarian may be necessary to determine proper treatment.

Urine leakage in spayed, older female dogs may commonly be attributed to urethral sphincter incontinence. This condition will usually start months to years after being spayed. The goal of drug treatment is to increase the urethral tone and continence. Estrogens and alpha-adrenergic agonists are the two drug classes identified to help increase urethral sphincter tone.

Proin, PPA Available at VetRxDirect

Proin, PPA for Urinary Incontinence in Spayed Dogs

The alpha-adrenergic agonist, phenylpropanolamine, also known as PPA (Proin, Propalin), is a commonly prescribed treatment option for urethral incontinence. Side effects of phenylpropanolamine may include restlessness, irritability, panting, excitability and increased blood pressure.  Phenylpropanolamine should not be used in dogs with pre-existing high blood pressure. Phenylpropanolamine may be prescribed alone or in combination with estrogen therapy.  The combination treatment is believed to provide a synergistic effect, meaning the combination may be more effective than either drug alone.

Estrogen therapy may also be considered for dogs who do not tolerate phenylpropanolamine. Many veterinarians are familiar with the estrogen product called diethylstilbestrol, also referred to as DES. Diethylstilbestrol is no longer made by a drug manufacturer and must be obtained through a compounding pharmacy like VetRxDirect. Diethylstilbestrol usually starts with a loading phase including five to seven days of daily treatment. In most cases, one to two doses per week are given thereafter.


Incurin: The newest drug for urinary incontinence in spayed female dogs.

A new FDA approved, veterinary-labeled, estrogen treatment option named Incurin (estriol) has recently been introduced. Incurin is made by Merck Animal Health and is available in a 1 mg estriol (sometimes referred to as oestriol) tablet. Incurin is indicated for the treatment of urinary incontinence due to sphincter mechanism incontinence (SMI) in spayed female dogs. Treatment is recommended to be started at one tablet per day for 7 to 14 days. If treatment is effective, your veterinarian may reduce this to the lowest effective dose. Always consult with your veterinarian before adjusting any medications’ dosing or frequency.

Incurin is not for use in male dogs and should not be used during pregnancy or lactation. Possible side effects have included signs of estrus (in heat), swollen vulva/teats and nausea. Rare side effects may include vaginal bleeding and hair loss. You should consult your veterinarian if you notice any side effects and keep all follow-up appointments.

If you have any questions regarding your pet’s incontinence, contact your veterinarian to schedule an appointment. If you or your pet’s veterinarian have questions about either of the drugs reviewed in this post, give us call. We here to answer any questions you have.

Shawn Roe, PharmD

Pharmacist, VetRxDirect