‘Congenital’ means that you are born with the condition, and ‘urinary incontinence’ is the unintentional passing of urine. Congenital urinary incontinence in dogs is a result of a problem during foetal development anywhere along the urinary tract; in the kidneys, the ureters (the tubes which connect each kidney to the bladder), the bladder, or the urethra (the tube which carries urine from the bladder to the outside). Congenital urinary incontinence in dogs is rare, but the most common cause is ectopic ureters. Urinary incontinence can also develop later in life, but this will be due to a different set of causes. 

So, that puppy who you can’t manage to house train properly, who’s continuously having frustrating accidents in the house or bed wetting…… speak to your vet as there may be an underlying medical reason for this.

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Causes of congenital urinary incontinence

Ectopic ureters

The most common cause of canine congenital urinary incontinence is ectopic ureters. Instead of emptying into the bladder, they bypass it, emptying directly into the urethra or vagina (in females). The bladder therefore doesn’t fill with urine like normal, and the urine drains straight from the kidneys to the outside, which is seen as urine ‘dribbling’, or incontinence. 

Female dogs are far more commonly affected than males, and you will typically see signs of an ectopic ureter in dogs between 3-6 months old (i.e. when house training is attempted, and futile!). 

Signs of an ectopic ureter include:
  • Urine ‘dribbling’ – you might notice urine dripping from your dog as they walk around, completely unaware, or wet patches left where they have been lying. 
  • Difficulty with house-training – these dogs may well go outside for intentional wees sometimes, and you think you’re making progress, then frustratingly you may notice a wet bed or urine drips on the floor. It’s really important not to tell them off; they genuinely can’t help it!
  • Urine staining / scalding – due to the continuous dribbling, the urine will cause a persistent wetness at the genitals. Over time, this will cause redness and discomfort of the skin and can stain the fur a yellow colour.
  • Licking of the genitals – although these dogs cannot help the urine dribbling, they may be aware that they are wet and try to clean themselves up by licking. If the skin becomes sore from urine scalding, the licking may become more excessive. 
  • Being unable to urinate properly at all – if both ureters are affected, the bladder will never fill with urine as it should, and the dog may never urinate normally. A dog with only one ectopic ureter will still have some bladder filling from the normal ureter and will urinate properly sometimes, as well as dribbling urine between times. 
  • Urinary tract infection (UTIs) – dogs with ectopic ureters seem more prone to getting UTIs. This may be seen as blood-tinged urine, or pain during urination. 

Bladder problems

As a foetus inside the mother, there is a tube called the urachus connecting the bladder to the umbilical cord. This normally shuts off before birth, but if the connection persists (a persistent urachus), urine can continue to drain from the bladder out of the umbilicus (i.e. the belly button, after birth). The signs will be very similar to those of an ectopic ureter, except the urine dribbling will be from the umbilicus, not the penis or vulva.

Urethral problems

These are very rare. A condition in male dogs called hypospadias results in the urethra opening before the tip of the penis; meaning urine dribbles out from somewhere along the length of the penis, rather than from the end of it.

A urethro-rectal fistula results in urine dribbling out of the anus, due to a connection between the urethra and the rectum. As well as the urinary incontinence, these dogs will be very prone to UTIs because bacteria from the rectum can easily pass into the bladder. 

Kidney problems

If the kidneys don’t develop correctly, this may lead to kidney failure. If severely affected, the puppy may only survive a few days after birth; but signs usually become apparent in the first few months or years of life. The first signs will usually be stunted growth, low energy, and your dog drinking and urinating excessively. The veterinary term for this is polyuria polydipsia (or PUPD), and it can easily be mistaken for urinary incontinence. They drink so much they can’t hold their bladder for long so have accidents in the house / bed wet, as opposed to true urinary incontinence where urine dribbles out unconsciously. 

What will your vet do?

In a very young dog with urine leaking, your vet will initially take a thorough history of the signs and symptoms noticed at home, do a clinical exam of your dog, and request a urine sample. These should differentiate PUPD from true incontinence. It’s very important to do this as the list of possible causes will be very different for each. A blood test will check the function of the kidneys and abdominal x-rays and ultrasound may be advised too. 

For a definitive diagnosis, a contrast study (using a dye to highlight the urine flow along the whole urinary tract to pick up any abnormalities), or cystoscopy (a tiny camera inserted up the urethra and into the bladder) will be needed. 

What’s the prognosis?

This will, of course, depend on the underlying cause. Kidney failure carries a poor prognosis. The signs are managed with diet and medication until quality-of-life declines and euthanasia is usually required. For ectopic ureters and the other causes of true congenital incontinence, surgery is often the answer to correct the abnormality. This surgery is complex and will be best done in the hands of a specialist soft tissue surgeon; if your local vet cannot perform the surgery (you wouldn’t expect your GP to perform a similar surgery on you!) they are likely to recommend referral to a specialist surgeon. Unfortunately, a high percentage of dogs (20-70%, depending on the study) will continue to have persistent urinary incontinence following surgery, so ongoing management may be necessary.

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