Post-surgery incontinence is likely bladder atony, not nerve damage from the procedure.
Bladder infections are common after surgery since the wider urethra allows easier bacterial entry.
Wendy posted the following question as a comment on my blog post about perineal urethrostomy, which I thought was worthy of a blog post all of its own:
Question:
Has anyone else had issues with incontinence after the surgery? My cat Henry had the procedure done almost one year ago. Everything was going great until this last month...No matter where he sits or lies, he leaks urine. I love my cat and I am heartbroken that this is happening to him. I have heard that in rare cases there can be permanent nerve damage during the procedure, but why would it have just started? Any advice?
Veterinarian Response:
You can see incontinence in this situation occasionally but it probably is not nerve damage from the surgery; more likely a result of bladder atony. The sphincter of the urethra is at the base of the bladder, not at the end of the urethra. When cats get "blocked" he is not able to urinate and the bladder gets distended. The muscles in the bladder wall that are responsible for constricting the bladder are stretched and are not able to work as well. This is called bladder atony. When the bladder becomes full enough, the pressure within the bladder overcomes the urethra and he dribbles.
Have Wendy ask her vet about two drugs that can help in some cases, phenoxybenzamine and bethanechol. The phenoxybenzamine will help decrease the urethral tone and the bethanechol helps the bladder muscle contract. I would also look to see if there are no strictures in the urethra.
Lastly, bladder infections are common after PU surgeries since the urethra is wider and bacteria can get in the bladder easier. This is the same reason bladder infection is more common is female cats as compared to males. So I would check a urinalysis and do a culture of the urine.
Perineal Urethrostomy, Incontinence, and Bladder Atony Questions
Incontinence after perineal urethrostomy surgery is typically caused by bladder atony rather than nerve damage. When cats become blocked before surgery, their bladder becomes distended and the bladder wall muscles stretch, making them unable to contract properly. This condition means the bladder cannot empty completely, and when it becomes full enough, pressure overcomes the urethra causing urine to dribble out. Your veterinarian can evaluate your cat's specific situation and recommend appropriate treatment options.
Incontinence problems can develop months after perineal urethrostomy surgery, as demonstrated by cases where cats experience issues nearly a year post-surgery. The timing often relates to bladder atony, where stretched bladder muscles from pre-surgical blockages gradually lose their ability to function properly. If your cat develops incontinence after PU surgery, even if it's been months since the procedure, contact your veterinarian promptly for evaluation and potential treatment options.
Two medications that may help with bladder atony after perineal urethrostomy are phenoxybenzamine and bethanechol. Phenoxybenzamine helps decrease urethral tone, while bethanechol assists the bladder muscle in contracting more effectively. These medications work together to improve bladder function and reduce incontinence issues. However, these treatments require veterinary prescription and monitoring, so discuss these options with your veterinarian to determine if they're appropriate for your cat's specific condition.
Yes, bladder infections are more common after perineal urethrostomy surgery because the procedure creates a wider urethra, making it easier for bacteria to enter the bladder. This is similar to why female cats typically experience more bladder infections than males due to their shorter, wider urethras. If your cat shows signs of incontinence after PU surgery, your veterinarian should perform a urinalysis and urine culture to check for infection, as treating any underlying infection is important for overall bladder health.
Bladder atony occurs when the muscles in the bladder wall become stretched and lose their ability to contract properly. This typically happens after cats experience urethral blockages, where the inability to urinate causes the bladder to become severely distended. The stretched muscles cannot work effectively to empty the bladder completely. When the bladder becomes full, pressure overcomes the urethra and causes urine dribbling. This condition can persist even after successful perineal urethrostomy surgery and may require ongoing medical management.
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