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  Discussion on Overfilled Bladder - Poor Bladder Tone
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Member:
Lccsi

Posted on Wednesday, Nov 9, 2005 - 6:42 am:

My horse started straining to urinate before I rode him. He would camp out and it could take up to 45 minutes for him to go.. Then under saddle he would start stopping and camping out again. Took him to the vet who said that the bladder was overfull and had poor tone.. It was so overful that the broad ligaments were painful to touch and the bladder almost had a heart shape. They manually fully emptied his bladder and everything came out.. ruling out sludge in the bladder.. He is going to start on Bethanacol to help the bladder contract when he goes.. I have'nt seen this topic covered elsewhere. Anyone have any experience with this..?? I was told causes can be mechanical or neurological disfunction of the bladder muscle.. Any info would be great.
Moderator:
DrO

Posted on Wednesday, Nov 9, 2005 - 10:33 am:

Hello Lori,
Urination problems are difficult for a number of reasons. One reason is that urination is such a complicated process. A complicated mixture of autonomic and voluntary muscle controls on bladder wall muscle and sphincter tone combine to make both localization for a diagnosis and treatment a hit or miss affair. That said, most treatable causes can be addressed with a simple regimen.

The single most important first step is rule out any primary disease entities that may have urinary incontinence as a secondary problem. A complete and thorough physical and neurological exam with an emphasis on evaluating the nerves to the rear of the horse is important. Any primary disease found needs to be treated if possible and will help with the prognosis.

Your veterinarians findings do seem consistent with bladder wall (detrusor) muscle atony and makes bethanechol part of a logical specific treatment. Bethanechol is a muscarinic receptor agonist and its effects on increasing bladder wall tone well known. I would also consider the use of phenoxybenzamine which will help reduce the resistance by the sphincter.

Bethanechol will also increase bowel motility which may cause changes in the stool character but it is uncertain whether this increase activity will cause diarrhea.
DrO
Member:
Lccsi

Posted on Wednesday, Nov 16, 2005 - 6:59 am:

Hi Dr. O. I have a call out to my vet but maybe you can answer a few questions as well. How long will it take to see the effect of the Bethanechol? Also should we wait before introducing the phenoxybenzamine or do the meds go together. My horse is now basically unrideable and where he used to urinate before riding is now just camping out with no progress.. he barely DrOps and does not go. His stall appears to be wet as usual and we never see him straining in the field. But it is obvious that with the additional pressure under saddle he is very very uncomfortable so I am assuming his bladder continues to be over full and although he is going he is not fully emptying. What is the long term prognosis for horses with this type of problem? Also do you know of any regional medical facilities (we are in New Jersey) that might have specialist's for this.
Thx
Moderator:
DrO

Posted on Wednesday, Nov 16, 2005 - 5:39 pm:

I would expect results within a day of beginning treatment Lori. If you have not seen effects by now try running them together. Unfortunately treatment is trial and error and because we cannot see the problem you can't really prognose it. Response to treatment is a good sign and those that don't usually develop permanent detrusor atony. I would not use the response under saddle as a diagnostic criteria and the fact you are finding wet spots without constant dribbling is an encouraging sign after all you don't know if he is urinating well or not. I would get a referral to the closest University with a Veterinary School.
DrO
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