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Discussion on Loss of sphincter tone in young mare
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Posted on Wednesday, Sep 6, 2000 - 1:12 pm:
a 5 year old rescued thoroughbred mare we have suffers from uncontrolable urination as tho she cannot feel the sensation of urination. she dribbles and has urine scald on her rear legs as well as having some, (we have improved it greatly) muscle atrophy in her rear end.. she also suffers from a sore spot on her saccreal region of her spine , is it possible all of these may be linked? she tested negative for DrOpped bladder, bladder calucli , equine herpes virus, but was positive for a bladder cystitis, which we are treating aggressivly.. can phenylproplamine be used in horses? and if her current weight is 1033 lbs by weight tape what dose would she be closest to ? feline doses? or canid? how is equine chiropractic treatment viewed? anyone have any success with it ? everyone calls me crazy for saving this poor girl, but i cannot help but think she can be helped... we put 250lbs on her , and her attitude has gone way up, she is happy and regaining some semblance of the expected attitude of a 5 year old thoroughbred... the stories we were told as to how she began her urination was that she "tied up " on the track... can tieing up cause this? and how much help at her age is pasture rest? we have noticed lately she flaggs her tail and has begun to actually "push" urine out , but only after she dribbles a little first... this is a 3 month long question for us... and she was ill for almost a year b4 we got her... any help would be so so appreciated ... thank you Melissa
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Posted on Wednesday, Sep 6, 2000 - 4:00 pm:
I can't help you at all with veterinary advice, obviously, but I just want to say how I admire you for taking this mare and trying to help her. I thank all large and small gods for people like you. I'm sure Dr. O will give you valuable advice - and pasture rest, lots of loving care and attention, good food, etc. etc. will make all the difference over and above her veterinary treatments. I will be very interested to read Dr. O's replies to your questions, and hope to hear how she is doing.
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Posted on Wednesday, Sep 6, 2000 - 6:23 pm:
Hi Melissa,
I'm not sure if this helps but many years ago there was a mare at the barn who did the same things. Apparrently she had a chronic inflammation (possible infection) of the urinary tract. Have you ruled out an infection of some sort?
TeresaA
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Posted on Wednesday, Sep 6, 2000 - 10:23 pm:
we know she suffered from a prolonged bladder infection (cystitis) which we have had treated with IV gentamyacin I believe it was and was also told it was a gram negative bacteria.. I work for a small animal vet, my best friend is also a vet, feline, and this mare is under the care of my equine vet and he just is under a wait and see attitude... personally ? I dont think he has ever seen this before as initially he said he believed it to be EHV... she was negative for that.. then he said DrOpped bladder, her bladder is not DrOpped, then he said , bladder paralysis, it is not paralyzed as it still has tone , and he now just shruggs , and says in 3 month intervals we will re-treat for the infection which he says is sure to reoccour... at her arrival , her vagina was seated at a marked 90 degree angle, causing feces to even DrOp onto it... now, with muscle tone and weight she is back to a completely vertical line... she was tested for a CBC, complete urinalysis, Kidney values were checked as well as thyroid , she was also checked for a uterine culture , thyroid values suggested a need for T4 supplimentation, her kidney values were normal, she was anemic, uterine culture came back positive for abnormal bacterial growth which we have also since treated , we were origionally concerned with myoglobin damaging the kidneys but there was no sign of that.. the cystitis would inflame the urinary tract but so far we have ruled out a catheter, as it isnt emptying that is her problem... it is filling... the mare never feels as tho she has a full bladder since she dribbles... so she never tries to urinate.. also ... anyone who might know of a way to buy desitin by the pound or gallon .... please let me know  Melissa ps... this mare had come to my attention 4x before she ended up here... once i had been asked to help train her, then to help sell her , then to do both, then just house her until she was sold... the first 3x I refused, she had too many problems.. the fourth I was asked to board her as she was unloaded... My heart went out to her... and felt there had to be a reason I could not yet see as to why she kept being put under my face... then As we paid for her and i took all her paperwork to my house ... i read her registered name... "Trust and Obey" ... so from all this she recieved the stable name "Hope" ... I can use all the help and advice for her I can get.. but she is i firmly believe in other hands than mine as well....
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Posted on Thursday, Sep 7, 2000 - 7:03 am:
The stories we were told as to how she began her
urination was that she "tied up " on the track... can tieing up cause this?
No though tieng up has the potential to damage the kidneys, it should not effect bladder control.
How much help at her age is pasture rest?
Help with what?
Several years I was asked to consult on a mare with loss of control of urination and I have always meant to write it up as an article, let me see if I can find those notes. This can be complicated problems with several possible causes that are difficult to treat. I will post it here.
DrO
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Posted on Thursday, Sep 7, 2000 - 9:38 am:
Dear Melissa,
Re: your search for Desitin &/or other med supplies in bulk - I once had to nurse a horse thru a hoof resection requiring gallons of pure tincture of iodine (usually sold in 1/2-ounce bottles), as well cases of Elastikon bandage and duct tape. Here are some successful sources I utilized for bulk supplies:
1. Write, call or e-mail the mfr - in your case Pfizer Corp. NY, NY who may be able to help you out with caseloads of their product.
2. Check local hospitals - mine graciously sold me several gallons of iodine from their supply when I needed it.
3. Any local pharmacy should be able to order any over-the-counter product in bulk for you.
4. Try both hospital and veterinary supply companies.
Good luck w/ your mare - my heart goes out to your concentrated nursing efforts.
Bonnie
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Posted on Thursday, Sep 7, 2000 - 10:07 am:
It's heartening that she's showing some improvement--and would make me think that you're doing the right things.
Sometimes it helps to keep a log of treatment & progress, just to keep us going when it seems futile.
Another suggestion: consider an equine acupuncturist. A good one might be able to help with the sacral problem & who knows--that might help to resolve the bladder problem.
At this point, it's "only" money, right?
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Posted on Thursday, Sep 7, 2000 - 10:39 pm:
Dr. O ummm help with her loss of ability to control her urination..... and her muscle atrophy ? will rest no riding and time in pasture with good food , care for her burns, and regular treatments for bladder infections possibly be a help to her? in the 3 months we have had her we have noticed that she "winks" when bathed and feels the water on her vagina... also causes her to urinate a bit... in the past month her stall is wet... VERY wet in a consistent place... the same corner every time.. every day... she drinks between 12-20 gallons of water a day... but is on creatine for her muscles and electrolytes, I worry about her dehydratiing... it gets so very hot and humid here... in the past 2 weeks she has been "flagging " her tail which after we bought her I cut off bobbed even with the tailbone to keep some of the urine off her legs .. which did help . but now... she is holding it straight up and keeping it there for as long as about 2 minutes sometimes... 3 months ago even the slightest pressure on a small raised scar on her saccreal region caused her to buckle in the rear .. almost going down... but she no longer does that ... and I would really have to apply pressure to have her flinch now (I used my fingertips to apply this pressure) the weight and muscle is easy for me to see the improvement... but if she suffered, a back injury, or muscle injury, or even has nerve damage ... (like a pinched nerve) not a severed one... would the things she has been doing be considered more activity in that region and possibly be looked at as positive gains? I have other horses I ride... and a 17 month old filly who is Hope's pasture buddy as well as "personal activity director" since when Hope would be too lazy to play and run... the baby gets her doing it... We own our own land, have our own barn, and I am allready a small animal nurse... (basicly) so the desire to help her is there... funds are tight however and all I can do ... without starving the family, I want to be able to do for her.... ultimate goal???? a nice quiet trail ride.... (she is not lame) sometime within lets say 2 years? nut the greatest would be to just get her healthy enough to possibly breed... and be a mom... she is great with our baby allready ... and a beautiful pasture ornament... with a big heart and a sweet disposition... I have a mare who is perfectly sound ... beautiful. but has no heart and hates to work... I would rather stand on the rail and just watch Hope, than ride the other mare... all I am looking for please is Ideas... possible things to look into... thank you for your time Melissa
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Posted on Friday, Sep 8, 2000 - 7:13 am:
Hello Mellisa,
The pasture rest will probably not help the urinary incontinence but certainly will help any muscle atrophy from disuse. The pasture rest will also help with the management problems you describe above and can see no downsides. It is interesting that she has enough control to use one place in the stall: that is not typical for incontinence which usually has a constant dribble so the urine is everywhere. Also the pushing out behavior sounds hopeful: as her general condition improves so might her urinary problems.
Well I can't find my earlier notes so here is what my research turned up:
Some treatments that have found to be useful are:
1) phenoxybenzamine (0.7 mg / kg orally 4 times daily)
2) Bethanechol chloride ( 0.2 to 0.4 mg / kg orally 3 to 4 times daily)
3) There has also been a case of estrogen responsive incontinence which was treated with 2 mg ECP every other day. ECP has become difficult to get lately.
4) continued monitoring for reocurrence of the infection needs to be done as this can be a primary cause. Intermittent week long treatments of TMPSMZ, which concentrate highly in the urine should be contmeplated unless culture results indicate resistance.
Hope this helps
DrO
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Posted on Friday, Sep 8, 2000 - 11:39 pm:
Dr O ... culture resistance is evident for SMZ ... also when you say constant dribble do you mean like a faucet almost ? she "squirts" when she whinny's , deficates, trots, or stamps her rear legs hard... and upon occasion when she has been standing awhile... when she first begins to walk off... but it only happens with movement... never when she is just standing there. Also whenever I wash her and allow the water stream to fall on her genitals she ALWAYS urinates. like it is stimulating to her. does that change anything ? or is this what you meant? thank you Melissa
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Posted on Saturday, Sep 9, 2000 - 1:46 pm:
When I say constantly dribbles: I mean dribbles small amounts of urine constantly. And no your statements do not change anything they reinforce the notion that this may improve or be amenable to treatment.
DrO
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Posted on Saturday, Sep 9, 2000 - 7:29 pm:
The improvements we see are slow but very steady . As she does not constantly dribble at all.. so phenylproplamine is not a drug that has ever been used in horses for assisting sphincter control ? In small animal practice it is used alot for dogs... for the same types of urinary difficulties?
also I read about something where u reccomended a fardac (spelling ) test ???? would this test help me to discover if she suffered nerve damage to her saccreal region ? and what are your opinions on chiropractors??? could this urinary dysfunction be a result of a pinched nerve or something where she has that small scar on her back ? thank you again Melissa
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Posted on Sunday, Sep 10, 2000 - 5:41 am:
Hello Melissa,
I have not seen any information about the use of phenylpropanolamine in horses. We do use it in the small animal hospital for urinary sphincter hypotonus but its mechanisim of action and pharmockinetics are not even known for dogs and cats. There are theories of course and it is useful in some small animal cases.
From the information we have so far I do not think we can begin to conjecture the cause saying yes or no could lead us astray, they are all on a long list of possibilities.
There are some very specialized tests that can be run but are not commonly available nor do they seem to provide much prognostic value. I am not sure what Fardac testing is nor do I have an opinion on chiropracters for this type problem.
Looking over the earlier posts I see that a important therapeutic point has been left out. Chronic distension of the musculature of the bladder leads to it loosing its ability to contract. Many feel an important therapy is preventing the bladder from remaining chronically distended. However maintaining a urinary cathether for any but the shortest times is quite a chore.
DrO
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Posted on Sunday, Sep 10, 2000 - 1:24 pm:
from what i understand due to her spontaniously urinating ... whenever... her bladder does not even get the chance to become distended.. the vet I work for made the calculation when we were treating a blocked male cat, that the catheter probably wouldnt help the mare as she dosent have a problem releasing urine... but holding it. I dont know if that line of thought is way off for a horse.. but when the equine vet we have palpated the bladder he stated it was not DrOpped, and urine was not pooling... and as she urinates with movement , keep her turned out as much as possible to keep the bladder empty... which we have done... and now when i make her work 5 min on each side at a slow trot there are many times where she does not urinate at all ... even when she feels good, and bucks and breaks into a lope... she has done that twice in the past week after being stalled for the day. (too hot to turn her out in mid-day here) but the ever curious wet spot is still present... curious because we still havnt seen her squat to pee... I appreciate all your answers .. I am feeling tho like time will prove to be my biggest answer... and to basicly just keep doing what I am doing... the whole adage of if what Iam doing is working..... and I see any improvement .. not to change what i am doing... my last question is tho any ideas y she flaggs her tail for such a long time ??? she does it before or after urination but holds it up for like 2 minutes before she relaxes and puts it back down... thank you again Melissa
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Posted on Monday, Sep 11, 2000 - 6:36 am:
No it does not have much meaning for me except of course she does not have wide spread spinal cord disease. If the problem is sphincter atony (chronically draining but bladder not distended) the medications above have a lower probability of working. However the phenylpropanolamine is theorized to help increase sphincter tone.
DrO
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