Urinary Incontinence in Spayed Female Dogs
- Everwell Pets
- Oct 7
- 8 min read
Understanding Traditional & Natural Solutions For Treatment & Healing
If your middle-aged spayed female is starting to leave little puddles where she rests, don’t panic—and don’t assume the only answer is a lifelong prescription drug.
Medications have their place, but they don’t have to be the only tools in your toolbox. By exploring integrative strategies—chiropractic adjustments for nerve flow, acupuncture and herbs for deep energy balance, homeopathy for constitutional support, and diet for everyday strength—you can often reduce or even avoid dependence on conventional medications. The goal isn’t just to stop the dribbles; it’s to restore your dog’s vitality from the inside out.
The Conventional Veterinary Perspective
From a conventional perspective, the culprit is usually urethral sphincter mechanism incompetence (USMI), which accounts for up to 80% of urinary incontinence cases in spayed females [1].
In plain English, the little valve that keeps urine in the bladder isn’t closing tightly anymore. In spayed females, reduced estrogen levels contribute to weaker sphincter tone [2], so the plumbing simply isn’t as watertight as it used to be.
Because estrogen is primarily produced in the ovaries—and both the ovaries and uterus are removed during a traditional spay—estrogen production drops dramatically afterward. This hormonal decline directly affects the tissues that help keep urine where it belongs, especially the urethral sphincter.
The standard veterinary treatment plan may include estriol, an estrogen that helps replace some of the hormonal support lost after spaying [3]. Sometimes both estriol and Proin are prescribed together. In my experience, though, I rarely see estriol added into the mix. Around here, Proin tends to be the go-to—and when it starts losing steam, the common response is simply to bump up the dose. It often works well enough for symptom control, but it doesn’t truly address the underlying imbalance that caused the leakage in the first place.
Proin (Phenylpropanolamine): "It's Not a Hormone"
I also often hear pet parents say, “She’s on a hormone,” when referring to Proin. It’s important to clarify: Proin is not a hormone. It is a sympathomimetic agent—a medication that works through the nervous system, not the endocrine system.
Mechanism of Action: Phenylpropanolamine (PPA), the active ingredient in Proin, acts as a synthetic sympathomimetic amine. It works primarily by releasing norepinephrine and stimulating α-adrenergic receptors in the smooth muscle of the urethral sphincter and pelvic urethra, increasing tone and closure pressure [4,5]. This helps the bladder “hold” urine more effectively. PPA also has weaker β-adrenergic and mild central nervous system stimulant activity [6]. Over time, some dogs may develop tolerance as α-receptor sensitivity decreases [7].
Common Side Effects of Long-Term Use:While many dogs tolerate Proin well, chronic use isn’t without potential downsides. Reported side effects include:
Gastrointestinal upset (vomiting, diarrhea, loss of appetite) [8]
Increased thirst (polydipsia) [8]
Restlessness, hyperactivity, or anxiety [8]
Elevated blood pressure (hypertension) [9]
Weight loss or reduced appetite [10]
Proteinuria (protein in the urine) [10]
Rarely, urinary retention or cardiovascular complications in sensitive dogs [11]
Because of these potential effects, periodic monitoring of blood pressure, kidney function, and urinary health is a smart step for dogs receiving long-term therapy.
Estriol: Hormonal Support For Incontenence
Estriol is a naturally occurring (bioidentical) estrogen and the active ingredient in Incurin, the FDA-approved estriol medication for dogs.
DES (Diethylstilbestrol): Why It’s Used — and Why It’s Controversial
You may also hear about DES (diethylstilbestrol) in conversations about urinary incontinence in spayed females.
DES is a synthetic, non-steroidal estrogen (not bioidentical to natural estrogen) and is not the same as estriol.
In the mid-20th century, DES was widely prescribed to pregnant women to prevent miscarriage and other complications. However, by the 1970s, it became clear that prenatal exposure led to devastating outcomes—most notably, a rare vaginal cancer (clear cell adenocarcinoma) and reproductive abnormalities in the daughters of women who took it. Research also revealed DES to be a potent endocrine disruptor with links to various cancers and hormonal imbalances [12–14]. Because of these findings, DES was withdrawn for most human uses and is no longer FDA-approved for women.
In veterinary medicine, DES continues to be used at extremely low doses (often 0.1–1 mg a few times per week) to tighten the urethral sphincter in spayed females with urinary incontinence [15]. At these small, intermittent doses, DES exerts an estrogenic effect strong enough to restore bladder control (supposedly) without producing the dangerous systemic effects seen in humans [16,17]. Its use is off-label, typically through compounding pharmacies, and sometimes paired with phenylpropanolamine (Proin) for extra support [18].
Even at these low levels, DES isn’t without risks. Potential side effects include:
Mammary gland enlargement or feminizing effects
Signs of “heat” or vaginal discharge in spayed females
Bone marrow suppression (rare but potentially serious)
Worsening of estrogen-sensitive tumors (if present) [16–18]
Because of these risks, most holistic and integrative veterinarians now prefer estriol (Incurin) as the first-line hormonal support, reserving DES only for cases where other therapies fail or aren’t available. DES remains “okay” for dogs primarily because of the small doses used and because it’s prescribed under careful veterinary supervision, often for short-term or rescue use.
Natural & Holistic Alternatives For Healing
Desiccated Hormones & Glandulars For Incontinence Support
If you’ve been exploring more integrative options, you may have run across desiccated (freeze-dried) glandular supplements or “whole tissue” hormone support. These are sometimes proposed as a gentler, more natural way to nourish hormone production.
What Are Desiccated Glandulars? Desiccated glandulars are supplements made from dried animal tissues (organs or glands) that contain enzymes, cofactors, and trace hormone precursors inherent in those tissues. In human health, desiccated thyroid is the most recognized example, providing a matrix of thyroid-related compounds such as T4, T3, and supporting nutrients [19].
Companies like Ancestral Supplements and Heart & Soil have popularized this ancestral approach to nutrition.
Ancestral Supplements offers targeted organ blends such as Grass-Fed Thyroid with Liver, Adrenal, and Ovary supplements, emphasizing the principle of “like supports like”—the idea that consuming healthy organ tissue from another animal supports the corresponding organ in the body [20].
Heart & Soil similarly provides nutrient-dense, freeze-dried organ supplements designed to restore foundational health and hormone balance through food-based nutrients rather than isolated compounds [21].
For pets, a noteworthy option is Dr. Mercola’s Bark & Whiskers Glandular Support, formulated specifically for dogs and cats. This hormone-free blend contains a combination of bovine glandular tissues—including adrenal, thyroid, thymus, pituitary, and ovary/testes—designed to nourish and balance the endocrine system naturally. It’s particularly useful for spayed or neutered animals whose hormonal landscape has shifted, providing broad-spectrum nutritional support without the direct addition of hormones [22].
Why Consider Supplementing with Desiccated Glandulars
The concept is simple: by providing the body with the building blocks, cofactors, and micro-signals from whole glands, the endocrine system may “remember” how to regulate itself more effectively. In this way, glandulars are seen as supportive of the body’s innate hormone rhythm—particularly when combined with a fresh food diet, reduced environmental toxins, and integrative therapies such as acupuncture and chiropractic care.
Because every dog’s hormone landscape is unique, these supplements are best used under the guidance of a holistic or integrative practitioner who can help assess energy, symptoms, and the overall terrain over time.
A Traditional Chinese Medicine Approach To Incontinence
This is where Traditional Chinese Veterinary Medicine (TCVM) offers a refreshing angle. In TCVM, bladder control depends on the strength of Kidney Qi and the supportive role of the Spleen [23]. When the Kidneys are weak, the lower orifices don’t seal properly, and leakage occurs—often while the dog is relaxed or sleeping. This fits our classic spayed female perfectly: hormonally depleted, midlife, and showing signs of weakened tone.
Food therapy brings yet another dimension, and it’s one that every pet parent can implement. A diet that supports Kidney Qi and Yang is warming and nourishing. Think lamb, venison, turkey, or rabbit for protein, and root or orange vegetables like sweet potato, pumpkin, and carrot for grounding energy. Bone broth adds both moisture and mineral support. Cold foods like raw fish, banana, or excessive raw vegetables can weaken Yang and worsen leakage [27].
Switching from a processed, dry kibble diet to fresh, moisture-rich meals often provides noticeable improvements not only in bladder control but also in overall vitality.
Homeopathy: A Tailored Match
Homeopathy has its own time-tested place in managing incontinence. For spayed females, Sepia is the classic remedy [24], matching the picture of a hormonally depleted dog who leaks urine when resting, looks a bit saggy in the abdomen, and may be more aloof or irritable than she once was. Causticum is another staple, particularly when leakage happens during sleep, exercise, or with effort like coughing or sneezing [24]. For younger, more clingy personalities, Pulsatilla can be a fit, while Cantharis is used if there’s bladder irritation or infection overlay [25]. When the right remedy is chosen, it can gently nudge the body’s own healing mechanisms back into balance, helping restore confidence—and dry bedding—to both dog and family.
Chiropractic and the Nerves Behind the Sphincter
And let’s not forget chiropractic care, which adds yet another tool in the natural healing kit. The nerves that control the bladder and urethral sphincter emerge from the lumbar and sacral spine—particularly the lumbar splanchnic nerves (L1–L4) that contribute to sympathetic control, and the pelvic nerve (S1–S3) that supplies parasympathetic fibers to the bladder [26].
When there are subluxations or restrictions in these regions, the communication between brain and bladder can be compromised. Chiropractic adjustments to the lumbar and sacral vertebrae help restore normal nerve flow, improving sphincter tone and bladder coordination.
In practice, dogs with weak sphincter control often benefit from adjustments along the lumbosacral junction, as well as the mid-thoracic spine to balance autonomic input. While chiropractic doesn’t replace hormonal support or medication, it can address the neurological component of incontinence that’s often overlooked in conventional care.
In Conclusion
Centralized medicine generally offers reliable symptom control—but it rarely addresses the core of the issue.
Instead of jumping straight to pharmaceuticals, we have many natural alternatives to try first—options ( glandular supplementation, whole foods, homeopathy, & chiropractic), that not only manage symptoms but also work on the root cause of the imbalance.
If you’re ready to walk a different path—one that supports your dog’s whole body rather than masking symptoms—I’d love to help. Book a wellness consult with me today, and we’ll build a personalized plan rooted in natural, integrative care.
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