Fecal incontinence

And other summer thoughts.

Should Sunny and Bo, the Presidential Pooches, encounter incontinence issues while visiting Martha's Vineyard, they might need the help of the Visiting Vet. – Pete Souza, Wikimedia Commons

When the Obamas are here, I have certain … fantasies. The President, back at the North Road house after an afternoon golfing at Farm Neck, puts his feet up on the coffee table. I hope he is barefoot. After all, he’s on vacation and this is the Vineyard. Sipping ice tea, he notices The Martha’s Vineyard Times lying near his liberated toes and decides to see what the locals consider news. He reads my column.

So you can see, the pressure to come up with something fascinating, weighty, or witty (just in case) weighs heavily on me. Having written this column for nearly 30 years, I occasionally struggle to find fresh topics. Certain subjects I address repeatedly. Tick-borne disease. Why you shouldn’t leave your dog in the car in the summer, not even for a few minutes (because you’re not an idiot, right?). How to make end-of-life decisions for your pet. But often inspiration comes directly from cases seen in practice. I thus combine researching the latest medical information for my patient with gathering material for my journalist alter-ego. I jot down ideas in my calendar as a reminder for later.

With the President in mind this week, I check my calendar. Two words scrawled in pencil. Fecal incontinence. My heart sinks. Really? I have seen several dogs recently who are leaving unwanted gifts of guano around the house. People are often uncomfortable talking about this. In fact, fecal incontinence is a common reason owners end up requesting euthanasia. It would be a worthwhile subject … but this is my one chance, no matter how remote, the President might read my column. Does it have to be about poop?

“I don’t know what to write,” I tell my husband. Max is actually much funnier than me. Without missing a beat, he replies that, considering the current presidential campaign, fecal incontinence is a perfect headline. I walk away. Maybe I can write about Portuguese Water Dogs. The First Dogs, Bo and Sunny, have their own Facebook page. I scan articles about them, trolling for material. Up pops an Associated Press piece. Michelle Obama talking about Sunny. “‘You know what she does sometimes? She leaves the kitchen and she’ll sneak and she’ll go poop on the other end of the White House,” the first lady said. Okay. I give up. If it’s good enough for that Michelle, it’s good enough for this Michelle. Let’s talk about fecal incontinence.

Pooping or peeing in an area unacceptable to owners is called “inappropriate elimination.” We’ll leave urination for another column. Today it’s all about doo-doo. First let’s differentiate voluntary from involuntary behavior. What Sunny is doing is voluntary. Well, I’d actually need a complete history and to examine her before making a diagnosis. (My number is in the book, Michelle.) But it sounds behavioral. Sunny needs help learning that “the other side of the White House” is not the same as “outside.” Sometimes voluntary inappropriate defecation can be a transient issue from gastrointestinal disease. There’s a reason it’s called “the runs.” When you gotta go, you gotta go. But dogs who repeatedly pass normal stools indoors usually have behavior issues related to housetraining.

True fecal incontinence is not voluntary. It is the inadvertent passage of stool due to a physical inability to retain fecal matter until accessing an appropriate time and place for elimination. Young animals may occasionally be incontinent until their plumbing matures fully, but this usually resolves with adulthood. Not so for the elderly. The classic scenario is Big Ol’ Dog who wakes up in the morning with an unexpected deposit on his L.L. Bean bed. Or he gets up to greet you, little logs dropping behind as he shuffles to the kitchen where you are brewing coffee. Big Ol’ has anal sphincter incontinence. Muscles may be weakened by age, trauma, tumors, infections, hernias, etc. Or there may be neurological dysfunction stemming from problems ranging from intervertebral disc disease to brain tumors.

Regardless of cause, incontinence is often exacerbated by aging changes such as senility, reduced mobility, and reluctance to move due to arthritis. These all lessen the odds that Big Ol’ will get up and go when he needs to get up and go. The more, ahem, crap, that builds up, the more likely something will just fall out unexpectedly. (Insert inappropriate Trump joke here.)

The prognosis for correcting fecal incontinence is generally guarded to poor. If you are one of the lucky few, Doc may find a treatable underlying cause and fix it. But usually all we can offer are suggestions for supportive care and ways to lessen the impact on everyone involved. Feeding “low residue” food will create less stool. Over-the-counter diarrhea medications like loperamide (Imodium) that alter intestinal motility don’t fix the sphincter, but they do make feces firmer and easier to clean up. Collies and related breeds may be hypersensitive to these drugs, and side effects can include constipation and bloating, so always check with your veterinarian.  

Personal hygiene is essential. Incontinent females are at risk for urinary tract infections, and either gender may get secondary skin problems from fecal matter matted in the fur. Shaving the hind end may help, especially in long-haired breeds. A rigidly regular schedule of feeding and walking will help a dog’s bowels develop a predictable routine, which facilitates managing incontinence. What you can’t do? You can’t decide to make him an “outdoor dog” and just boot him out of the house. He’s old. He can’t handle heat or cold. He’s achy. He shouldn’t be exposed to rain, wind, or snow. And he’s soiling himself. This is an invitation for flies. Flies lay eggs, which hatch into maggots. Need I say more?  

In my fantasy, I close with a clever comment (or one of the unpublishable Trump jokes that crossed my mind) and make Barak chuckle. But scatological and political humor aside, you should have a frank conversation with your veterinarian about Big Ol’ Dog. Fecal incontinence  is a serious condition, and sometimes beyond what even the most dedicated owner can live with.