Patient: “Stitch” (and Kyle – Vet Assistant)
Stitch came to see Dr. Cooke in April of 2021.
His owner sought a consult for persistent urinary dribbling and fecal incontinence. Stitch had been unable to differentiate whether he was urinating or defecating since birth. As a result, he wore a belly band or diaper at all times.
During his first two years of life, Stitch experienced chronic urinary tract infections, a kidney infection, constant urine dribbling, and fecal incontinence. He would posture to defecate up to 15 times before he could actually pass stool. This chronic straining led to constipation and eventually hemorrhoids.
Stitch’s mom had already consulted with her regular veterinarian and an internal medicine specialist to find help for his condition.
Stitch’s Problem List
- Constant urinary dribbling
- Recurrent urinary tract infections
- Difficulty defecating
- Kidney infections
- Hemorrhoids
- House soiling
Why Does Stitch Have This Problem?
Stitch’s issues were likely the result of birth trauma. He was born with a herniated umbilicus—his intestines were protruding through his belly button. His caregivers quickly replaced the intestines and sutured the umbilicus, saving his life.
At the time he presented to Dr. Cooke, he was receiving testosterone injections every 4 to 6 weeks under the care of the internal medicine specialist, as well as Miralax to manage chronic constipation.
His internal medicine workup included:
- Abdominal ultrasound
- Repeated urine cultures
- Contrast CT excretory urography
These diagnostics showed no abnormalities in the prostate, ureters, or kidneys.
While he showed mild improvement under the care of the internist, Stitch continued to dribble urine and required a belly band indoors. His owners hoped for a better quality of life and sought out Dr. Cooke.
Possible Reasons for Stitch’s Condition
Congenital causes of urinary incontinence in male dogs include:
- Ectopic ureters
- Congenital urethral sphincter mechanism incompetence
- Detrusor instability or hyperreflexia
- Neurologic disease affecting lower motor neuron function
Neurological lesions involving the distal spinal cord—specifically L1 to S3 (lumbosacral region)—or impacting the hypogastric or pudendal nerves can contribute to urinary incontinence.
Dr. Cooke suspected lower motor neuron damage in the L1 to S3 region as the underlying cause, likely due to Stitch’s traumatic birth.
What Can Be Done for Stitch?
Electroacupuncture (EAP) was selected as an ideal treatment to help stimulate damaged nerves and improve nerve conduction and function.
Traditional Chinese Veterinary Medicine (TCVM) herbal therapy was also recommended to support recovery, but was not elected due to the extent of previous diagnostics and financial considerations. Although EAP and herbal therapy are most powerful when combined, each can still provide significant benefit on its own.
TCVM Diagnosis and Findings
Stitch’s TCVM pattern was diagnosed as Lin Syndrome with Jing Deficiency. In Chinese medicine, patterns are used in place of Western-style diagnoses. Lin Syndrome involves urinary dribbling and difficulty holding urine due to congenital Qi (Chi) deficiency.
Dr. Cooke’s physical exam revealed:
- Pale tongue
- Dull anal tone
- Hypersensitivity to panniculus stimulation along the spine
The neurological lesion was localized to L4–S1.
Panniculus stimulation involves gently pinching the skin along the spine. A normal neurologic response involves the skin twitching as sensory (afferent) signals travel to the spinal cord and brain, which then trigger motor (efferent) signals to produce movement. Abnormal responses include lack of reaction or exaggerated responses, indicating possible nerve dysfunction.
Electroacupuncture Treatments
First EAP – April 5, 2021
After his first session, Stitch immediately went outside and urinated normally—a first for him. His belly bands were noticeably drier over the following weeks. He began voiding more completely rather than simply dribbling.
Second EAP – April 19, 2021
Prior to this session, the owner reported Stitch was 15–20% improved. He urinated more easily, was more active after treatment, and seemed less confused about whether he was urinating or defecating.
Third EAP – June 7, 2021
By this point, Stitch’s urination was 60% improved. His belly band had only been soaked once since the second treatment. He continued to show improvement in distinguishing between urination and defecation.
Fourth EAP – September 16, 2021
Stitch was now 70–80% improved. He rarely dribbled, and when he did, it was only while sleeping and only every few days. The owners were thrilled with his progress. He no longer needed the belly band indoors during the day. His overall quality of life had significantly improved.
Case Conclusion
This case beautifully illustrates the benefits of combining Western and Eastern medicine. Stitch showed significant progress after incorporating electroacupuncture. With just four treatments, he was 70–80% improved.
Continuation of his Western treatments—testosterone and Miralax—is recommended. Chinese herbal support for Lin Syndrome remains a viable addition to his treatment plan. Ongoing electroacupuncture sessions are advised periodically to maintain and potentially further his progress.