Incontinence and Constipation in Dogs With Kidney Disease

Name: Incontinence and Constipation in Dogs With Kidney Disease
Creator: Dr. Zubair Khalid

By Dr. Zubair Khalid, DVM, MS, PhD · 2026-10-03

Incontinence in dogs with kidney disease usually happens because damaged kidneys can no longer concentrate urine, so the bladder fills faster and leaks between walks. Constipation is the other half of the story, because dehydration and changes in diet slow the gut at the same time. This article explains what is expected, what needs urgent care, and how diet and fluids fit into daily management.

This article is educational and is not a substitute for veterinary diagnosis or treatment.

Quick Answer

Increased urination and accidents are expected in chronic kidney disease (CKD) because the kidneys lose the ability to concentrate urine, so more water leaves the body as urine [1].
True incontinence means unconscious leaking, dribbling, or wet fur around the vulva or prepuce, and it can also come from a separate bladder or urethral problem, not the kidney disease itself [2].
Constipation is common because a dog with kidney disease is often mildly dehydrated and may be eating less fiber and less food overall.
Never limit your dog's water to reduce accidents. Free access to fresh water is part of basic kidney care.
Any sudden stop in urination, straining with no urine produced, vomiting, or collapse needs emergency care the same day you notice it.

What Is Happening in Your Dog's Body?

Chronic kidney disease involves the loss of functional kidney tissue through a prolonged, usually progressive process [1]. The kidneys do many jobs, but two matter most for this article. They filter waste from the blood, and they decide how much water to keep or send out as urine.

Healthy kidneys concentrate urine well, so a dog can hold a normal amount of water and still produce a small volume of urine. When kidney tissue is lost, that concentrating ability drops. The dog drinks more to keep up, and produces more urine. The bladder fills faster and reaches its limit sooner. That is why a house-trained dog with kidney disease may suddenly need to go out at 2 a.m. or may have an accident near the door.

Kidney disease often develops over months or years before it becomes clinically apparent, and by the time signs show up, the changes are usually irreversible and frequently progressive [1]. That sounds grim, but it also means the goal of care is steady management, not a cure. Many dogs live well for a long time with the right plan.

It helps to separate two problems that look similar at home. One is a full bladder that empties at the wrong time. The other is a bladder that leaks because the sphincter or urethra is not holding urine properly. Disorders of micturition come from abnormal storage or voiding of urine, and signs include unconscious passage of urine, dribbling, or difficulty urinating [2]. Incontinent animals may leave a pool of urine where they have been lying or dribble while walking, and the coat around the vulva or prepuce can stay wet, which can lead to urine scalding and skin infection [2].

Signs Owners Notice: Dog Kidney Disease Urination Changes

The first sign most owners catch is a change in drinking and peeing. Your veterinarian will ask about changes in how much water your dog drinks, how often it urinates, how much urine it produces, how the urine looks, and how your dog behaves [3]. Those questions are not small talk. They are part of the diagnosis.

Watch for these patterns.

Drinking more than usual and asking to go out more often.
Larger puddles than before, or a full bladder that empties quickly.
Accidents in the house in a dog that was previously reliable.
Dribbling while walking or a wet, urine-stained coat.
Straining to urinate, or squatting often with little urine coming out.
Constipation, which may look like circling, squatting, or a hunched posture with small, hard stools.
Weight loss, reduced appetite, vomiting, or low energy.

Some of these overlap with other problems. Straining to urinate can mean a bladder infection, bladder stones, or a urethral blockage, not kidney disease alone. Straining to defecate can mean constipation, but it can also mean pain or a mass in the pelvis. A veterinarian needs to sort this out with an exam and testing.

Causes and Risk Factors

CKD is the main driver of the urination changes. As functional kidney tissue is lost, urine becomes dilute and volume rises [1]. CKD is frequently seen in older dogs, and it often shows up with vague signs that require careful testing to confirm [4]. Age is the biggest risk factor simply because kidney tissue has had more time to wear down.

Incontinence itself has its own list of causes that can exist alongside kidney disease. Failure of urine storage causes inappropriate leakage because of poor urethral tone, failure of the bladder to relax, or anatomical defects [2]. Some dogs are born with ectopic ureters, which are uncommon congenital abnormalities that lead to urinary incontinence and are seen more often in female dogs than males [5]. Those cases are treated with surgery, not with kidney diets.

Other common contributors include urinary tract infections, which are more likely in dilute urine, and hormone-related leaking in spayed females. Your dog's medications matter too. Your veterinarian needs to know what medications your pet has taken or is currently taking, along with appetite, diet, body weight changes, and previous illnesses or injuries [3].

Constipation usually has a simpler explanation. A dog with kidney disease may be dehydrated, eating less, and eating a diet with different fiber than before. Less water in the colon means harder stools. Less food means less stool volume and slower transit. Add reduced activity in an older dog, and the gut slows further.

How Veterinarians Diagnose This

Diagnosis starts with history and a physical exam. Your veterinarian will ask about water intake, urination frequency, urine volume, urine appearance, and behavior, plus medications, appetite, diet, weight changes, and past illnesses [3]. Then comes testing.

Blood work measures creatinine and SDMA, the two markers used to stage CKD. CKD is classified into four stages defined by blood creatinine and blood SDMA concentrations, assessed on at least two occasions in a stable, hydrated patient after food withholding [1]. Staging is then refined with substages based on proteinuria and on systolic arterial blood pressure [1]. Proteinuria substaging uses the urine protein-to-creatinine ratio, ideally based on at least two urine samples collected over at least two weeks [1].

A urinalysis checks concentration, infection, crystals, and protein. Imaging such as ultrasound or X-rays can look at kidney shape, bladder stones, and the ureters. If incontinence is the main complaint, your veterinarian may watch your dog urinate, because observing the stream tells a lot about whether the problem is storage or voiding [2]. Some cases need advanced procedures to visualize the urinary tract [2].

For a deeper look at staging and what the numbers mean, see Canine Chronic Kidney Disease: Staging, Diagnosis, and Management and Dog Kidney Disease: What Do the Stages Mean for Your Dog?.

Treatment Options

Treatment depends on which problem you are treating. Kidney disease management and incontinence management are related but not identical.

Fluids and Hydration

Water is the foundation. Do not restrict water to cut down on accidents. Offer fresh water at all times, in more than one bowl, and consider a water fountain if your dog likes moving water. Some dogs need subcutaneous fluids at home, which your veterinarian will prescribe and teach you to give. The volume and schedule are set for your individual dog based on weight, stage, and bloodwork. Signs of dehydration are easy to miss in a dog with kidney disease, so learn what to watch for in Dog Kidney Disease: How to Tell If Your Dog Is Dehydrated.

Diet

Therapeutic kidney diets are a mainstay of CKD care. They are typically lower in phosphorus and protein-controlled, and many are formulated to support hydration and stool quality. Diet changes should be gradual and guided by your veterinarian, because a dog that refuses the new food loses more than it gains. Practical feeding guidance is covered in Dog Kidney Disease Diet.

Fiber matters for constipation. Your veterinarian may suggest a fiber source, a stool softener, or a prescription diet with a different fiber profile. The dose depends on your dog's weight and other conditions, so let your veterinarian calculate it.

Medications and Other Support

Your veterinarian may treat high blood pressure, protein in the urine, metabolic acidosis, or infections. Metabolic acidosis is common in dogs with CKD and triggers a breathing response, and its severity tracks with that response [6]. Reduced urine ammonia excretion has been linked to shorter survival and faster progression in dogs with stable CKD, which is one reason monitoring matters [7]. Some drugs used in kidney care are prescribed off label, and your veterinarian will explain the reasoning and the monitoring plan for your dog.

For incontinence specifically, options depend on the cause. If the problem is urethral sphincter weakness, medications can help. If the cause is an ectopic ureter, surgery is often needed, and minimally invasive techniques have been used successfully in dogs with incontinence from ectopic ureters [5]. A 2024 consensus statement from a panel of veterinary experts reviewed diagnostic testing and treatment recommendations for urinary incontinence in dogs, and it noted that large prospective trials comparing treatment outcomes are still lacking [8]. That is a fair way to think about it. Many treatments work, but the evidence base is still growing.

Managing Constipation

Constipation care usually combines more water, more appropriate fiber, more movement, and sometimes medication. Keep a simple log of stool size, frequency, and effort. That log is genuinely useful at your next appointment.

Recovery, Outlook, and Long-Term Management

CKD is not reversible, and it is often progressive [1]. The realistic goal is slowing progression, controlling symptoms, and protecting quality of life. Many dogs do well for months to years with consistent care.

Long-term management usually includes regular bloodwork and urine testing, blood pressure checks, weight tracking, and diet adjustments over time. Staging and substaging are repeated because they guide treatment changes [1]. Some dogs also develop other problems, including metabolic and inflammatory changes. One study found that dogs with CKD had significantly higher insulin levels than healthy controls, and insulin resistance is documented in people with CKD [9]. This is an area of active research, and it is not yet a routine part of treatment decisions in dogs.

Survival varies widely by stage and by how well other problems are controlled. In one study of dogs with IRIS stage 2 CKD, dogs treated with an oral prostacyclin analog had a median survival time of 1,101 days compared with 198 days in a control group [10]. That is a single study in a specific population, and it does not mean every dog will respond the same way. Ask your veterinarian whether any newer options fit your dog.

Practical home changes help a lot. Put washable pads or waterproof covers where your dog rests. Keep the coat around the genitals clipped and clean to prevent urine scalding [2]. Offer more frequent, shorter walks. Keep the litter area or yard path easy to reach at night.

Prevention

You cannot prevent all kidney disease, but you can catch it earlier. Annual or twice-yearly wellness visits with bloodwork and a urinalysis are the single best tool for older dogs, since CKD often develops silently for months or years before signs appear [1]. Tell your veterinarian about any change in drinking or urination at the first visit, not the next one.

Keep water available at all times, avoid unnecessary medications that stress the kidneys, and manage blood pressure and dental disease with your veterinarian. Bad breath can be a clue to problems beyond the mouth, which is covered in Dog Bad Breath Kidney Disease. If your dog is on a therapeutic kidney diet, stick with it and ask before adding supplements or table food.

Sign	What it often means	What to do
Drinking and peeing more, accidents in a previously reliable dog	Dilute urine from CKD [1]	Routine visit with bloodwork and urinalysis
Dribbling while walking, wet fur around genitals	Storage failure or incontinence [2]	Routine visit, sooner if skin is red or raw
Straining to urinate with little or no urine	Possible blockage or severe inflammation	Emergency care now
Hard, small stools, straining to defecate	Constipation from dehydration or diet	Call your veterinarian, increase water access
Vomiting, not eating, weakness, collapse	Advanced kidney disease or a crisis	Emergency care now

Limitations and When to Contact a Veterinarian

No article can tell you what is happening in your dog's kidneys. Your veterinarian needs to examine your dog, review the history, and run tests before recommending treatment. Individual cases vary, and the plan for your dog should be built for your dog.

Call your veterinarian the same day if you see any of these.

Your dog has not urinated in 12 hours or more.
Your dog strains to urinate and produces only drops, or nothing.
There is blood in the urine, or the urine smells strongly foul.
Your dog is vomiting, refusing food, or seems painful in the belly.
The skin around the genitals is red, raw, or infected from urine contact.

Go to an emergency clinic now if your dog is collapsed, unresponsive, breathing hard, having seizures, or has a hard, painful belly with no urine output. A urethral blockage is life threatening and cannot wait until morning.

Frequently Asked Questions

Is incontinence in dogs with kidney disease permanent?

It depends on the cause. If the leaking comes from dilute urine and a full bladder, better fluid and diet management often reduces accidents but may not eliminate them. If the cause is a separate problem such as a weak sphincter or an ectopic ureter, treatment can improve or resolve the leaking [2][5].

Can I reduce my dog's water to stop the accidents?

No. Restricting water makes kidney disease worse and does not fix the underlying problem. The kidneys are already losing water, so limiting intake leads to dehydration and can cause a crisis. Keep water available and talk to your veterinarian about timing, walks, and bedding instead.

Why is my dog with kidney disease constipated?

Dehydration is the usual reason. When the body is short on water, the colon pulls more water from stool, which makes it hard and dry. Eating less food and a diet change can slow the gut further. Your veterinarian can adjust fiber, add a stool softener, or change the diet.

Does kidney disease always cause incontinence?

No. Many dogs with kidney disease urinate more often and in larger amounts but still hold urine normally. Incontinence means unconscious leaking or dribbling, and it has its own causes, including urethral problems and anatomical defects [2]. Your veterinarian can tell the difference with an exam and testing.

Can constipation medicine help my dog's kidney disease?

No, treating constipation does not treat the kidneys. It does improve comfort, appetite, and quality of life, which matters in long-term care. Constipation and kidney disease are managed together but as separate problems, and your veterinarian will set the plan for both.

References

Renal Dysfunction in Dogs and Cats - Urinary System. Merck Veterinary Manual.
Disorders of Micturition in Dogs and Cats - Urinary System. Merck Veterinary Manual.
Detecting Disorders of the Kidneys and Urinary Tract in Dogs - Dog Owners. Merck Veterinary Manual.
Chronic kidney disease in a dog with hematologic and cardiovascular alterations: A case report. Open veterinary journal, 2026.
Minimally Invasive Surgical Techniques for the Treatment of Dogs with Urinary Incontinence Due to Ureteral Ectopia. Life (Basel, Switzerland), 2025.
Ventilatory compensation for metabolic acidosis is independent of hypertension in dogs with chronic kidney disease. The Veterinary record, 2026.
Association of impaired ammonia excretion with survival in dogs with stable chronic kidney disease. Journal of veterinary internal medicine, 2026.
ACVIM consensus statement on diagnosis and management of urinary incontinence in dogs. Journal of veterinary internal medicine, 2024.
Exploratory analysis of insulin resistance and pro-inflammatory cytokines in dogs with chronic kidney disease. Domestic animal endocrinology, 2026.
Overall survival with beraprost in dogs with IRIS stage 2 chronic kidney disease. Frontiers in veterinary science, 2026.