Recurrent Cystitis in Dogs

Cystitis is common in canines and can usually be treated easily. It is usually caused by bacteria entering the urinary tract from the outside environment or from the dog’s feces. Canines that experience more than three UTIs per year, or more than two UTIs in six months are defined as having recurrent cystitis.

Diseases such as diabetes, Cushing’s and tumors in the bladder can also cause recurrent cystitis as a secondary complication.

Recurrent cystitis is the repeated recurrence of an inflammation of the urinary bladder. Cystitis is also referred to as a urinary tract infection (UTI) which is caused by bacteria.

In recurrent cystitis your pet will have the following repeated symptoms:

• Increased frequency of urination
• Pet appears to strain while urinating
• Blood in the urine
• Discomfort while urinating
• Urgency to urinate
• Small amount of urine voided
• Urine looks darker
• Strong smelling urine
• Low grade fever
• Poor appetite
• Dripping little spots of urine 

Types

There are 2 major types of recurrent urinary tract infections (UTI), relapse and reinfection.  Relapse or reinfection are important to diagnose and manage recurrent UTI.  Relapse is the recurrence of the same species and serologic strain microorganisms within several weeks of the end of therapy. Reinfections are recurrent infections caused by microorganisms that are different than the prior UTI.  In addition, there are super-infections which are persistent infections. Persistent infections are when the same organism does not resolve during the treatment of cystitis.

Recurrent cystitis infections in dogs may be caused by:

• Bladder stones in the urinary tract
• Cancer in the urogenital tract
• Inflammation in the urogenital tract
• Parasites in the urinary tract 
• Congenital – urinary tract abnormalities present at birth
• Incorrectly mistreating urinary tract infections
• Neurological disorders causing retention of urine
• Trauma to the bladder
• Side effects to medications being taken by your pet 
• Secondary to Cushing’s disease, kidney disease or diabetes

Your veterinarian will go over your pet’s health history with you. It would be a good idea to write down any medications your pet is currently taking. The review of the pet’s history for diseases and drugs helps determine immunosuppression.  

He will perform a total physical exam of your pet which will include a bladder palpation. Rectal examination may be part of the physical examination to check the urethra for masses or uroliths that contribute to recurrent UTI. Diagnostic tests that may be performed by your veterinarian team are:

• A urine culture and sensitivity will determine if bacteria is present
• Abdominal x-rays will show common bladder stones        
• Abdominal ultrasound can visualize stones as well as tumors and polyps; it can also identify abnormalities of the bladder wall
• Urinary biopsy and culture may help diagnose cancer
• Contrast radiographs may be recommended when plain x-rays and/or ultrasounds do not provide a diagnosis
• A biochemistry profile and a complete blood count (CBC) will be done to evaluate metabolic and organ function
• If a clotting problem is suspected, a bleeding or clotting profile is appropriate
• Cystoscopy (camera inserted in the bladder) can help rule out anatomic abnormalities, polyps, neoplasia or uroliths and allows for a mucosal biopsy for culture, cytology and histopathology

Once it is determined why your pet has recurrence of cystitis, your veterinarian can start prescribing the best appropriate treatment plan. If your veterinarian discovers an underlying disease such as diabetes or Cushing’s disease your veterinarian will treat the disease. 

Mild bacterial dog cystitis is usually treated by using antibiotics such as amoxicillin and cefadroxil for 2-3 weeks. In severe cases of recurrent cystitis proper antibiotic therapy; type, strength and length of administration will be discussed with you. If tumors or stones were discovered your pet may have to undergo surgery.  Your veterinarian may also discuss a different dietary plan for your pet to avoid more stones.

It is critical that you follow your veterinarian team’s treatment for your pet. Please contact your veterinarian if any new symptoms arise or if your pet seems to be in discomfort. Follow-up visits will be necessary to repeat the urine culture usually 7-10 days into treatment. If a culture comes back positive for cystitis, your veterinarian may recommend an additional course of antibiotics.  Bloodwork will have to be reevaluated to see how treatment is responding.  If an underlying disease such as Cushing’s disease, kidney disease or diabetes was diagnosed your pet will have an ongoing treatment plan prescribed.