Abstract
Background:
We report on a 16-month-old, spayed female miniature poodle diagnosed with urethral sphincter mechanism incontinence (USMI), refractory to common treatment regimes. This dog was examined by multiple veterinarians and underwent extensive testing, including blood work, urinalysis, urine culture and sensitivity, ultrasound, cystoscopy, and contrast abdominal computed tomography to confirm this diagnosis. Failure to respond to pharmaceutical intervention led to the recommendation of placement of a urethral hydraulic occluder. Instead of pursuing a surgical intervention, the owner elected to consult a veterinary sports medicine and rehabilitation specialist (VSMR).

Case description:
At the time of VSMR assessment, the patient had been incontinent for 14 weeks, despite receiving the maximal doses of phenylpropanolamine and estriol. The VSMR diagnosed lower back pain (LBP) and treated the patient accordingly with manual therapy, acupuncture, and photobiomodulation. The patient was treated twice, 2 weeks apart, becoming continent within 2 days of treatment. Medications were gradually discontinued over 4.5 months after the first VSMR visit, and the patient remained continent 644 of 648 days (99.4%) after the discontinuation of all medications.

Conclusion:
Although a relationship between canine USMI and LBP has already been drawn, this is the first published report of a patient who received a comprehensive workup to diagnose USMI, failed to respond to months of pharmaceutical therapy, but rapidly responded to treatment of LBP, thus avoiding a surgical intervention. This case report demonstrates the importance of early assessment of patients with canine USMI for LBP by a qualified specialist. Testing for LBP as part of the diagnostic assessment of urinary incontinence, and treating it when found, may prevent the need for pharmaceutical intervention and/or expensive diagnostics that owners may be unable to pursue, leading to relinquishment or euthanasia of dogs with USMI.

Key words: Urethral sphincter mechanism incontinence, Lower back pain, Photobiomodulation, Incontinence