Boxer Leaking Urine? What To Know And Do About Urinary Incontinence

Urinary incontinence can be a challenging problem with the potential to make a Boxer’s life as an inside dog difficult.

Spay incontinence is the most common cause of urine leakage in young female Boxers, while in males the condition still occurs but is less common and poorly understood.

There are several treatments for incontinence in Boxers, but they usually don’t fix the problem 100 per cent.

Ultimately, it may be necessary to adjust how your Boxer is managed in the home.

I am not a vet. This article is intended for general informational and educational purposes. I encourage readers to see my full disclaimer here.

What Is Urinary Incontinence In Boxer Dogs?

Incontinence refers to the loss of control over the bladder, resulting in urine leakage.

In many cases, a Boxer will urinate normally when going potty, but leak urine at other times.

Common times for a Boxer to leak urine include when there is raised pressure inside the abdomen such as when:

  • Lying down
  • Excited
  • Coughing

Often leakage will occur while a Boxer is resting or asleep, without her being aware it’s happening.

In severe cases, even minor movement of the body can cause leakage.

Signs Of Urinary Incontinence In A Boxer Dog

Aside from the obvious — leakage of urine — other telltale signs a Boxer is experiencing incontinence include:

  • Urine scalding of the skin (A form of moist dermatitis involving irritation, inflammation, redness, burning, fur loss, usually on the belly and genitals)
  • Staining of the perineum (The area under a dog’s tail)
  • Wet perineum
  • Wet patches on bedding or where the dog lies
  • Dog licking self (In an attempt to clean)
  • Urine smell to the dog’s fur

Causes Of Urinary Incontinence In Boxers

An adult Boxer may begin leaking urine for many different reasons including:

  • Spaying in females (More on this below)
  • Old age
  • Weakened muscles in the urethra (The tube that empties urine out of the body from the bladder)
  • As a side effect of medication e.g. the steroid prednisone
  • Urinary Tract Infection (UTI)
  • Excitement/anxiety (Puppies that pee when their owner comes home or when meeting someone new)

The technical name for the most commonly diagnosed cause of urinary incontinence in adult dogs is urethral sphincter mechanism incompetence (USMI).

A diagnosis of USMI is settled upon after ruling out other possible causes of incontinence including:

  • Infection
  • Urinary stones
  • Bladder tumors
  • Pelvic, neurological or lower urogenital tract abnormalities

Incontinence In A Boxer Puppy

If a Boxer puppy has continual incontinence from birth or from a very young age, it may be caused by an ectopic ureter.

Ectopic means “in an abnormal place or position”.

This condition is the leading cause of incontinence in juvenile dogs.

The ureter (as distinct from the urethra) is the tube that carries urine from the kidneys to the bladder.

In the case of an ectopic ureter, the tube bypasses the bladder and opens into the urethra instead.

Incontinence associated with an ectopic ureter may be intermittent and related to a dog’s position.

The second most common type of incontinence in puppies is congenital USMI (as opposed to the acquired USMI seen in adults).

Congenital USMI can self correct.

About half of female puppies with congenital USMI become continent after their first heat cycle.

Female Boxer Dog Incontinence

If a young female Boxer in the prime of her life begins leaking urine, the first consideration is: Has she been fixed?

If so, there’s a fair chance the cause of the urine leakage is spay incontinence.

Spay incontinence is also called estrogen-responsive incontinence or, in technical terms, urethral sphincter mechanism incompetence (USMI).

Incontinence is one of the many negative health consequences of spaying a Boxer that many vets unfortunately neglect to mention when recommending the procedure.

This kind of urine leakage usually has an early onset just a few years after spaying, typically by the time a dog is three years old.

It can even occur within days of an ovariohysterectomy, which is the standard spaying procedure that removes both a dog’s uterus and the ovaries.

When the hormone-producing ovaries are removed, the drop in estrogen circulating through the body is thought to result in a loss of urethral tone (sometimes called urethral sphincter hypotonus).

Besides estrogen deficiency, incontinence can also stem from spaying via several other mechanisms including:

  • Vaginal stump adhesions (left by the operation) which interfere with sphincter activity
  • Damage to the bladder’s supporting structures during the procedure
  • Pelvic bladder (Displacement of the bladder from its normal position)
  • Obesity (Made more likely be spaying)

Diagnosis Of Urinary Incontinence

There are many types of urinary incontinence, each caused by a slightly different mechanism.

Your vet will ask you questions about your Boxer’s bladder habits and any changes you’ve noticed.

She will physically examine your dog, perhaps including:

  • Rectal exam
  • Digital vaginal exam in females
  • Palpating the abdomen to determine bladder size — a full bladder may suggest problems with emptying
  • Manual expression of the bladder (To gauge urethral resistance)

She may order additional tests including:

  • Urinalysis and urine culture to check for infection or inflammation
  • Blood tests

Male Boxer Dog Incontinence

Vets used to think that incontinence was a problem affecting only female dogs.

More recently, it’s been recognized as a major issue for both genders.

Though more common in females, incontinence can affect an estimated one to four per cent of male dogs.

The exact mechanism by which incontinence develops in males is poorly understood.

There is conflicting information as to whether neutering increases the risk of urine leakage in males.

A survey of the veterinary literature reveals:

  • Congenital USMI in males is most commonly associated with abnormalities called urethral dilatations and prostatic urethral diverticula
  • Disease of the prostate can cause incontinence (because one of the sphincters controlling the passage of urine in male dogs is located inside the prostate)

In males, USMI is less likely to respond to drug therapy with less than 44% of dogs having a satisfactory response to medication.

Incontinence And Euthanasia

British researchers in 2018 made the disturbing finding that urinary incontinence can be such a problem for owners that it results in them putting their dogs down.

This makes incontinence one of the conditions that can have the heaviest impact on a dog’s welfare.

In the study, urine leakage was cited as a main or contributing reason for ending a dog’s life in 41.6 per cent of cases where dogs were euthanized.

It’s important to find ways to manage your Boxer’s urine leakage that minimize the stress and disruption caused to you and others in the household.

Treatment Of Urinary Incontinence In Boxer Dogs

Treatment for urinary incontinence may require referral to an internal medicine specialist or surgeon.


First line treatment typically involves drugs like:

  • Estrogens e.g. diethylstilbestrol (Function primarily by increasing tone in urethral smooth muscle, reported to be effective in 40 to 83% of dogs)
  • Alpha-adrenergic agonists e.g. PPA (phenylpropanolamine) and ephedrine to increase the tone of urethral smooth muscle. These are reported to be effective in 74 to 92% of dogs but PPA has been associated with significant side effects (See below)
  • Gonadotropin-releasing hormone (GnRH) analogues (Less commonly used than the other two drugs but have a reported efficacy of 71% and there is some evidence they may work where other drugs have failed)

Estrogens and alpha agonists can be used in combination and this may be more effective than either used alone.

Side Effects Of Drugs Prescribed For Incontinence In Dogs

Note that PPA has been associated with a range of serious adverse side effects including:

  • Loss of appetite
  • Gastrointestinal disorders
  • Restlessness
  • Convulsions
  • Cardiac complications
  • Excitability
  • Aggressiveness

These side effects were considered significant enough that the marketing of this drug has been prohibited in Brazil since 2000.

In the US, the Food and Drug Administration has approved both the PPA called Proin and, in 2019, the extended release version Proin ER which allows the convenience of once daily dosing.

According to the FDA, Proin ER’s most common side effects are:

  • Vomiting
  • Weight loss
  • Hypertension
  • Diarrhea


If drugs don’t work, there are a range of surgical options including:

  • Colposuspension (Suturing between the vagina and the prepubic tendon to increase pressure on the urethra and relocate the bladder neck)
  • Cystourethropexy (Pulling the bladder and urethra forward and suturing the urethra to the abdominal wall, increasing the pressure required for urine to pass through)
  • Reconstruction of the bladder neck if the urethra is too short
  • Urethral sling (Flaps created from the patient’s own tissue or synthetic material are used to compress the urethra against the pelvic bone, increasing urethral resistance to urine flow)
  • Collagen injections into the urethra (Although relapse is common, necessitating repeated treatments)
  • Implantation of artificial urethral sphincters (As used in humans to correct incontinence in men treated for prostate cancer)

Surgery comes with the risk of complications, both due to the procedure and as a result of anesthesia.

Note that Boxers should never be given the very common pre-anesthetic agent Acepromazine.

The most common post-surgical complications are difficulty urinating or inability to urinate immediately after the operation.

These problems are often transient, managed with a temporary urinary catheter.

Generally, treatment doesn’t completely fix canine incontinence but does result in enough improvement that the condition can be more easily managed.

Are Boxers Prone To Urinary Incontinence?

Larger breeds are more commonly affected by incontinence than small dogs.

Boxers are among the breeds at increased risk, along with:

  • Dobermans
  • Rottweilers
  • Old English Sheepdogs
  • Giant Schnauzers
  • Bull Mastiffs
  • Irish Red Setters
  • Rough Collies
  • Dalmatians

Small dogs overrepresented among cases of incontinence include:

  • Fox Terriers
  • Bulldogs

Old Boxer Dog Incontinence

Older dogs are more prone to leakages.

Some research suggests male dogs aged nine to 12 are more than 10 times as likely to suffer from urinary incontinence as dogs under three.

Boxer Dog Having Accidents In the House

If your Boxer begins peeing in the house after being fully potty trained, consider whether incontinence could be to blame.

Other possible reasons for frequent urination or an increase in urination include:

  • Puppyhood (Puppies can’t physically hold their bladders and need frequent pottying after drinking/eating, after sleeping, after playing etc)
  • Anxiety
  • Being left alone too long without the chance to go potty
  • Change of diet to one with higher moisture content e.g. kibble to raw can take dogs and owners by surprise at first
  • Detox as a result of discontinued drugs or improved diet (Detox can mimic UTI symptoms like peeing a lot, straining to pee or blood in the urine but this is less “infection” and more accurately an irritation of the tissues as toxins exit the body)
  • Scent marking behavior as a result of changed dynamics between dogs in a multidog household e.g. addition of new dog, onset of sexual maturity in one dog
  • UTI (Inflammation can cause the bladder to make involuntary contractions. Usually there will be other symptoms like abnormally frequent urination, passing small volumes of urine or unsuccessful attempts to urinate)
  • Cushing’s disease (A condition involving abnormally high cortisol levels, in which excessive drinking leads to excessive urination and difficulties holding the bladder overnight or during the day)
  • Boxer Juvenile Kidney Disease or JKD — Signs include excessive water intake (olydipsia) and urination (polyuria), peeing during the night, uncontrolled dribbling of urine, as well as blood in the urine, recurrent UTIs and difficulty house training. Left untreated, kidney disease can lead to kidney failure due to a buildup of waste products in the body
  • Diabetes (Increased drinking and peeing are hallmarks)
  • Kidney stones (May be a possibility if incontinence is accompanied by difficulty urinating or failed attempts to empty the bladder)

Equipment To Help Manage Urine Leakage In Your Boxer

If your Boxer is leaking urine, a few supplies can make life easier.

You may like to use:

  • Doggy diapers
  • Pee pads
  • Waterproof liners for beds
  • A steam cleaner (Allows you to clean effectively without the use of toxic chemicals)


Incontinence in Boxers can occur from birth, but is more often acquired as a result of spaying a female Boxer.

It is not something your Boxer can control.

The usual treatment for spay incontinence is medication akin to hormone replacement therapy in humans but adjusting the way you manage your Boxer in the home may well be a key part of the solution.


Food and Drug Administration, Freedom of Information Summary: Original New Animal Drug Application Proin ER, Animal Drugs, 2019

Hall, JL et al, Urinary incontinence in male dogs under primary veterinary care in England: prevalence and risk factors. Journal of Small Animal Practice, 2018

Kraun, Michael, DVM, Incontinence: Urethral sphincter Mechanism Incompetence, Dallas Veterinary Surgical Center

Langston, Cathy E, DVM, Urinary incontinence in dogs (Proceedings), DVM 360, April 1 2008

Verde, Islene A L and Crivellenti, Leandro Z, Urethral sphincter mechanism incompetence in male dogs — review, Revista Portuguesa de Ciencias Veterinarias