Urine Trouble

My 2-1/2 year old spayed female Akita is showing a pattern of recurring bladder infections. An ultrasound showed scar tissue from a long-term infection before I adopted her from a rescue group. When she gets an infection, there is blood in her urine and the pH is 9.0.

I understand there is a chicken and egg argument about the high pH and infections. Is there anything that will help lower the pH of her urine and make her less prone to infection, or is the high pH more likely just a result of the infection?

-Jim Price
Raleigh, NC

We turned over this question to Dr. Nancy Scanlan, a veterinarian for 28 years, who has integrated holistic medicine into her practice for 11 years. Dr. Scanlan is also a prolific writer, authoring a column for Natural Pet for two years as well as a book, “Stop That Itch!” Dr. Scanlan’s practice is located in Sherman Oaks, California.

Let’s define some terms before I address your specific questions. You sound well versed in the terminology of urinary tract infections, but for the benefit of others who may be earlier in their education about this multi-faceted problem, allow me to review.

Urine is formed by the kidneys, and stored in the bladder before being excreted. Urine is 95 percent water, and it’s function is carrying the waste products of metabolism out of the body. Those waste products make up the other five percent of the urine, which is normally composed of dissolved urea, uric acid, mineral salts, toxins, and other waste products. Urine that contains red or white blood cells, protein, a large number of crystals, bacteria, yeast cells, or parasites, indicates an infection or other health problem.

The normal pH for dog urine is around 6 to 6.5. A pH of 7.0 is neutral (neither acid nor alkaline). A “high pH” refers to something above 7.0 and is considered alkaline. A “low pH” is something under 7.0 and is considered acid. Some people consider 7.0, which is neutral, to be normal for dogs, though, as I’ll explain in a moment, I prefer the urine to be a little lower (more acidic). If it is already at a pH 6 to 6.5, I’d leave it alone. You don’t want it more acid than that.

The classic sign of a urinary tract infection is frequent urination of small amounts. However, this can also be a sign of chronic bladder inflammation without infection; many people aren’t aware that these are two separate issues. If your dog has to urinate frequently, but only passes tiny amounts of urine each time, you must take him to a veterinarian for a urinalysis. This will determine whether you are really dealing with a chronic bladder infection, as opposed to chronic bladder inflammation without infection. This can be accomplished only with a sterile urine culture obtained with a bladder tap; you can’t just catch some urine and take it in. This is important, because the treatment for each condition will be different.

Next, the pH of the urine must be tested. As you suggested, a high pH can make a dog more prone to urinary tract infections, but the high pH can also be the result of an infection. Some dogs chronically produce alkaline (high pH) urine, and it has been my experience that these animals are more prone to chronic infections – but not all of them are. On the other hand, dogs with chronically low pH urine (too acidic) are prone to oxalate crystals.

Crystals and stones can hurt
The urine should also be checked for the presence of any crystals, which are simply minerals that have bonded together. When enough crystals bond, they can completely or partially block the excretion of urine, which is painful and very dangerous for the dog; they can also form stones, an advanced form of the crystals.

There are a number of different types of urinary crystals. The most common are struvite or struvite/apatite “infection stones,” which are actually caused by the presence of certain bacteria in the urinary tract. Dogs who have neutral or alkaline urine tend to get struvite crystals, but fortunately, a diet that helps acidify the urine can help dissolve these crystals. In contrast, oxalate crystals are more common in dogs with acidic urine. Unfortunately, they are not easily dissolved with dietary and pH adjustments.

Finally, you need to determine whether their urine is concentrated or dilute. If it is very concentrated, it will help everything to make it more dilute. You can accomplish this by adding a pinch of salt to their diet or finding ways to add water to the diet. Some people make all their dogs’ meals soupy to force greater intake of fluids. Make sure she always has fresh, clean, water wherever she is.

Chronic infections
I’m assuming that a proper urinalysis was performed on your dog, and the presence of blood or pus indicated that the dog did in fact have an infection. If the problem is truly a recurring infection, the goal is to treat the infection, and then concentrate on boosting the dog’s entire immune system so that he or she can better battle the bacteria in the future.

It’s critical to give the animal antibiotics as soon as possible when they have an infection. This will help prevent the formation of struvite crystals, as well as reduce the odds of the dog developing scar tissue in the urinary tract. Scar tissue does leave a dog more susceptible to more infections, for two reasons. One is that if there is a lot of scar tissue then often they cannot fully contract the bladder, so it will not empty all the way, and leftover urine in the bladder gives bacteria a perfect medium for growth. Also, scar tissue creates little nooks and crannies where bacteria can grow.

Cranberry extract has been proven to be very helpful in preventing infections in dogs that are prone to them. Cranberry helps prevent bacteria from attaching to the wall of the bladder, and it also slightly acidifies the urine. It’s also good because its action is not extreme; it doesn’t make the urine excessively acid. However, I wouldn’t give cranberry to a dog whose urine had a high acidity (a number lower than 6.0); you don’t want to make the urine more acid than that.

I suggest that people use cranberry extract capsules, the kind they can get from the health food store. Cranberry juice is inadequate for this job; you couldn’t feed a dog enough juice to get the job done.

The strength of the capsules vary, so check the label, but generally, the standardized capsules provide 300 mg. of cranberry extract. For little dogs, under 35 pounds, I’d suggest a half a capsule twice a day until the urine is more acid; the bigger guys can get a whole capsule twice a day. If the dog has an infection, keep the dose relatively high until the infection is gone, then reduce it to a maintenance dose.

Some animals, once you get things under control, only need the cranberry right at the very signs of the beginning of infection. Other dogs do better if they receive a low dose all the time. A low dose would be a quarter capsule twice a day for animals up to about 25 pounds, a half capsule twice a day for 25 pounds to 60 pounds, and the really big guys could get a whole capsule twice a day. In cases of extreme infection, they may need three doses a day. At the beginning of an infection, you’d want to give your big dog a relatively high dose; she’s such a big dog, she could have two capsules three times a day at the beginning.

An immune-boosting campaign should include herbal and nutritional supplements – especially some antioxidants like Vitamin C and E. You also have to take a long, hard look at the dog’s diet, and determine whether it is contributing to the dog’s overall health and vitality or not. You might also consider some herbal support. Echinacea supports immune function and kills bacteria. Plus, it doesn’t affect the urine pH – which is good, because then it can be given to a dog with any pH.

When it’s not an infection
There are a lot of dogs who show symptoms of infection – such as urinating tiny amounts very frequently, and whining or yelping in pain when they urinate – without having an infection; no bacteria, blood, or pus can be found in their urine. Usually, I find that animals with chronic irritation (without infection) have neutral to alkaline urine. Increasing the acidity of the urine usually helps the problem. However, if oxalate crystals are present, you don’t want to increase the acidity very much. You can take it up to the neutral point, but you shouldn’t go past that.

Again, cranberry extract is very helpful for slightly increasing the acidity of the urine. Apple cider vinegar is also great for acidifying the urine (you can give one teaspoon to one tablespoon twice a day for a 50-pound dog). So is methionine, which is an amino acid. Generally, the dosage for methionine would be about 100 mg, twice a day for animals up to 20 pounds; 200 mg. twice a day for dogs up to 60 pounds or even larger. Many large or giant dogs do well on 200 mg. twice a day, others may need as much as 500 mg. twice a day. You want to try to use the smallest dose at which you get the results you want, and you need to use the urine tests to determine the optimum dosage.

You will hear the claim that Hills CD diet is the only thing that will help her, because Hills CD acidifies the urine. If the dog has neutral or alkaline urine, acidifying the urine can help, whether you do it with Hills CD or a specially formulated homemade diet. Meat products also acidify the urine. (Curiously, a diet high in citrus fruits, vegetables, or dairy products will increase the alkalinity of the urine.)

Also, you should make these changes only assisted by urine tests. Doing it blindly will get you into trouble, because supplements that can make an animal a teensy bit more acid or a teensy bit more alkaline will cause extreme changes for the next animal.

These changes should definitely be done with the help of a veterinarian, and the regular use of home pH testing kits. And be aware that there are a few animals that won’t respond – either with a more acid pH or a more dilute urine – no matter what you do; it’s just how their bodies work.

Inflammation and stones
One final caution: I have also seen chronic inflammation and stones in animals that were being given too many mineral supplements. In one case I saw, a woman was using a commercially prepared natural diet, which had calcium in it, but she was also gave the dog supplemental calcium and a trace mineral supplement – which happened to be mostly calcium.

Of course, the dog developed stones. She took the dog to a veterinarian who prescribed medication to make the urine more acid. But then the dog developed stones from the urine being too acid. It didn’t matter what they did, it kept getting stones and inflammation both. Incidentally, they are much more likely to get stones if they have chronic inflammation.

Finally the woman brought the dog to me, and I asked to see the diet. I also asked her what other supplements she was giving the dog, and the long list came out. The point is, you shouldn’t over-supplement with minerals.