Dog looking up at camera, sitting next to urine accident on carpet due to urinary incontinence

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It's not uncommon to find "accidents" around the house occasionally. However, if your dog is fully housetrained, finding urine spots could indicate that your dog is experiencing urinary incontinence.

Urinary incontinence is a common health issue, especially in older dogs and females. This uncontrollable urine leakage can cause discomfort and stress for the dog while posing significant difficulty in maintaining hygiene for pet owners.

If your dog has been diagnosed with urinary incontinence, there are solutions available to help them. Keep reading to learn more about two FDA-approved urinary incontinence drugs: Incurin vs. Proin for dogs.

Urinary Incontinence in Dogs

Urinary incontinence in dogs is the inability to control urination, leading to involuntary urination.1 This common health issue can occur at any age but is most common in older dogs and spayed females.

Symptoms of urinary incontinence


Urinary incontinence is not the same as a dog willfully urinating in the home. You won't find large wet puddles of urine. Instead, you'll find dribblings that can occur when your dog is walking or lying down.

Dogs experiencing incontinence may have damp legs or bellies because they've involuntarily urinated on themselves. They may also have an unpleasant odor.

Another common sign is irritation or excessive licking of the penis or vulva because they're trying to clean themselves.


Your dog can become incontinent for many reasons. However, ectopic ureters are the most common cause of incontinence in young dogs.1 With an ectopic ureter, one or both of the tubes that carry urine from the kidneys to the bladder don't connect properly, resulting in urinary incontinence because the dog can't control the flow of urine to the outside of their body.2

Neurologic problems can also cause decreased urethral closure pressure, resulting in urinary incontinence in dogs.1

In addition, hormone-responsive incontinence can affect both male and female dogs, but it's most common in females. This occurs in spayed dogs when their hormone levels are insufficient to maintain proper control of the urinary sphincter, a muscle that controls the release of urine. It can then lead to urethral sphincter hypotonus, a condition in which the muscles in the urethral sphincter are weakened.2

Older dogs are more susceptible to urine leakage because the urinary sphincter weakens over time. However, some health conditions, such as a urinary tract infection (UTI) or urinary obstruction, can lead to temporary incontinence. In these cases, once the health issues are treated, the incontinence should stop with the other symptoms.


Urinary incontinence in dogs is often treated with surgery and medications.2 However, the specific treatment for your dog will depend on the underlying cause. For instance, if your dog is suffering from a UTI, your vet will prescribe an antibiotic, and the symptoms should clear up within a few days.

However, if your dog is experiencing urinary incontinence not due to an underlying disease, there are other medications they can try to prevent involuntary urination and treat urinary issues.


Incurin, also known as estriol, is a medication used to treat hormone-responsive urinary incontinence in female dogs who have been spayed.3 Estriol is a naturally-occurring hormone that can help strengthen the bladder's muscles and urinary sphincter to reduce incidents of incontinence.

It works by supplementing the lowered estrogen levels that may occur in spayed females to improve muscle tone and reduce urine leakage. Incurin has been proven effective in reducing or eliminating urinary incontinence,

with 93 percent of dogs improving or fully continent by six weeks.3

Incurin tablets are administered orally with dogs starting with a once-daily dose of 2 mg.3 Unlike other medications, the dosage is not determined by weight.

This medication is generally well tolerated by dogs. In a study involving 324 spayed female dogs, there was a low frequency of side effects with no safety concerns associated with long-term use.3

The most common side effects of Incurin include loss of appetite, vomiting, excessive thirst, and swollen vulva. However, Incurin has not been tested on puppies, intact females, male dogs, or dogs used for breeding.3 In addition, this medication should not be given to dogs experiencing excessive thirst or urination or those that are pregnant.3


Proin, phenylpropanolamine hydrochloride, is a once-daily medication used to treat urinary incontinence due to urethral sphincter hypotonus, the same as Incurin.4

This medication works by stimulating the smooth muscles of the urethra, bladder neck, and urethral sphincter to increase muscle tone and close the neck of the bladder, providing more control and less leakage.5

In a study conducted by the FDA, 119 dogs diagnosed with urethral sphincter hypotonus and who were already taking Proin Chewable Tablets were given Proin ER for 28 days. The main difference between these medications is that Proin ER is given once a day.6

Their owners noted how many accidents the dogs had each day. 75 out of 104 dogs who completed the study had no accidents, while 19 had fewer accidents on PRoin ER than with Proin Chewable tablets. 10 dogs in total had more accidents taking Proin ER than Proin Chewable Tablets.6

Proin ER is administered once daily, regardless of a dog's weight. The brand's patented extended-release technology provides a controlled release to ensure steady absorption and constant therapeutic levels throughout the day to reduce instances of incontinence.

Like Incurin, Proin side effects were generally mild, including vomiting, weight loss, hypertension, and diarrhea.6

Unfortunately, some dogs shouldn't take Proin. For instance, dogs with pre-existing heart disease, high blood pressure, liver disease, kidney insufficiency, diabetes, glaucoma, and other conditions associated with high blood pressure should avoid Proin. In addition, the effects on breeding, pregnant, and lactating dogs have not been evaluated.4

Incurin vs. Proin comparison chart

Comparing Incurin Vs. Proin for Dogs

Incurin and Proin are both approved by the FDA to treat urinary incontinence in female dogs due to urethral sphincter hypotonus. However, there are several key differences between the two, including the active ingredients, gender of the dog that can be treated, method of action, dosing, and potential side effects. Factors to keep in mind when comparing Incurin vs. Proin for dogs include:

  • Active ingredient: Incurin contains estriol, a naturally occurring estrogen hormone that increases the levels of estrogen in spayed females to help strengthen the urinary sphincter muscles and improve urine control. On the other hand, Proin contains phenylpropanolamine, a synthetic compound that works by tightening the bladder sphincter muscles.
  • Sex of dog treated: Because Incurin contains estriol, it's designed for use in spayed female dogs only. However, since Proin contains a synthetic, non-hormonal compound that works by tightening the urinary sphincter muscles, it can be used in both male and female dogs.
  • Method of action: Incurin increases estrogen levels to strengthen the muscles of the urinary sphincter and improve urine control. On the other hand, Proin works by tightening the sphincter muscles to help control leakage.
  • Dosing: Both medications are usually given once a day. However, the dosage for Incurin may be adjusted by the veterinarian based on the dog's response to treatment. Conversely, Proin ER is administered once daily regardless of weight due to its extended-release formula.
  • Potential side effects: Both medications are generally well tolerated but can have side effects. Incurin's side effects may include increased thirst and urination, decreased appetite, and vomiting. On the other hand, Proin's potential side effects include increased heart rate, loss of appetite, and hypertension.

So which option should you choose – Proin vs. Incurin? The only way to determine which medication is right for you is to discuss your options with a vet. If your dog has been diagnosed with urethral sphincter hypotonus, your veterinarian will consider various factors to determine the most suitable medication. This includes your dog's overall health, the severity of the symptoms, the specific cause of the incontinence, and how your dog may react to different medications.

For instance, Incurin, which contains a form of estrogen, is often used for spayed female dogs suffering from hormone-responsive incontinence. On the other hand, Proin, which strengthens the bladder sphincter muscles, can be used for both male and female dogs with urinary incontinence due to various causes.

Both of these medications can effectively manage urinary incontinence, but their suitability will depend on your dog's specific circumstances. The veterinarian will guide you through the process, explaining the benefits and potential side effects of each option.

Remember, it's important to monitor your dog's response to the prescribed treatment and report any changes or concerns to the vet.


How long can a dog stay on Incurin?

The length of time a dog remains on Incurin is largely determined by the medication's effectiveness. If Incurin is successful in reducing urinary leakages, it's generally safe for your dog to stay on this treatment for an extended period, potentially indefinitely.7

However, it's crucial to have regular veterinary check-ups. These appointments allow the vet to watch for any potential side effects and to ensure that the medication continues to work effectively for your dog.

Can you give a dog Proin and Incurin together?

Sometimes there's no need to decide between Incurin vs. Proin. It's safe for your dog to take Proin and Incurin together. Both medications are used to treat urinary incontinence in different ways, but they can also work together to provide a synergistic effect, making them stronger and more effective.6

What is the best incontinence medicine for female dogs?

The best incontinence medicine for female dogs largely depends on their needs. Incurin and Proin are FDA-approved and have been proven effective, but there are several key differences that may make one the better option for your pet. Your vet may also want to try using both together.

The choice between Incurin vs. Proin should be made with your vet, who will consider your dog's health, underlying causes of the incontinence, and potential for side effects. In addition, your vet will require regular follow-ups to monitor the effectiveness of the medication and your dog's overall response to it.

Blonde woman hugging her dog that is sitting on her desk

Final Notes

Urinary incontinence in dogs is a manageable condition with the right approach and medication. Proin and Incurin are both generally well tolerated among dogs and have shown significant success in managing incontinence by strengthening the urinary sphincter to control the release of urine.

Each dog's needs are unique, so you should always consult with a vet to determine the best treatment option.

Schedule an appointment with Dutch telemedicine for pets today for comprehensive guidance from the comfort of your own home. We can evaluate your pet's symptoms, diagnose the problem, and determine the best medication for the job. Try Dutch today to consult a vet and order your dog's medicine from our online pet pharmacy.



  1. Gardiner, John. "Urinary Incontinence in the Dog." School of Veterinary Medicine, 22 June 2018,

  2. "Urinary Incontinence in Dogs." Veterinary Teaching Hospital, 26 Oct. 2021,

  3. "Incurin® Tablets." Merck Animal Health USA, 12 June 2023,

  4. "Home." PROIN ERTM, 26 July 2023,

  5. “Proin® (Phenylpropanolamine).” PetMD, 8 Dec. 2022,

  6. "FDA Approves New Once-a-Day Treatment for Urinary Incontinence in Dogs." AAHA,

  7. “Incurin® (Estriol).” PetMD, 6 July 2022,

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