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When a senior dog starts having indoor accidents after years of reliable house training, it is rarely “just old age.” In many cases, it is your dog communicating a health problem, a mobility barrier, confusion, or a change in how their body holds and releases urine.
Because the causes range from minor and easily treated to time-sensitive emergencies, the safest approach is to treat new or worsening house-peeing as a medical issue first, then work on the behavior and home setup after you have a plan with your veterinarian. If your dog is suddenly peeing in the house again, schedule a veterinary visit. Even if it turns out to be “just” aging-related incontinence, that is still a medical condition with real options.
This article will walk you through what it might mean, what you can do today, and what your veterinarian may recommend. Please use it as a guide, not a diagnosis, and always check with your dog’s veterinarian before starting or stopping any treatment.
Start here: Is this incontinence or a potty-training problem?
Many people call every indoor accident “incontinence,” but the details matter because the causes and fixes can be very different.
Signs that point more toward urinary incontinence (leaking):
- Wet spots where your dog was lying down or sleeping
- Dribbling urine while walking or shortly after standing up
- Your dog seems surprised by the puddle, or does not “choose” a spot
- The accidents happen even if you are still doing regular potty breaks
Signs that point more toward increased urgency or behavior:
- Your dog asks to go out more often, then urinates small amounts
- Squatting repeatedly with little output
- Straining, licking the genital area, or seeming uncomfortable
- Accidents happen mostly when your dog is awake and moving around
- Marking behavior (small amounts on vertical surfaces), especially in males
A lot of senior dogs have a blend: for example, arthritis makes it hard to get outside quickly, and a urinary tract issue increases urgency. That is why step one is usually medical evaluation.
When you should treat this as urgent
Call your veterinarian the same day (or go to an emergency clinic) if you see any of the following:
- Straining to urinate, crying out, or producing little to no urine
- Blood in the urine
- Vomiting, collapse, extreme lethargy, or refusal to eat
- A distended belly or obvious pain
- Sudden accidents paired with excessive thirst, rapid weight loss, or new weakness
Some urinary problems can become dangerous quickly, especially urinary obstruction (more common in male dogs) or severe infection.
Common medical reasons senior dogs pee in the house again
Indoor peeing in older dogs most often traces back to one or more of these categories.
Urinary tract infection and bladder inflammation
A bladder infection (bacterial cystitis) can cause frequent urination, urgency, discomfort, and accidents. However, not every dog with bacteria in the urine has a true infection that needs antibiotics, and contamination can confuse results. That is why many veterinary guidelines emphasize proper sampling and testing rather than guessing. AAHA notes that urine collected by cystocentesis (a sterile needle sample from the bladder) helps reduce contamination, and culture and susceptibility testing can guide appropriate antibiotic choices.
What you might notice at home:
- More frequent squatting
- Accidents soon after coming inside
- Licking the vulva or penis
- Changes in urine odor, or blood-tinged urine (not always present)
Urethral sphincter mechanism incompetence (hormone-responsive incontinence)
In many older spayed female dogs, the urethral “seal” becomes weaker and urine leaks, especially during sleep. Veterinary references describe this as a common cause of acquired urinary incontinence in spayed females, and it is often managed medically after diagnosis.
What you might notice at home:
- Damp bedding
- Leaking that is worse when relaxed or asleep
- No obvious straining or pain
Your veterinarian may discuss medications such as phenylpropanolamine (which increases urethral tone) or estriol in appropriate cases, but these should only be used under veterinary direction because dosing and safety depend on your dog’s health history.
“More pee made than usual”: endocrine disease and kidney disease
Some diseases cause polyuria and polydipsia (peeing and drinking more). When the bladder fills faster than your dog’s routine or mobility can handle, accidents happen.
Conditions that commonly show up in seniors include:
- Diabetes mellitus, which often involves increased thirst, increased urination, increased appetite, and weight loss.
- Cushing’s disease (hypercortisolism), which can include increased thirst and urination, increased appetite, panting, and skin changes; AAHA’s endocrinopathy guideline describes these as common clinical signs in suspected cases.
- Chronic kidney disease, where a history of polyuria and polydipsia can be part of the picture, especially as kidney function declines.
You might also see nighttime accidents, larger-than-usual puddles, or a dog that cannot “hold it” as long as they used to.
Pain and mobility problems (arthritis is a big one)
Sometimes the bladder is not the main issue. The problem is access.
If your dog has arthritis, spinal pain, or weakness, they may not be able to:
- Stand up quickly
- Navigate stairs to the door
- Walk far enough to your usual potty spot
- Posture comfortably long enough to fully empty the bladder
AAHA’s pain management guidelines highlight musculoskeletal pain, including osteoarthritis, as the most common form of chronic pain in dogs and note that pain is often under-recognized and action is sometimes delayed. That delay can look like “sudden” house-soiling, when the real change is that coping has become harder.
Canine cognitive dysfunction (dog dementia)
Cognitive decline can cause house soiling even when the urinary tract is healthy. Dogs may forget the routine, get disoriented, misread the signal to go outside, or wake at night confused.
Recent veterinary review literature describes canine cognitive dysfunction as common in geriatric dogs and includes house soiling among classic signs. Importantly, the same review notes it is underdiagnosed partly because objective diagnostic tools are limited. That means research is still catching up, and diagnosis often relies on history, patterns, and ruling out medical look-alikes.
What you might notice at home:
- Night waking and pacing
- Staring at walls, seeming “lost” in familiar rooms
- Changes in social interaction
- Accidents that do not match prior patterns
Medications, diet changes, and other health shifts
A few other common triggers:
- Steroids and some other medications can increase thirst and urination
- Diuretics (water pills) do exactly what their name suggests
- New diets, especially higher sodium, can change drinking behavior
- New stressors or household changes can cause regression, especially if your dog already has cognitive decline
This is another reason a veterinary visit is helpful. A medication review can be as important as a urine test.
What your veterinarian may do (and why)
Expect your veterinarian to focus on two goals: confirm whether the urinary tract is inflamed or infected, and look for systemic disease that changes urine production.
Common steps include:
- A detailed history: timing, volume, sleeping vs awake, water intake, mobility, new meds
- Physical exam: pain, abdominal palpation, neurologic status, vulvar/penile anatomy
- Urinalysis (often with a sterile sample) and sometimes urine culture when infection is suspected. AAHA emphasizes diagnostic testing and notes that cystocentesis helps distinguish true bacteriuria from contamination and that culture supports appropriate antimicrobial choices.
- Bloodwork: screening for diabetes, kidney disease, electrolyte issues, and other problems
- Blood pressure and kidney staging tools when CKD is diagnosed, since staging guides monitoring and treatment decisions.
- Imaging (x-rays or ultrasound) if stones, masses, prostate disease, or anatomy problems are suspected
If incontinence is likely, your veterinarian may also work through a “storage vs voiding” framework (whether the bladder cannot hold urine vs cannot empty properly), which helps target treatment choices.
What you can do at home right now (while you’re booking the vet visit)
Home management is not “giving up.” It is reducing stress for your dog and protecting the bond you have with them.
Adjust the potty schedule, but do it strategically
- Add a late-night potty break and an early-morning one.
- For dogs with urgency, try shorter intervals during the day.
- If mobility is an issue, use the closest safe potty option, even if it is not your usual spot.
Make it easier to succeed
- Use ramps or block off stairs if stairs are the barrier.
- Put non-slip runners on slick floors so your dog can move quickly.
- Consider a bell or button only if your dog can still learn and use it; cognitive decline can limit this.
Manage the mess in a way that does not confuse your dog
- Clean accidents with an enzyme cleaner designed for pet urine (so lingering odor does not “mark” the area as a bathroom).
- Avoid ammonia-based cleaners; they can smell urine-like to dogs.
- If your dog keeps choosing the same area, temporarily block access and create a new, easy-to-reach potty route.
Use protective gear thoughtfully
- Belly bands (male dogs) and dog diapers can help, especially overnight, but they require frequent changes to prevent skin irritation and urine scald.
- Clip long hair around the genital area (or ask your groomer) to keep skin dry.
- Talk with your veterinarian about barrier creams if redness develops.
Track patterns for your veterinarian
For one week, jot down:
- Time of meals and water refills
- Time and size of urination (small vs large)
- Accidents: where, when, asleep vs awake
- Any straining, licking, or signs of discomfort
This log often shortens the time to a correct diagnosis.
Treatment options depend on the cause
Once your veterinarian identifies the driver, treatment is usually much more effective than “more training.”
Examples (not a prescription, just an overview):
- Confirmed infection: targeted antibiotics based on culture when appropriate, plus follow-up if signs recur
- Sphincter weakness: medications that increase urethral closure, selected for your dog’s risk profile
- Diabetes: insulin and diet plan, monitored closely
- Cushing’s: endocrine testing and treatment plan based on the type and severity
- Kidney disease: staging, monitoring, diet and supportive care tailored to stage and substaging factors
- Pain and mobility: multimodal pain management and home modifications; AAHA emphasizes early detection and multimodal approaches in chronic pain
- Cognitive dysfunction: a combination of medical options, enrichment, routine consistency, and environmental support. Research notes that diagnosis is limited by lack of an objective, reliable tool, so response to interventions and pattern tracking matter.
What research is strong on, and where it is limited
There is good agreement in veterinary medicine that senior house-soiling is often medical and deserves diagnostic workup. There are also strong guideline-based recommendations around urine sampling and culture when UTI is suspected.
Where the science gets murkier:
- Canine cognitive dysfunction: It is widely recognized and increasingly studied, but it remains underdiagnosed and objective diagnostic tools are limited, which makes prevalence estimates and treatment comparisons harder.
- Urinary incontinence treatments: Veterinary literature acknowledges that large prospective trials comparing treatments are limited, so recommendations often blend evidence, physiology, and clinical experience.
- Arthritis prevalence numbers: Published prevalence varies depending on whether studies look at radiographs, owner reports, or veterinary records, and whether the population is primary care vs referral. For example, AAHA’s pain guideline cites reported prevalence for osteoarthritis-related chronic pain that is much higher than what some primary-care record studies report, likely reflecting underdiagnosis and differences in methodology.
The takeaway: do not let a single statistic reassure you or alarm you. What matters is the pattern in your dog, and what your veterinarian finds.
The bottom line
If your senior dog is peeing in the house again, assume there is a reason and go looking for it with your veterinarian. In many cases, the problem is treatable or manageable, and even when it is not fully reversible, small changes can dramatically reduce accidents and stress.
Please check with your dog’s veterinarian before trying new medications, supplements, or major diet changes, and seek urgent care if you see straining, pain, blood in urine, or your dog cannot urinate.
Sources
- American Animal Hospital Association (AAHA). Diagnostic testing in antimicrobial stewardship guidelines (urinary tract infection context). (AAHA)
- International Society for Companion Animal Infectious Diseases (ISCAID). Guidelines for diagnosis and management of urinary tract infections in dogs and cats. (iscaid.org)
- American Journal of Veterinary Research (2025). Recent advances in diagnostic and therapeutic strategies for canine cognitive dysfunction. (avmajournals.avma.org)
- MSPCA-Angell (2025). Canine Cognitive Dysfunction (CCD) overview and prevalence discussion. (MSPCA-Angell)
- MSD Veterinary Manual. Diabetes mellitus in dogs and cats (clinical signs). (MSD Veterinary Manual)
- MSD Veterinary Manual. Cushing disease (pituitary-dependent hyperadrenocorticism) overview and diagnostic testing. (MSD Veterinary Manual)
- AAHA (2023). Selected endocrinopathies guideline section on suspected Cushing’s clinical presentation. (AAHA)
- MSD Veterinary Manual. Renal dysfunction in dogs and cats (clinical findings of CKD). (MSD Veterinary Manual)
- IRIS (International Renal Interest Society). IRIS Guidelines and CKD staging framework. (IRIS)
- AAHA (2022). Pain management guidelines for dogs and cats (chronic pain and osteoarthritis context). (AAHA)
- Royal Veterinary College (VetCompass). Osteoarthritis prevalence in dogs under veterinary care (recorded prevalence and underdiagnosis context). (rvc.ac.uk)
- Today’s Veterinary Practice. Diagnosing and managing urinary incontinence in canine patients; Focus on phenylpropanolamine for urinary incontinence. (Today's Veterinary Practice)