Home Care Information
Conservative or medical management of intervertebral disc extrusions is what we call any
treatment regime that does not include surgery. This usually involves 4 main parts: pain
relief, strict rest, bladder management and physiotherapy.
Pain Relief
Intervertebral disc extrusions are often very painful so normally we prescribe a combination
of medications (something termed multimodal analgesia). By using multiple medications,
we can more successfully manage their pain whilst also reducing the risk of side effects of
each medication. Generally, we prescribe non-steroidal anti-inflammatory drugs (e.g.
Metacam), paracetamol and gabapentin although this plan is modified depending on your
dog’s pain score and any other health conditions they may have.
Strict Rest
Strict rest is an important part of conservative management of intervertebral disc
extrusions. Most commonly this is recommended to be in a cage but occasionally a pen is
more appropriate. The aim of this rest is to reduce the risk of more disc material (the jam
from the middle of the doughnut) being squeezed out making your dog’s signs more severe
and potentially delaying recovery. Whilst rested it is important to monitor your dog for
pressure sores (see images below) and urine scold and to report any problems to your vet.
Pressure sores can be avoided by using soft, supportive bedding such as a mattress and
regularly turning your dog if they are unable to do so themselves. Urine scold is also
avoidable by using absorbent bedding and if required, regular bladder expression (see
bladder management section).
Longer term, rest also has another function. Many dogs who are not able to walk will learn
that using their front legs to manoeuvre is more efficient, giving them less incentive to learn
to use their back legs again. For this reason, we often continue to recommend strict rest
even after the risk of further material extruding has passed.
Bladder Management
Many dogs with intervertebral disc extrusions who are unable to walk are also unable to
urinate. This has the potential to cause serious problems and must be monitored closely.
Often dogs will be hospitalised until they are able to urinate consciously, but you still may
be asked to express your dog’s bladder at home. Please note that this will always be
demonstrated to you by your vet. Bladder expression can be done with your dog standing
or lying down. Using the flat part of your fingers on each side of their abdomen press softly,
slowly increasing the pressure. You should feel a small ‘balloon’ – this is your dog’s bladder.
As you apply constant pressure to this ‘balloon’ urine will begin to flow. The pressure
should be constant and slowly increased until the bladder is empty, and no more urine can
be expressed. It is important to try to always empty the bladder completely to minimise the
risk of urinary tract infections. It is usually recommended to do this every 6-8 hours but in
some dogs it may be recommended to do this more frequently. Occasionally medication is
also prescribed to aid bladder expression.
