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When a housetrained dog suddenly isn't housetrained, the first thought is it's a behavior issue. It usually isn't. More often than not, there's an underlying health issue. Start with a veterinary examination, including stool and urine check, but don't stop there. Subtle physical issues can affect housetraining. Enlist your veterinarian's help in exploring possible root causes. Some physical impediments to housetraining include intestinal parasites, bladder, kidney or other infection, thyroid, pancreas or other organ dysfunction just to name a few.

How long is your dog cooped up?

This seems almost too obvious to mention - but leaving a dog too long without relief isn't fair to the dog. If your dog just can't hold it as long as you're requiring him to, don't blame the dog. Arrange for a pet sitter or other reliable person to take your dog out, or use doggie daycare.

Schedule changes

Dogs are creatures of habit that need time to acclimate to changes in their schedule. Once she's adjusted, things should be fine. To help her adjustment, arrange for someone to take her out on her previous schedule, gradually shifting in 15 or 30-minute increments to the new one.

Changes in diet can cause digestive upset. You don't have to switch dog foods for your dog to experience a diet change. Dog food manufacturers often adjust recipes from one batch to another. If you've just opened a new bag of food, that may be what's going on. The good news is that once acclimated to the change, your dog will probably be OK.

Some commercial dog foods cause dogs to drink a lot of water. And many foods contain excess non-digestible fillers that increase stool volume. Both increased water intake and stool volume can create urgency. The fact is sometimes a dog just plain can't hold it.

And then there are food sensitivities. Dogs, just like people, may become sensitive to specific ingredients, causing digestive upset. For example, if your dog has difficulty digesting beef, he may experience intestinal upset and possible incontinence on a beef-based diet. See our diet information and suggested reading for more information.

Dogs form associations between the environment and behavior. A dog on grass gets used to the feel, smell and other properties of the turf - all of which trigger her "go" button. If that's what she's used to, and she is taken to a city where there's nothing but concrete, those environmental cues are missing. She may hold back until she's on a surface that more closely resembles grass - perhaps Grandma's oriental.

Teaching your dog to can help alleviate this problem, as does socialization to different places throughout your dog's life. For more solutions, see behavior issues.

Similar to environment, dogs get accustomed to eliminating in a specific context. If the framework changes, so does the dog's housetraining. Here's a common example: The dog has a fenced yard where she eliminates off-leash with no one watching. That's her framework - free and alone.

So when you take her for a walk on leash, she's attached to you and you're watching. In the different context, she doesn't eliminate. When you bring her into the house and remove the leash, she goes into another room by herself and eliminates. "She was outside for hours and never went!" you cry. But the framework was different.

Some people call this "sneaky." It's not. It's just a question of framework. Sure it's upsetting, but understandable from your dog's point of view.

Socialization creates flexibility in a dog's framework. And it helps to have a cue to eliminate.

Stress - both good and bad - can affect your dog and his housetraining. Just a few of the things that may temporarily interrupt housetraining are moving house, marriage, the birth of a baby, divorce, illness or the death of a loved one.

Much as with people, things can be done to help your dog deal with stress. Make sure he's getting an adequate diet, exercise and meaningful attention through training sessions, play, and grooming.

You've just adopted a dog. The rescue organization or previous owner told you she is fully housetrained - but she's not! You think you've been lied to, but you probably weren't. Most likely, she just needs to adjust - to a new diet, a new environment, a different context - all or many of the above issues. Be patient and understanding. She's going through changes, and so are you. The difference is, you know what's going on. She doesn't have a clue.

Now that you know what can stand in your way, here are 10 aspects to housetraining the adult dog.

1) Start with a healthy dog. No matter how hard you try, housetraining can't succeed if your dog has a physical problem. (See Impediments to Housetraining). Cure the problem before starting a housetraining program.

2) Management and supervision. Your dog is either under your watchful eye, or he's confined in a crate. Those are the only options, period. If necessary, keep your dog on leash and hold the leash whenever he's is out of his crate. This isn't forever; just during housetraining.

If your dog relieves himself in a crate, you'll likely need the help of a professional trainer to work with you on some strategies.

3) Watch for the signals that mean he has to go out. Note what he does just before he eliminates. Does he sniff? Circle? Whine? Pant? Look distressed? Once you notice this behavior, you'll be able to tell when he needs to relieve himself. Ask, "Want to go out?" and take him immediately to his bathroom spot.

4) Regular, direct, quick access to the bathroom spot. Each time you ask "Want to go out?", take him immediately and directly to a bathroom location close to your door. You can change this spot later, but during housetraining get there as quickly as possible.

5) Patience, patience and more patience. At the bathroom spot, stand still and wait. If nothing happens, take your dog inside and crate him. Wait ten minutes then take him out again. Repeat this until he relieves himself. If your dog isn't used to going on leash or in a new location, it may take a while before he relieves himself. But once you've had your first success, each successive wait will be far shorter.

6) Stay with your dog. If you're not watching, you won't know if he's gone. You may think he has and five minutes after he's come back into the house he has an accident. Your responsibility: Keep an eye on him.

7) Train a "Go" signal. As soon as your dog starts to squat or lift his leg, quietly utter a cue such as "hurry up." Keep repeating your "go" signal with quiet praise until your dog is finished.

8) Keep a schedule - and keep records. Follow a regular schedule seven days a week. Keep a written record of all eliminations and the time of day, including accidents. After a few days, you may notice a helpful pattern. For instance, an accident everyday around 7:00 means you need to take him out at 6:00 or 6:30.

9) Verbal praise. Tell your dog how terrific he is when he relieves himself. Use your voice rather than petting, as touching will interrupt him. Also, it is not necessary to click - in fact, using a clicker for housetraining may hamper your efforts. Clicker training is so powerful, your dog may learn to hold back, to urinate in small amounts - all the better to get you to click, my dear.

10) What about mistakes? When your dog has an accident in the house, as soon as he starts to eliminate, utter a sharp "Ah Ah!" If possible, get your dog outside to finish (and praise). If you didn't see him relieve himself - go back to #2 and re-read all these!

Clean the spot with a non-ammonia cleaner (ammonia is one of the elements in urine, so the smell will draw your dog back to that spot). Then make the commitment to watch him more closely next time.

Accidents are not your dog's fault. If you feel the need to punish your dog, roll up a newspaper, secure it with a rubber band, hit yourself on the head and repeat "I'll watch more closely. I'll watch more closely."