What To Expect: Botox Injection For Overactive Bladder
Youve probably heard of Botox being used to improve the cosmetic appearance of facial wrinkles. However, botox has many medical uses that go beyond improving ones appearance. For example, botox is commonly used to improve internal body functions. In the field of urology, it can be injected into the bladder muscle to improve symptoms of overactive bladder .
What is botox?
Botox is derived from the most poisonous substance known to manbotulinum toxin. This neurotoxin is produced by the Clostridium bacterium, responsible for botulism. Botulism is a rare but serious illness that can result in paralysis. Botulinum toxin, when used in minute quantities in a derivative known as botox, is a magically effective and powerful potion.
How does botox work?
Botox is a neuromuscular blocking agent that weakens or paralyzes muscles. Beyond cosmetics, it can be beneficial for a variety of medical conditions that have some form of localized muscle overactivity. Botox is generally used to improve conditions with muscle spasticity, involuntary muscle contractions, excessive sweating and eyelid or eye muscle spasm.
Botox to treat Overactive Bladder
Overactive Bladder syndrome can be described by the symptoms of urinary urgency , with or without urgency incontinence . Its usually accompanied by frequent urination during both day and night hours. OAB has been described as the bladder squeezing without your permission to do so.
What Is The Role Of Botulinum Toxin In Urinary Incontinence Treatment
A neurotoxin produced by Clostridium botulinum, onabotulinumtoxinA prevents acetylcholine release from presynaptic membrane. Therapy for urinary incontinence consists of 30 intradetrusor injections via cystoscopy.
In August 2011, onabotulinumtoxinA was approved by the FDA for urinary incontinence in patients with neurologic conditions who have overactive bladder. Placebo-controlled trials have shown significant reduction in urinary incontinence episodes and improved urodynamics at 12 weeks in patients who received onabotulinumtoxinA.
In January 2013, the FDA expanded the approved use of onabotulinumtoxinA to treatment of adults with overactive bladder who cannot use or do not adequately respond to anticholinergic drugs. The new indication was based on results of two placebo-controlled clinical trials in 1105 patients with symptoms of overactive bladder. After 12 weeks, patients who received injections of 100 units of onabotulinumtoxinA experienced urinary incontinence an average of 1.6 to 1.9 times less per day than patients treated with placebo. Treatment with onabotulinumtoxinA can be repeated if necessary, but at least 12 weeks should elapse between treatments.
Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, et al. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas. 2021 Jan. 143:223-230. .
Vaughan CP, Markland AD. Urinary Incontinence in Women. Ann Intern Med. 2020 Feb 4. 172 :ITC17-ITC32. .
Botox For Overactive Bladder Urgency Incontinence And Neurogenic Lower Urinary Tract Dysfunction:
Botox injection into the bladder is a well-established treatment for overactive bladder and urgency incontinence, including urgency incontinence associated with neurological disease. It is usually used when behavioral and exercise therapies and medications have not been effective in treating symptoms. Botox has been shown to produce dramatic improvements in symptoms and quality of life in women who have not responded to or could not tolerated other treatments. At the Center for Women’s Pelvic Health at UCLA, our physicians did some of the pioneering work on use of Botox for overactive bladder and incontinence over the past 15 years. In most cases Botox can be done in an office setting with local anesthesia instilled into the bladder.
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What Does Treatment With Botulinum Toxin Involve
Treatment with Botulinum toxin involves a day case procedure in hospital or a day procedure unit with the use of either general or local anaesthesia.
The recommended dose of Botulinum toxin for OAB is 100 Units whereas the dose recommended in people with neurological problems is 200 to 300 Units.
A cystoscope is passed into the bladder through the urine pipe and is used to inject the solution of Botulinum toxin. Tiny amounts of diluted Botulinum toxin solution is injected directly into about 20 to 30 locations inside the bladder muscle using a fine needle.
Muscular wall of inside of a bladder due to OAB.
Botulinum toxin solution is injected directly into the bladder muscle using a fine needle under guidance of the cystoscope.
Bladder appearance immediately after injection with Botulinum toxin solution.
The procedure has minimal side effects and patients are discharged home quickly after the procedure.
It is important to realise that the effects of the treatment with Botulinum toxin are NOT immediate and become apparent within 1 to 2 weeks.
A review appointment is made within 1 to 2 weeks after the treatment with Botulinum toxin to check bladder emptying .
Botox Bladder Treatment For Bladder Incontinence
Your doctor will review your medical history and perform a physical examination to rule out other conditions that might cause urinary incontinence, such as pelvic organ prolapse, bladder infection, kidney stones or bladder stones.
If you are a candidate for Botox bladder treatment, the procedure will be done on an outpatient basis. You do not need anyone to drive you to and from the procedure and there is no advance preparation needed. When you arrive for your appointment, you will have a urine check to ensure there is no active infection . If there is no infection, you will receive medication to numb the bladder and urethra. You will then be asked to sit for 20 to 30 minutes to allow the anesthesia to take effect.
To begin the procedure a tiny tube with a camera is inserted through the urethra, the natural opening where urine comes out. A needle is passed through and into the bladder where a series of small injections are made. The numbing medication prevents you from feeling pain although you may feel some discomfort. The injection part of the procedure takes approximately four minutes.
In clinical trials, the majority of patients receiving Botox had at least a 50 percent reduction in leakage. Approximately one in four participants reported their leakage episodes stopped completely.1
Keep in mind that it may take several weeks for the medication to calm the bladder down and to experience relief from incontinence.
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What Are The Side Effects Of Botox
The lists below include some of the main side effects that have been reported in people using Botox. For information about other possible side effects of the drug, talk with your doctor or pharmacist.
You can also learn more about side effects from this in-depth Botox article or from the drugs medication guide.
Note: After the Food and Drug Administration approves a drug, it tracks and reviews side effects of the medication. If youd like to notify the FDA about a side effect youve had with Botox, visit MedWatch.
What Is The Typical Dosage For Botox
Below are commonly used dosages of Botox for bladder conditions. But your doctor will determine the right dosage to fit your needs.
For OAB symptoms in adults, the recommended dose is 100 units of Botox. This is also the maximum recommended dose for treating this condition.
For use in adults with detrusor overactivity caused by a neurological condition, the recommended dose is 200 units of Botox. This is also the recommended maximum dose for treating this condition.
Botox is used in children ages 5 years and older with detrusor overactivity caused by a neurological condition. For this purpose, the Botox dose is determined based on the childs weight:
- For children who weigh at least 75 pounds , the dose is 200 units of Botox.
- For children who weigh under 75 pounds, the recommended dose is 6 units of Botox for every kilogram of body weight. Your childs doctor will calculate the appropriate dose for them.
Note: Botox has other uses in addition to treating bladder problems. The dosage may be different for these other uses. To learn more, talk with your doctor.
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How Does Botox Work
Botox helps relieve the symptoms of bladder problems by promoting bladder control.
The detrusor muscle that lines the bladder plays an important role in bladder control. When the muscle relaxes, the bladder can fill with urine. When youre urinating, the muscle contracts to release urine.
If you have overactive bladder symptoms or detrusor overactivity, your bladder muscles spasm involuntarily . Botox is injected into the detrusor muscle to block the nerve signals to the muscle. This helps control the muscles contractions.
Below are answers to some commonly asked questions about Botoxs use in treating bladder conditions.
Botox Eases Overactive Bladder 2 Studies Find
Skin smoother brought relief for majority — but not all — of patients who got injections for urinary incontinence
FRIDAY, May 15, 2015 — Although Botox has long been used to smooth aging skin, new research finds that the muscle relaxant is also a useful treatment for urinary incontinence.
With the condition, an overactive bladder contracts too often or without warning, leading to the constant urge to urinate and/or bladder leakage. But two studies, slated to be presented Friday at the American Urological Association annual meeting in New Orleans, offer evidence that injecting Botox directly into the bladder muscle may be an effective and safe way to treat the problem.
“The bottom-line gist is that we found that Botox has a good, long-lasting, safe and consistent effect over time among patients who do initially respond well to it and choose to continue treatment,” said Dr. Victor Nitti, vice chair of the department of urology at NYU Langone Medical Center in New York City.
Nitti, who is also director of NYU’s department of female pelvic medicine and reconstructive surgery, was involved in two of three new studies of Botox.
In the first study, the only one funded by Botox maker Allergen Inc., Nitti and his colleagues analyzed data on 227 patients who received Botox injections over a four-year period.
All of the patients had been diagnosed with a form of incontinence for which no specific underlying cause could be identified.
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How Does Botox Treat Urinary Incontinence
Botox has been used to treat urinary incontinence for many years. It acts to decrease the muscular contractions of the bladder. These bladder spasms can arise from routine overactive bladder, which commonly occurs in women with aging or they can be more serious in patients with neurogenic bladder from neurologic disease or injury.
Bladder spasticity has a lot of different names it is also called overactive bladder, detrusor overactivity, detrusor hyperreflexia, and neurogenic bladder.
How Often Will I Get Botox Injections
How often you receive Botox injections may vary. Youll need to track the symptoms of your bladder condition so that your doctor can determine how often you need the injections.
The minimum period between injections is 12 weeks, but in some cases, people feel the effects of Botox for longer periods. This means that they may need injections less often.
If you have questions about how often youll need to get Botox injections for your condition, talk with your doctor.
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Bladder Botox: Side Effects
Some people experience mild pelvic or abdominal discomfort after receiving Botox in the bladder. This has been described as a sensation like period cramps. This discomfort typically doesnt last more than a couple days. Other potential side effects from Botox injections in the bladder include:
- Urinary tract infection
- Difficulty urinating
- Inability to empty your bladder
These side effects are not common and are temporary. If you are experiencing any issues with urination after Botox injections in the bladder you should contact your doctor.
What Can I Expect After Receiving Botox Injections For My Bladder Problem
After receiving a Botox injection, you may have improved bladder control for about 12 weeks. Some people may still have bladder control after 24 weeks. After this period, the effect of Botox wears off, and youll need more injections.
Your experience with Botox injections may vary. If you have questions about the results you can expect with this drug, talk with your doctor. And for more information, see the How effective is Botox? section below.
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What The Treatment Involves:
Botox injection treatment is administered in the office under local anesthesia. Local anesthetic is placed via a catheter and allowed to remain in the bladder for 20-30 minutes to provide numbing of the lining of the bladder. After 20-30 minutes, a small scope which is connected to a camera is placed into your bladder through the urethra and a series of injections of Botox solution are done into the muscle of the bladder using a small needle that is passed through the scope. The actual injection procedure takes about 5 minutes or less.
Comparing Bladder Botox To Similar Treatments
Botox can have multiple benefits for overactive bladder or incontinence. This can be the ideal treatment for people of all ages. For older patients, this may be preferable to surgery since it will take less of a toll on the body.
Botox injections for the bladder are comparable in cost with most insurance coverages for oral medications, InterStim or percutaneous tibial nerve stimulation .
Below we highlight the pros and cons of Botox compared to other treatment options.
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Botox May Beat Neural Stimulation For Urge Incontinence But Has Risks
DURHAM, N.C. — When women suffer from bladder incontinence, the urge to urinate can come on suddenly and sometimes uncontrollably, leading to leakage. Patients looking for relief can initially opt for first- and second-line therapies such as drinking fewer liquids or caffeinated beverages, pelvic floor muscle training, and medication.
If those treatments prove inadequate however, patients may seek more invasive options, including a form of nerve stimulation called sacral neuromodulation , or a bladder injection of botulinum toxin, which is sold as Botox.
A head-to-head comparison of sacral neuromodulation and botulinum toxin led by a Duke Health researcher shows that Botox provides more daily relief for women, but might also be associated with more adverse events.
The findings were Oct. 4 in the Journal of the American Medical Association .
An injection of botulinum toxin in the bladder muscle works to address urgency urinary incontinence by relaxing the overactive bladder muscles that cause the condition. A sacral neuromodulation implant does the same thing by sending electrical pulses to nerves in the spine.
The study involved 381 women from nine U.S. medical centers who recorded at least six urgency incontinent episodes over three consecutive days and had not improved with other treatments.
Botulinum toxin participants also reported a greater reduction in bothersome symptoms, higher satisfaction with treatment, and a greater likelihood of endorsing the treatment.
Are There Any Long
In general, you may have side effects within the first week of receiving Botox injections. Most of the time, these side effects are temporary, but sometimes, side effects can last for several months or longer.
But possible long-term side effects of Botox can include:
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How Does Botox Treat Bladder Problems
Botox treats certain bladder problems in adults and in children. To learn more about the specific conditions its used for, see the What are the bladder conditions Botox treats? section above.
Botox isnt a first-choice medication for treating bladder problems. Its used when anticholinergic drugs didnt work well enough for someones condition.
What Are The Side Effects Of Botox When Injected In The Bladder For Treatment Of Bladder Control Problems
Large studies have shown that Botox, when injected in the urinary bladder for treatment of urinary symptoms including urinary urgency, frequent urination and for bladder control in patients with urinary incontinence, is a safe and effective treatment with few serious side effects.
While the warning label states that distant side effects of Botox are possible such as difficulty speaking/swallowing/breathing, they are apparently exceedingly rare when Botox is injected for treatment of OAB. No patients experienced distant side effects in randomized studies of Botox. In theory, the onabotulinumtoxinA can spread to other areas of the body but this would be an extremely rare occurrence following a relatively small dose of the medication which is given directly into the bladder.
Most common side effects from Botox administration in the bladder:
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Injection Of Botox Into The Bladder
Botulinum toxin is a naturally occurring toxin produced by some bacteria. The toxin causes muscle paralysis. Small quantities of Botox can be injected into selected muscles to reduce the side effects caused by unwanted or excessive muscle contraction.
The bladder muscle can be unnecessarily ‘overactive’ in some patients. This is usually manifest by frequency and urgency of urination and sometimes urinary incontinence. Patients with neurological abnormalities such as spinal cord injury or multiple sclerosis may experience similar symptoms. If treatment with anticholinergic tablets such as Oxybutynin or Solifenacin do not provide adequate relief then injection of Botox into the bladder may be recommended. Botox is injected via a telescope, usually under a general anaesthetic. The effect usually takes several weeks to become noticeable and may last for up to 12 months. Following this further Botox may be required. The dose of Botox varies between 100units and 300units and depends upon the indication and previous response to Botox.
What Are Botoxs Mild Side Effects
The mild side effects of Botox can vary depending on the condition its being used to treat. Some side effects also differ between adults and children using the drug.
Mild side effects reported in people using Botox for overactive bladder symptoms include:
- trouble urinating, or pain or discomfort while urinating
- urinary retention
Mild side effects reported in people using Botox for detrusor overactivity* linked with a neurological condition include:
- urinary retention
Mild side effects reported in children using Botox for detrusor overactivity linked with a neurological condition include:
- bacteria in the urine
- leukocytes in the urine
In many cases, mild side effects from the drug can be temporary. Some side effects may be easy to manage, too. But if side effects last for a longer time, or if they bother you or become severe, talk with your doctor or pharmacist.
* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.
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