Botox As Incontinence Therapy
A minimal Botox procedure can provide dramatic results for older adults who experience urinary incontinence.
For the large percentage of older Americans who struggle with urinary incontinence, a growing body of research suggests that Botox is a therapy worthy of serious consideration.1-5
Close to one-half of Americans over the age of 65 who live at home struggle with urinary incontinence, and the figures are substantially higher for older adults who are institutionalized: Fully 75% of long-term nursing home residents lack complete bladder control. Both genders are susceptible, though the condition disproportionately affects women.6
A study presented at the American Urological Association annual meeting in June 2015, however, found that Botox is a highly effective treatment, with approximately 80% of patients reporting being “improved” or “greatly improved” following treatment.5 According to Victor Nitti, MD, a professor of urology and obstetrics/gynecology at New York University Langone Medical Center and one of the researchers involved in the study, the success rate in the study is similar to that reported previously in other studies and in clinical practice.
“The improvement is often much more dramatic than the types of improvement seen with medication,” Nitti says. “That’s not to say that you can’t have somebody who starts on an oral medication and has a phenomenal response,” but the likelihood is lower, he says.
Do You Need Anesthesia For Bladder Botox Injections
Botox bladder injections are performed as an outpatient procedure. You do not need general anesthesia for Botox injections in the bladder, but your doctor will administer a local anesthetic to temporarily numb your bladder so you will not feel the injections, similar to how a dentist numbs your mouth before filling a cavity. The local anesthetic generally wears off within one hour of completing the injections. Because Botox bladder injections do not require general anesthesia, you can drive yourself to and from your treatment.
Botox Injections For The Treatment Of An Overactive Bladder
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What is Botox ?
Botox is a muscle relaxant that is injected into the muscles of the bladder. It can relieve symptoms of overactive or irritable bladder, with/ without urge incontinence. It is recommended by NICE for women who have tried but not had any relief from other treatments, such as medication and bladder retraining.
What are the benefits of Botox injections?
Botox injections can reduce the frequency, urgency and incontinence symptoms associated an with overactive bladder.
What are the side effects or risks of Botox injections?
- Urinary Retention/ Temporary inability to pass urine. Some women may need to perform intermittent self-catheterisation and you will be taught how to do this prior to your procedure.
- Flu-like symptoms and fatigue.
- Blood in the urine, which should settle within 48 hours.
- Risk of urinary tract infection.
If you experience any of the following symptoms, please see your GP:
- Passing urine frequently.
- Pain on passing urine/ Cloudy urine.
- Feeling hot/ having a temperature.
- How is the procedure performed?
Botox is most often injected as an outpatient procedure under local anaesthetic. A local anaesthetic gel will be applied to the urethra. A narrow telescope is then used to examine your bladder this is called a cystoscopy. The Botox will then be injected through a special needle into areas around your bladder.
After the Procedure
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How Effective Is Botox
Botox has been shown to be an effective treatment option for bladder problems. In studies, people who received Botox injections for overactive bladder symptoms saw improvements in certain symptoms, such as frequent urination, in the 12 weeks after treatment. People also noticed an increase in the amount released during urination.
Another improvement that people using Botox for OAB symptoms noticed after receiving the injections was fewer episodes of urinary incontinence. In studies, these improvements lasted from 19 to 24 weeks.
In other studies of Botox used for OAB symptoms in adults, people reported improvements in their symptoms and in their quality of life.
Two studies looked at adults who had urinary incontinence with detrusor overactivity* linked with a neurological condition. These studies found that people who received Botox injections had fewer episodes of urinary incontinence. These improvements lasted 42 to 48 weeks for at least half the people in the study.
If you have questions about the results you can expect with this drug, talk with your doctor.
* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.
- urinary incontinence in adults with detrusor overactivity* linked with a neurological condition such as multiple sclerosis or a spinal cord injury
- detrusor overactivity linked with a neurological condition in children ages 5 years and older
Botulinum Toxin A Injections
Botulinum toxin A can be injected into the sides of your bladder to treat urge incontinence and overactive bladder syndrome.
This medicine can sometimes help relieve these problems by relaxing your bladder.
This effect can last for several months and the injections can be repeated if they help.
Although the symptoms of incontinence may improve after the injections, you may find it difficult to completely empty your bladder.
If this happens, you’ll need to be taught how to insert a thin, flexible tube called a catheter into your urethra to drain the urine from your bladder.
Botulinum toxin A is not currently licensed to treat urge incontinence or overactive bladder syndrome, so you should be made aware of any risks before deciding to have this treatment.
The long-term effects of this treatment are not yet known.
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Boxed Warning: Spread Of Toxin Effects
This drug has a boxed warning . This is the most serious warning from the Food and Drug Administration . A boxed warning alerts doctors and patients about drug effects that may be dangerous.
Receiving Botox injections can raise your risk for botulism. Botulism is a fatal condition that causes paralysis. In rare cases, Botox may spread away from where its injected to other parts of your body. This is known as botulism.
Symptoms of botulism may include:
- muscle weakness all over your body
- double vision or blurred vision
- drooping of your eyelids
- change in or loss of your voice
- loss of bladder control
- trouble breathing or swallowing
If you have any of these symptoms after receiving Botox injections, call 911 right away or seek immediate emergency medical care.
If you have questions about your risk for botulism from Botox injections, talk with your doctor.
Botox Eases Incontinence But Comes With Risks
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When women suffer from bladder incontinence, the urge to urinate can come on suddenly and sometimes uncontrollably, leading to leaks.
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 dont offer relief, more invasive options are available, including nerve stimulation called sacral neuromodulation , or a bladder injection of botulinum toxin, sold as Botox.
Researchers conducted a head-to-head comparison of the two and discovered that Botox provides more daily relief for womenbut also might be associated with more adverse events.
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.
Published in the Journal of the American Medical Association, the study involved 381 women from nine US medical centers who recorded at least six urgency incontinent episodes over three consecutive days and had not improved with other treatments.
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What Is Used For
Botox® has been used widely to treat a number of conditions including facial wrinkles, muscle spasms and more recently the overactive bladder. Injection into the bladder wall can partially paralyse the bladder, inhibiting involuntary bladder contractions and treating urinary urgency and urge incontinence. Botox® is approved by the Therapeutic Goods Administration for use in neurogenic and non-neurogenic overactive bladder in Australia.
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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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.
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.
Has Anyone Tried Botox Injections To Treat Bladder Spasms Or Incontinence If So What Happened
I’ve gotten an inquiry from an EmpowHER member, and need your help to assist her. She sought a second opinion from a new urologist who has recommended the use of Botox injections to treat her bladder spasms. Her primary urologist says he will not do this procedure because he doesn’t believe there is enough data available. The treatment is not approved by the Food and Drug Administration .
She would really like to know if any of you have tried this, and what type of experience you had. Did the process help you? If so, for how long? Was it a treatment of last resort? Would you recommend it to others? Why or why not?
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How Botox For Bladder Control Works
Botox relieves symptoms of urge incontinence by calming the nerves that overstimulate your bladder. It relaxes bladder muscles, allowing the bladder to store larger volumes of urine and reducing overactive bladder episodes. The benefits last from 6-12 months, and the procedure can be repeated if successful. A major study found that men and women given Botox used the bathroom 1 to 2 time less often after treatment.
Solving Bladder Problems With Botox
Once believed to be only useful for filling fine lines and wrinkles, Botox is now used to treat a number of medical conditions from migraines to muscle spasms. For many women living with overactive bladder, Botox has been able to provide welcome relief. When injected into the bladder, Botox is able to relax the muscles and reduce impulses and incontinence for a long period of time. We consulted board-certified urogynecologist Dr. Nathan Kow with AdventHealth Medical Group Urogynecology to learn more about this helpful treatment.
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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.
Who Is A Candidate For Botox Bladder Injections
This type of treatment is not for every patient. The procedure may be helpful for those who have bothersome OAB symptoms, such as urinary frequency , urgency and incontinence, and who have tried and failed with OAB medications. Botox bladder treatment may also be recommended for people who have medical conditions such as uncontrolled high blood pressure or glaucoma, or who have chronic constipation and therefore should not take OAB medications. The procedure is also approved for patients who have incontinence problems due to a neurologic condition, such as a spinal cord injury or multiple sclerosis .
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Can It Be Repeated
Yes, after 3 months at the earliest. About 5% of patients lose their response to Botox® over time because they develop antibodies to the Botox®. This is more likely if injection treatments are given more frequently than every 2-3 months. Currently there is no evidence that repeated injections causes damage to the bladder but this is a new treatment and the long term effects of repeated injections is not fully investigated.
Who Is Eligible For Botox Treatments
A patient who is complaining of overactive bladder/urinary urge incontinence may be a candidate to receive this treatment. The good thing about Botox is that there is no age range of who is a best candidate and it’s not limited to one gender. However, this treatment is not used to treat stress urinary incontinence, which is a separate condition where an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.
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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.
Who Are The Best Candidates For Botox Bladder Injections
Overactive bladder syndrome is diagnosed in women who suffer from urinary urgency, with or without urinary incontinence, who usually have frequency of urination during the day and throughout the night, says Dr. Kow.
He explained that your physician may start with simple first-line treatments like lifestyle and behavioral changes to try to improve OAB. These might include changing your fluid intake , food habits, and voiding patterns, as well as pursuing bladder retraining and pelvic floor muscle exercises.If first-line treatments don’t help, second-line treatments typically involve medication. Finally, the third line treatments include Botox.
We call Botox bladder injections, InterStim Neuromodulation , and Percutaneous Tibial Nerve Stimulation third-line treatments or advanced therapies. They are used to treat OAB in women who cannot tolerate the first- and second-line treatments or did not find them effective.
Women who are unable to empty their bladder well or who have recurrent urinary tract infections may not be good candidates for this treatment because the injections can worsen the voiding dysfunction and result in more UTIs.
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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.
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.
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Botox Treatment For Urinary Incontinence
In the 1980s, Botox® was developed and approved by the FDA for the treatment of certain eye muscle disorders. Shortly thereafter, Botox gained acclaim as a cosmetic product to treat wrinkles. Since the late 1990s, it has been used to treat disorders of the bladder, primarily overactive bladder. Doctors typically try to treat incontinence with medication before using Botox, but Botox is an extremely effective treatment for bladder leakage.
Botox Injections Procedure For Incontinence
To treat incontinence, Botox is injected into the bladder muscle using a specialized instrument called a cystoscope that allows the physician to look at the bladders inner lining. The procedure takes 15 minutes or less, requires no incisions, and can be performed under general or local anesthesia on an outpatient basis. There are few or no restrictions following the procedure you can return to work and regular activities immediately. It may take two weeks to see any results from the Botox procedure, but a recent study found that four in ten women became completely continent after six weeks and remained continent up to 6 months after the procedure.
Women who are currently pregnant cannot have Botox treatment for incontinence, but Botox is an alternative to surgical treatments for women who plan to become pregnant. Surgical treatments such as the bladder sling are not recommended for women who are planning to have children because pregnancy reverses the positive effects. Botox treatment however, can be used safely in between pregnancies.
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