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.
Posterior Tibial Nerve Stimulation
Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor.
It’s thought that stimulating the tibial nerve will affect these other nerves and help control the urge to pee.
A very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and your foot to move.
You may need 12 sessions of stimulation, each lasting around 30 minutes, 1 week apart.
Some studies have shown that this treatment can offer relief from urge incontinence and overactive bladder syndrome for some people, although there’s not enough evidence yet to recommend tibial nerve stimulation as a routine treatment.
Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not improved with medicine and you do not want to have botulinum toxin A injections or sacral nerve stimulation.
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.
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What Is Botox Treatment
Botox is a natural, purified protein has the ability to relax muscles. The treatment helps to reduce bladder contractions, the occurrence of urine leakage and the feeling of needing to urinate.
BOTOX treatment can be done in the comfort and privacy of Dr Gailani’s treatment rooms with no need for general anaesthetics.
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.
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Botox Injection For Bladder Problems
Botox injection has recently been approved by the Food and Drug Administration for the treatment of overactive bladder for patients who have failed to respond to standard therapy with anticholinergic medications.
Overactive bladder is a type of urinary incontinence caused by overactivity of the muscles in the bladder, causing frequent squeezing of the bladder and, thus, frequent urge to urinate. Botox can be injected into the bladder directly through a cystoscope .
Common side effects of Botox injection may include incomplete emptying, urinary tract infection, and painful urination.
What Is Botulinum Toxin
Botulinum toxin is a substance produced by the bacteria Clostridium botulinum. Botulism is caused by the harmful effects of this toxin. If the toxin enters the bloodstream, it can spread throughout the body, causing widespread muscle weakness. In its full-blown form, botulism can cause difficulty with swallowing and breathing by causing weakness of the muscles that control these functions.
The good news is that decades ago, scientists learned how to isolate the toxin and harness its power for medical use, and it can be safely injected into particular muscles in order to decrease unwanted movements of those muscles.
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Is Urge Incontinence Putting Pressure On Your Life Find Relief With Drs Bechara George Tabet David G Heiser And Steven Ochs
Urge incontinence results in unpredictable spurts of needing to urinate. These spurts can surface quickly and result in urinating whether or not youâre ready, and regardless of if youâre near a bathroom or not.
Are you suffering from urge incontinence? Your body and condition are both unique and require specialized care. The good news is that incontinence is rarely permanent. Learn more about your incontinence and our approach to your care here.
Are you ready to stop urge incontinence from controlling your life? Discuss Botox for male urge incontinence with the specialists at Urology One. Request your appointment or continue reading about how Botox for male urge incontinence can help increase your enjoyment of life and decrease frustrating emergency sprints to the bathroom.
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.
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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.
Botox Offers Fast Results
Botox starts to work over the course of the first two weeks followingtreatment. Most patients begin to notice a decrease in the frequency of theurge to urinate.
Whatâs more, Botox has a prolonged influence on the bladder. This meanstreatment for UI and OAB lasts longer than when injected into other areas.Results may vary, however, most patients experience an average of eight monthsof relief from their symptoms. Repeat treatments are recommended to provideoptimal results.
Botox is highly effective in treating UI
Weâre happy to inform patients that Botox has been found to be more effectivethan traditional medications used to treat urinary incontinence. Up to80% of patients reportsignificant improvement or complete resolution of their symptoms within two tofour weeks of treatment.
Botox is ideal for women who have not had success controlling their symptomswith standard treatment. The procedure is done on an outpatient basis,requiring no hospital stay, and takes about 20 minutes.
If youâre struggling with the symptoms of urinary incontinence, effectivetreatment is within your reach. To learn more and get started, call407-203-9232 to schedule an appointment at ourOviedo office, or 407-203-9669 to visit our Kissimmee clinic.
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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.
Botox Shots Little Better Than Nerve Stimulation For Incontinence
By Lisa Rapaport, Reuters Health
4 Min Read
– Botox injections may be slightly better at reducing urinary incontinence in some older women than InterStim, an implanted bladder control device, results of a U.S. trial suggest.
Researchers tested onabotulinumtoxinA against InterStim in patients with overactive bladder who couldnt tolerate or didnt respond to other drugs or treatments such as pelvic floor muscle training or fluid restriction.
Six months after treatment, women randomly assigned to receive Botox injections in the bladder muscle had an average of 3.9 fewer episodes of incontinence a day, compared with 3.3 fewer accidents with InterStim.
That small difference is statistically meaningful, but it may not be clinically important and is based on twice the Botox dose recommended for overactive bladder, researchers conclude in JAMA.
Both treatments are very good options, said lead study author Dr. Cindy Amundsen of Duke University in Durham, North Carolina.
Millions of older women in the U.S. alone suffer from urinary incontinence, a condition that is linked to obesity and having had multiple pregnancies.
Botox, commonly used to smooth wrinkles, can also relax muscle spasms that cause incontinence. Women selected for this treatment in the study received injections of 200 units of Botox the usual recommended maximum dose in the U.S. for overactive bladder is 100 units.
They were having an average of six episodes of incontinence a day.
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Urinary Incontinence And Overactive Bladder
Overactive bladder causes a sudden urge to urinate. For some women, this canlead to the involuntary loss of urine. Women with UI may feel embarrassed andlimit their activities. They may also develop anxiety around the frequent andurgent need to go to the bathroom.
While the risk of UI increases with age, itâs important for women to avoidcasting UI off as a normal part of aging. UI is not a normal part of aging andcan significantly impact a womanâs quality of life, affecting her physical andpsychological health.
Botox Eases Urinary Incontinence
Botox is a purified form of botulinum toxin A, made from the bacteriumClostridium botulinum. Itâs commonly used to reduce the appearance of finelines and wrinkles but its muscle-relaxing effects benefit women with a leakybladder.
In women with UI, the bladder contracts too often and spasms suddenly, causingthe urgent need to release urine. Weak or damaged pelvic floor musclescontribute to the leakage of urine in women with the condition.
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What To Expect After A Botox Injection In The Bladder
After your doctor finishes administering Botox in your bladder, they will monitor you in the office for about 30 minutes. You will be asked to empty your bladder before leaving the office and your doctor will check that no extra urine is retained when you use the restroom. Your doctor may prescribe 1-3 days of antibiotic pills to make sure you dont get an infection.
How Choosing To Suffer From Incontinence Complicates Your Happiness
You didnât choose to have incontinence, but you can choose to put an end to it. Urge incontinence comes with uncertainty. You canât possibly know when it will strike, making you question, âwill I be able to make it to the bathroom on time?â Having this thought in the back of your mind takes up space that could be occupied by happier thoughts.
Happiness requires certainty and trust. You deserve to be certain that you can make it to the bathroom before leaking, and be able to trust your body to perform. Botox for male urge incontinence may be able to bring you the certainty you need and build trust between you and your body to make life easier and more enjoyable.
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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.
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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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:
What Are The Alternatives
For urge incontinence there are other treatments including pelvic floor exercises, bladder training, neurostimualtion and anticholinergic medications such as Ditropan, Amitripylline, Detrusitol, Vesicare, Oxytrol or Betmiga. Other options are sacral neuromodulation, percutaneous tibial nerve stimulation or .
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Things To Be Aware Of With Botox
The effects of the botulinum toxin may spread from the area of injection and produce symptoms that may last as long as some weeks after injection. Swallowing, speaking, and breathing difficulties can be life threatening.
Other serious adverse reactions that may affect areas not connected to the injection site could include loss of strength and all-over muscle weakness double vision, blurred vision and drooping eyelids speaking problems, loss of bladder control, swallowing difficulties, and breathing problems.
Common side effects reported within the first 12 weeks following treatment include urinary tract infection, urinary retention, presence of blood in the urine, fatigue, and insomnia.
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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.
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What Other Warnings Should I Know About
In addition to the boxed warning described above, Botox has other warnings. If any of the following medical conditions or other health factors apply to you, talk with your doctor before using Botox:
- if you have a history of side effects from any botulinum toxin product
- if you have a condition that affects your muscles or nerves, such as amyotrophic lateral sclerosis or myasthenia gravis
- if you currently have or have a history of breathing problems, such as asthma or emphysema
- if you currently have or have a history of problems with swallowing
- if you currently have or have a history of bleeding disorders
- if you have a urinary tract infection
- if you have trouble emptying your bladder on your own
- if you have surgery scheduled
- if youre pregnant or breastfeeding
- if youve had an allergic reaction to the drug or any of its ingredients
Botox injections may interact with other medications youre taking. Tell your doctor about all drugs youre using, including prescription and over-the-counter products.
Also, tell your doctor if you:
- have received other botulinum toxin products or injections in the past
- have recently received antibiotics by injection