Potential Side Effects Of Treatment With Botulinum Toxin
Like all medications Botulinum toxin can have potential side effects.
- Burning and blood in the urine may be noticed immediately after the procedure but settles very quickly and can be managed with Ural® sachets and paracetamol.
- Urinary tract infection can occur after treatment with Botulinum toxin.
- This risk is minimised by giving a dose of antibiotics at the time of the procedure and potentially after the procedure, as well as checking that no bacteria are present in the urine with a MSU a few days before the procedure.
- UTI can easily be treated with antibiotics.
Other Treatments To Try
In rare cases when all OAB treatment fails and overactive bladder is severe, doctors may recommend one of several types of surgery.
A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. Or, urinary diversion, an alternate route for bladder drainage for severe, complicated OAB patients.
Sacral nerve stimulation. Another procedure implants a small device, similar to a pacemaker, under the skin. The device is connected to a wire, which sends small electrical pulses to nerves around the pelvic floor that control the bladder and muscles surrounding it. This helps build bladder control. Itâs often called a bladder pacemaker. The main limitation with this treatment is that it keeps you from having a spinal MRI.
Percutaneous tibial nerve stimulation. The doctor places a needle on nerves near your ankle that affect bladder control. Youâll have one session a week for 12 weeks and then maintenance treatments as needed. This procedure is done in the office.
An overactive bladder doesnât have to get in the way of your daily life. With a little time, patience, and the right treatment, you can regain control — and peace of mind. Whatever treatment for overactive bladder you and your doctor decide upon, it’s important that you stick with it. If you do, chances are your condition will improve in time.
Drugs For Overactive Bladder
In people with overactive bladder, muscles in the bladder wall contract at the wrong time. A group of drugs called anticholinergics combat this problem by blocking the nerve signals related to bladder muscle contractions. Research suggests that these drugs also might increase bladder capacity and decrease the urge to go.
Anticholinergic drugs include:
Oxytrol for women is the only drug available over the counter. Overall, these drugs work about the same in treating overactive bladder, and generally people tolerate all of them well. The main side effect is dry mouth, but anticholinergics also can cause constipation, blurred vision, and increased heartbeat.
Anticholinergics aren’t right for everyone. Some people with glaucoma, urinary retention, or gastrointestinal disease should avoid using anticholinergic drugs.
The drugs mirabegron and vibegron called beta-3 adrenergic agonists. These medications work by activating a protein receptor in bladder muscles that relaxes them and helps the bladder fill and store urine.
Doctors also treat men with drugs that relax a muscle at the bladder neck and prostate to help with emptying. They include:
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Adult Detrusor Overactivity Associated With A Neurologic Condition
The most frequently reported adverse reactions within 12 weeks of BOTOX injection for detrusor overactivity associated with a neurologic condition include UTI urinary retention and hematuria .
The following adverse event rates were reported at any time following initial injection and prior to reinjection or study exit : UTIs , urinary retention , constipation , muscular weakness , dysuria , fall , gait disturbance , and muscle spasm .
Bronchitis And Upper Respiratory Tract Infections In Patients Treated For Spasticity
Bronchitis was reported more frequently as an adverse reaction in adult patients treated for upper limb spasticity with BOTOX compared to placebo . In adult patients with reduced lung function treated for upper limb spasticity, upper respiratory tract infections were also reported more frequently as adverse reactions in patients treated with BOTOX compared to placebo . In adult patients treated for lower limb spasticity, upper respiratory tract infections were reported more frequently as an adverse reaction in patients treated with BOTOX compared to placebo . In pediatric patients treated for upper limb spasticity, upper respiratory tract infections were reported more frequently as an adverse reaction in patients treated with BOTOX compared to placebo . In pediatric patients treated for lower limb spasticity, upper respiratory tract infection was not reported with an incidence greater than placebo.
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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.
Pediatric Detrusor Overactivity Associated With A Neurologic Condition
The most frequently reported adverse reactions during the 12 weeks following BOTOX injection of 200 Units for pediatric detrusor overactivity associated with a neurologic condition include bacteriuria , UTI , leukocyturia , and hematuria .
The most common adverse reactions in patients who received BOTOX 6 Units/kg and less than a total dose of 200 Units were UTI, bacteriuria, and hematuria.
These patients were not adequately managed with at least one anticholinergic agent and were using CIC at baseline.
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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.
How It Works: Now Vs Then
The Botox procedure for OAB is performed primarily in the clinic setting, but may also be performed in an ambulatory surgical center under mild sedation.
It takes about tenminutes to complete. Doctors perform a cystoscopy and partially fill thebladder with saline. In the past, the doctor would then administer about 10 to15 injections into the dome of the bladder. Today, UVA providers have cut thenumber of injections in half.
Were still using the same amount of medication, but were doing fewer injection sites – around five, says Vaughan. A recent study showed that this approach is just as effective at decreasing the number of incontinence episodes compared to the traditional 10 to 15 injection sites. But with fewer injection sites, patients tolerate the procedure better because there is less discomfort.
Another change UVA has implemented is administering antibiotics sooner to lower the risk of urinary tract infection post-procedure, which affects around 20% of patients. I coauthored a paper published recently that showed it was beneficial to start antibiotics before administering Botox injections compared to starting them after, says Vaughan. Those patients who received antibiotics before the procedure had a decreased frequency of UTIs. So that is what we are doing currently at UVA.
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Exceptional patient care is a way of life for us. Our nurses, clinicians and support teams are dedicated to the care of a very small number of patients, so have more time for you. Theyll be with you every step of the way, tailoring your care around you and giving the peace-of-mind that comes with knowing youre in the best hands.
We work together as one to guide you through each step of your experience, with complexities unravelled and answers readily to hand. Your personal treatment plan will be laid out for you, with all the details taken care of so you can focus on you.
Important Safety Information Including Boxed Warning
WARNING: DISTANT SPREAD OF TOXIN EFFECT Postmarketing reports indicate that the effects of BOTOX and all botulinum toxin products may spread from the area of injection to produce symptoms consistent with botulinum toxin effects. These may include asthenia, generalized muscle weakness, diplopia, ptosis, dysphagia, dysphonia, dysarthria, urinary incontinence, and breathing difficulties. These symptoms have been reported hours to weeks after injection. Swallowing and breathing difficulties can be life threatening, and there have been reports of death. The risk of symptoms is probably greatest in children treated for spasticity, but symptoms can also occur in adults treated for spasticity and other conditions, particularly in those patients who have an underlying condition that would predispose them to these symptoms. In unapproved uses and approved indications, cases of spread of effect have been reported at doses comparable to those used to treat cervical dystonia and spasticity and at lower doses.
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Adverse Effects And Complications
Systemic effects are rarely observed with lower urinary tract injection of botulinum toxin. However, due to its paralytic mechanism, theoretical concerns for systemic effects do exist. Possible side effects may include generalized weakness, dysphagia, diplopia, and blurred vision. Weakness has been reported in 2 to 6 percent of patients treated with 1000 U Dysport®, but were also reported with 750 U Dysport® and with 300 U Botox®. The reported duration of such symptoms varies from two weeks to two months. Wyndaele and Van Dromme reported two cases of severe generalized muscle weakness after injection of botulinum toxin in the detrusor muscle for neurogenic bladder overactivity. However, to date there have been no reports of respiratory paralysis after lower urinary tract injection of botulinum toxin. Most documented severe cases of respiratory paralysis from Botox® treatment have occurred after cosmetic uses due to incorrect dilution of high-potency research formulations.
In a systematic review of the literature regarding intra-detrusor Botox® injections in adults with NDO, Karsenty et al. found that the most common reported complaints after treatment appeared to be pain at the injection site, procedure-related urinary tract infections , mild hematuria , and an increase in post-void residual volume potentially resulting in urinary retention or de novo intermittent self-catheterization .
What Is An Overactive Bladder
An overactive bladder causes various problems, including urinary incontinence , frequent urination, and nocturia .
People with an overactive bladder typically urinate at least eight times during the day and wake two or more times overnight to urinate. Women with overactive bladders typically suffer from urgency incontinence and urine leakage or gushing.
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Who Is A Candidate For Treatment With Botulinum Toxin
People who have not responded to medications, bladder retraining and pelvic floor physiotherapy for their overactive bladder symptoms are potential candidates for treatment with Botulinum toxin.
People who have neurological problems with their bladder may benefit from treatment with Botulinum toxin.
The use of Botulinum toxin is contra-indicated in people with certain neurological conditions such as Myasthenia Gravis or Motor Neuron Disease, and in pregnancy or when breastfeeding.
Part of the assessment before treatment with Botulinum toxin is a urodynamic study both to help confirm the diagnosis and suitability for this treatment.
Botulinum toxin is NOT effective in treating stress urinary incontinence which is leakage associated with a rise in abdominal pressure e.g. due to cough, sneeze and exercise.
Dysphagia And Breathing Difficulties
Treatment with BOTOX and other botulinum toxin products can result in swallowing or breathing difficulties. Patients with preexisting swallowing or breathing difficulties may be more susceptible to these complications. In most cases, this is a consequence of weakening of muscles in the area of injection that are involved in breathing or oropharyngeal muscles that control swallowing or breathing .
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Botox Treatment For The Bladder
Botox is a powerful drug that acts to temporarily paralyze muscles when it is locally injected. Botox is known for its popular use in cosmetics, but it actually has far reaching medical applications. It is commonly used for diverse conditions like muscle spasticity, headaches, as well as the treatment of urinary incontinence.
Botox is a well-tolerated treatment and the application of this therapy ranges from simple conditions like overactive bladder to treatment of severely spastic bladders from neurologic disease. In many instances, Botox can be injected in a short procedure in our clinic. The therapy last for six to eight months and then is re-injected. There is no limitation to the duration of using this type of therapy.
How Do Bladder Botox Injections Work
Topics in this Post
Botox injections are not just for wrinkles on your face. They also can be used to help if you have ongoing bladder continence issues. Botox is one option to treat urge incontinence or overactive bladder in people who have not had success with other treatment options.
Urinary incontinence is common and can impair your social, physical or mental well-being. Approximately 17% of women and 3% to 11% of men suffer from urge incontinence at some point in their lives.
Urge incontinence is the unintentional loss of urine caused by your bladder contracting.
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Onabotulinumtoxina For The Treatment Of Overactive Bladder
Accepted for publication 5 June 2014
21 July 2014Volume 2014:6 Pages 7989
Supplementary video showing injection technique.
Lindsey Cox, Anne P Cameron Department of Urology, University of Michigan, Ann Arbor, MI, USA Abstract: OnabotulinumtoxinA injection is a safe and effective treatment for adults with refractory overactive bladder. There is sufficient level 1 evidence to support offering onabotulinumtoxinA injections as a second-line treatment to patients who have failed behavioral therapy and oral medications such as antimuscarinics and 3 agonists. An intradetrusor injection of 100 U of onabotulinumtoxinA is likely the optimal dose to balance risks and benefits, and this is the dose approved by the US Food and Drug Administration. Improvement in urgency urinary incontinence episodes, as well as symptom scores and quality of life, were seen in around 60%65% of patients, and were significantly improved compared with those on placebo. Most studies have reported a duration of symptom relief ranging from 6 to 12 months, with repeat injections being safe and efficacious. Overall, the risk of urinary retention was around 6% across the study populations. Keywords: urgency urinary incontinence, urinary retention, nocturia, frequency
Results for onabotulinumtoxinA in OAB
Complications and their management
Botox For Overactive Bladder
Approved new use
Botox isnt just for wrinkles anymore. In 2013, the U.S. Food and Drug Administration expanded the use of Botox to include the treatment of overactive bladder .
Overactive bladder isnt a disease, but rather a group of symptoms related to the function of your bladder. If you arent sure whether you have OAB, ask yourself these questions:
- Do I often experience an urgent need to urinate right away?
- Do I need to urinate at least eight times during the day, or more than twice at night?
- Do I frequently leak urine?
If you answer yes to at least two of these questions, then you may have OAB.
How Is Botox Administered
Botox needs to be injected into the muscle of the bladder. This is done in the clinic or operating room. First the bladder is flushed with a local anesthesia, via a catheter, which is allowed to thoroughly numb the bladder. Then a scope is passed up the urethra into the bladder. A small needle is placed through the scope and several injections are made into the bladder designed to spread Botox throughout the muscle of the bladder. Most patients tolerate this procedure well.
Botox Injections For The Treatment Of An Overactive Bladder
Please note, this page is printable by selecting the normal print options on your computer.
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 48hours. 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.
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