What Should I Expect After Treatment
You should not experience significant pain during or after the Botox treatment, although it may sting or burn when urinating the first few times. You may also see some blood in the urine initially after the treatments.
It may take several days for the effect of Botox to be known. Initially, you may not notice any change in your urinary symptoms, but over several days to a week or so, you should begin to experience relief of sudden urges to urinate, and a lessening of the frequency and severity of leakage episodes. You will be able to hold your bladder for longer periods of time between urinations, and will wake up less frequently to empty your bladder. If you are taking medications by mouth to relax the bladder, you may be able to wean yourself off of these once the Botox treatment begins to take effect, and your doctor will advise you about this. We usually recommend cutting the dose in half after 1-2 weeks, then trying to stop altogether by 2-4 weeks.
Risks Of Botox Injections
Treating an overactive bladder with BOTOX injections is considered safe, although there are certain risks. Potential risks may include:
- Urinary tract infection
- Painful urination
- Difficulty emptying the bladder completely
If a patient is not able to fully empty the bladder, a catheter may be necessary on a short-term basis. These serious side effects occur rarely.
What Is The Most Important Information I Should Know About Botox
You should not be treated with Botox if you are allergic to botulinum toxin, or if you have:
- an infection in the area where the medicine will be injected or
- if you have a current bladder infection or if you are unable to urinate and you do not routinely use a catheter.
Tell your doctor if you have ever had:
- other botulinum toxin injections such as Dysport or Myobloc
- amyotrophic lateral sclerosis
- myasthenia gravis
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About Oab And Detrusor Overactivity
OAB and detrusor overactivity can both cause trouble with urination. With these conditions, you may have involuntary spasms in your bladder muscles, even when you dont actually need to urinate.
The exact cause of OAB isnt known. But some possible factors or causes may include:
- consuming caffeine, alcohol, or other bladder irritants
- taking medications that increase urine output
- other bladder problems, such as bladder stones
- not completely emptying the bladder
Detrusor overactivity can be linked with neurological conditions such as MS or a spinal cord injury. These neurological conditions affect how your brain communicates with the rest of your body. In some cases, they can cause bladder problems such as detrusor overactivity.
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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Are There Any Other Important Points
Because Botox inhibits the action of bladder muscle, it is possible that the effect may be too much for your bladder, and that you may not be able to pass urine normally for as long as it takes the effect of Botox to wear off . This is rare, but if it occurred, you would need to perform intermittent self-catheterisation for this period of time. It is usual for you to be taught ISC before you have Botox to ensure that, in the rare event that you were affected in this way, you would be able pass a catheter yourself.
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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 .
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Should You Use Botox Or Oxytrol Patch Otc For Bladder Problems We Say Maybe Not
If you suffer from overactive bladder you now have two new options: Botox injections , and an over-the-counter version of the Oxytrol patch, which used to require a prescription. The Food and Drug Administration approved both recently. But our medical advisors recommend caution before trying either medication.
The decision to move Oxytrol patch from prescription to OTC status may have been premature, says Marvin M. Lipman, M.D., Consumer Reports Chief Medical Adviser. The symptoms of overactive bladder, which include incontinence and a frequent need to urinate, overlap with those of bladder infections, other forms of incontinence, and even bladder cancer. Those conditions might go untreated if you mistakenly think your symptoms are due to overactive bladder. So see your physician, initially, for proper diagnosis.
In addition, Oxytrol is only moderately effective for relieving overactive bladder symptomslike all drugs in its classand it can cause dry mouth and constipation. The patch form, which will be available OTC probably starting next fall, can cause skin reactions at the site of application in about a quarter of patientsin 11 percent of people the reactions are so severe, they stop using the patch.
If those drugs dont work or you cant take them, you could consider Botox. But make sure you understand the risks and benefits of the shots. For details, read our Botox precautions. And see our advice on off-label prescribing.
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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.
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What Is The Prognosis After The Procedure
- The prognosis after a Botox Treatment for Overactive Bladder is usually excellent for a majority of individuals the symptoms of OAB subside within 4-7 days
- However, Botox injection therapy is only a temporary treatment method and its effectiveness only lasts for a period of 6-9 months. Thus, the injections have to be administered again to control symptoms of OAB
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How Often Do You Need To Do Botox Injections
As soon as two weeks after treatment you can start to experience relief of urine leakage and other OAB symptoms. Everyone responds to treatments differently, but most people can manage the symptoms of overactive bladder with just two Botox treatments a year. You should follow up with your doctor after your first treatment to see how youre responding and be proactive in scheduling your next appointment for approximately six months after your last appointment.
You dont have to continue to plan your day around bathroom breaks, constantly check to make sure a restroom is available, and frequently excuse yourself from important meetings or fun social situations. Botox is just one of many treatments available for overactive bladder. Schedule an appointment with your doctor to learn more about Botox injections and other treatment options for overactive bladder.
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Side Effects In Few Patients
The main side effect of the procedure, which occurs in about 5 to 8% of patients, is urinary retention, or problems emptying ones bladder.
Those patients may need temporary catheterization to guard against an increased risk of urinary tract infections, Dr. Vasavada says. And for that reason, some patients decide against the procedure.
We just cant predict whos likely to go into retention, he says. Its not a high likelihood, but not zero, either. We still have no direct ability to predict.
But most patients havent had that hesitancy, Dr. Vasavada says. Since its been approved for incontinence, its certainly generating more enthusiasm and interest, he says.
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Refractory Overactive Bladder Symptoms Improve Days After Botox Injection
Refractory overactive bladder patients treated with 100 units of intradetrusor onabotulinumtoxinA reported a median time to improvement at 3 days post treatment, with maximum improvement at 7 days, according to research presented at the 2021 American Urological Association Annual Meeting.1
Prior to this study, there was really no data on exactly how long it takes until Botox begins to take effect in the bladder. Patients always ask the question, How many days till I will notice an improvement? The original studies could really only give us an idea that it should happen by two weeks, said study author Howard B. Goldman, MD, professor and vice chair, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
Cleveland Clinic investigators conducted a prospective, non-randomized study of 51 patients with non-neurogenic, refractory urgency-frequency syndrome and urgency urinary incontinence undergoing first-time BTX-A injection. Patients median age was about 72 years with an average body mass index of 33.8. All stopped taking overactive bladder medications and completed a daily Patient Global Impression of Improvement diary for 3 weeks following BTX-A treatment.
Forty-eight patients reported symptom improvement according to Patient Global Impression of Improvement scores.
There were a few adverse events. Three patients had urinary tract infections and 2 had symptomatic retention.
The findings change how Goldman counsels patients.
Reference
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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 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 And How Does It Work
Botox is a purified form of Botulinum toxin type A, a very powerful muscle relaxant. It causes muscle relaxation by preventing the release of chemicals called neurotransmitters that normally are released from a nerve cell, travel across to a muscle cell, and signal it to contract. This action of the toxin lasts for a limited amount of time, eventually wearing off as the nerve cells regain their ability to release these molecules.
What Are The Possible Risks And Complications During Botox Treatment For Overactive Bladder
There are general factors that increase the risk of complications during the procedure and they include:
- Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
- Smoking: The longer the smoking history , the greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension , especially if it is poorly controlled
- Poor nutritional status
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders and chronic infections
- Poor immune system due to a variety of causes
The possible complications that may arise during the procedure are:
- Infection
- Accidental injury to the neighboring tissue, blood vessel, nerve, or bone
- Side effects of Botox, which may be immediate and severe in some individuals
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Botox Bladder Injections: How Do They Help With Overactive Bladder
If youve ever had to get up in the middle of a movie, the middle of the meeting, or the middle of a meal to use the restroomeven though you went not too long agoyou may have overactive bladder. Overactive Bladder, sometimes referred to as OAB, is the frequent and urgent need to empty your bladder. It can be inconvenient and frustrating to pull yourself away from activities to go to the bathroom and can even lead to anxiety, shame, and depression. If you feel like youre the only one who must constantly excuse themselves from meetings, meals, or movies to use the restroom, you arent. OAB affects approximately 33 million people in the United States. The good news is, there are treatment options available. One of the more effective? Botox bladder injections. Were sharing what you need to know about Botox bladder injections to treat OAB.
How Do Bladder Botox Injections Work
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 percent of women and 3 to 11 percent 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. With an overactive bladder you may feel a sudden urge to urinate that is difficult to control, experience incontinence as soon as you feel the need to urinate, urinate frequently , or wake up two or more times in the night to urinate.
Its important to understand that urge incontinence and overactive bladder are not caused by physical activity or movement, such as when you cough, exercise or sneeze. That type of incontinence would be classified as stress incontinence. It is possible to have stress and urge incontinence at the same time.
The good news is that most people get symptom relief quickly in as short as a few days. The treatment results last about six months, and you can have additional injections. One possible side effect is urine retention, and it is not recommended for males with a risk or history of enlarged prostate.
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Why Use Botox For Bladder
Botox is essentially a muscle relaxant it is composed of botulinum toxin type A, a neurotoxin isolated from the anaerobic bacterium Clostridium botulinum that acts on motor or autonomic nerve terminals to prevent the release of the neurotransmitter acetylcholine, thus producing a localized paralysis via chemical denervation. When treating bladder dysfunction, Botox is injected into the detrusor muscle where it affects the efferent pathways as described previously to stop the detrusor from contracting and thus reduce its overactivity. The effect that Botox exerts is temporary, lasting a few months before the results slowly wear off.
How The Procedure Works
Treating overactive bladder with BOTOX is minimally invasive, he says.
We do it with a small camera, where I place a needle through the camera, and then the needle itself goes into the bladder muscle lining, Dr. Kohut says. We inject the medication that way.
The whole procedure takes 15 to 20 minutes, and the treatment lasts between six and nine months.
You can get follow-up treatments when the BOTOX starts to wear off. Youll know the BOTOX is wearing off because your overactive bladder symptoms will start to come back.
The procedure is more likely to be recommended for women than men because it is more difficult to perform on men.
Your health care provider might recommend BOTOX as a good treatment option for you if medications and behavior modifications havent worked to help with your overactive bladder.
Dr. Kohut says behavior modifications that your provider might have you try first could include:
- Avoiding things that can irritate your bladder
- Monitoring your fluid intake
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What Should I Expect Before The Procedure
You will usually be admitted on the day of your surgery.
Please tell your surgeon if you have any of the following:
- An artificial heart valve.
- A heart pacemaker or defibrillator.
- An artificial joint.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel , Brilinta®, or Aspirin.
- Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.