Many people think of Botox® as a treatment for wrinkles, but Botox® is also approved to treat overactive bladder (OAB). OAB can be described as the feeling of having to go to the bathroom “right away” and includes symptoms such as severe urgency, inability to delay urination, and urinary sphincter spasm. You may leak urine when you feel the urge to go to the bathroom.
Botox is made from the botulinum bacteria and it works by blocking the ability of some nerves to communicate with bladder or sphincter muscles. It is used by several medical specialties, including Urology, Ophthalmology, Orthopedics, Plastic Surgery, and Colorectal Surgery to treat medical conditions that are not responsive to medications or other conservative therapies.
How can Botox® be used to treat urinary incontinence?
In some situations, urinary incontinence does not respond to medications and behavioral therapy. To treat with Botox®, the doctor passes an instrument called a cystoscope into the bladder to see the inside of the bladder. Then, the doctor injects tiny amounts of Botox® into the bladder muscle. The procedure is performed in our office with local anesthesia. The treatment can last 6-8 months, and can be repeated if symptoms return. It takes approximately 20 minutes for our doctor to complete the injections, but you are in the office for longer and are cared for by our Botox® nursing staff. The procedure may be performed under local or general anesthesia, depending on the surgeon’s decision. It is considered an outpatient procedure, meaning that there is no expected hospitalization afterwards.
What are the expectations?
Botox begins to work at about 1 week, but the full effect of the medication may take up to two weeks. Our goal is to see a 50% improvement in urinary symptoms after the injections – for example: longer intervals of holding urine, less nighttime urination, less incontinence. It is rare that all symptoms will resolve.. The procedure may be repeated when the symptoms return. Botox has been used to treat urinary incontinence and OAB for years and 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 patients with neurogenic bladder from conditions like multiple sclerosis or spinal cord injury we use much more Botox than in a patient with overactive bladder. The reason for this is patients with neurogenic bladder often are dependant upon catheterization to start with. In these patients the goal is to inject enough Botox so the bladder does not contract at all. This will eliminate leakage from bladder spasms and patients often are dry in between catheterizations.
What are the risks?
Botox acts to decrease the strength of the bladder’s natural contraction. It eliminates bladder spasm by this method. Even though no incision is made, Botox® injections are considered an invasive therapy. One potential side effect of this is urinary retention. In other words the Botox works to well and patients cannot void on their own, or they have some residual urine in their bladder that does not pass with normal urination. Some residual urine does not cause much problem, but if this residual urine is high, or a patient cannot void a catheter has to be placed or a patient has to periodically pass a catheter in order to drain their bladder. This complication is rare in patients with overactive bladder, because we limit the amount of Botox we inject.
There have been very few instances of Botox ever causing systemic weakness. This is a risk of Botox therapy, but extremely uncommon.