Botox for Urinary Incontinence and Overactive Bladder

Bladder Botox at a glance

  • Botox is a drug prepared from the bacterial toxin botulin, used medically to treat certain muscular conditions and cosmetically to remove wrinkles by temporarily paralyzing muscles.
  • Botox is an FDA-approved treatment for overactive bladder, urinary incontinence and spastic bladders caused by neurologic diseases.
  • Botox temporarily paralyzes the bladder muscle, with effects lasting approximately 6 months.
  • Botox injected in the bladder is well-tolerated, with the most common side effect being a urinary tract infection.
  • At Urology Associates this treatment is performed in an ambulatory surgical center under general anesthesia or sedation.

What is Botox?

Botox (botulinum A toxin) is a drug that temporarily paralyzes muscles with it is locally injected. Botox is commonly known for its use in cosmetics but it can actually help with a range of medical conditions.
Botox is a neurotoxin derived from the organism Clostridium botulinum. This can be found in many natural settings including lakes, soils and forests. It can also be found in the intestinal tracts of fish and mammals, and in the organs and gills of crabs and other shellfish.

This can be a very poisonous substance if not used correctly. When injected into humans in small concentrations it can prevent signals from the nerve cells reaching the muscles.

For muscles to contract, the nerves must release a chemical messenger acetylcholine where the nerve endings meet the muscle cells. Botox prevents the release of acetylcholine, preventing the contractions of the muscle cells.

How can Botox injections treat overactive bladder or incontinence?

In 2013 the U.S. Food and Drug Administration (FDA) approved Botox to be used to treat overactive bladder (OAB). This expanded the previous approval to use this treatment option for urinary incontinence and severe spastic bladders from neurologic diseases such as multiple sclerosis or Parkinson’s disease. From 2013 to 2017, 245,000 people with OAB have used Botox to treat their symptoms.

For men, an enlarged prostate could also cause problems in the bladder, which Botox can help with.
Botox works by calming the nerves to help block the signals that trigger OAB or incontinence. This should not be a first-line treatment but can be a good option before surgery for both men and women.

The Botox treatment procedure

Prior to the day of treatment, the patient will be given an antibiotic to reduce the chances of a urinary tract infection (UTI). Before treatment, a test will be completed to make sure the patient does not have a UTI. If they do have one, the treatment will be rescheduled.

At Urology Associates Botox is administered under general anesthesia or sedation in an ambulatory surgical center. The doctor performs a cystoscopy by inserting a cystoscope through the urethra, the opening where urine exits the body. Botox is given through the cystoscope by a series of quick injections into specific areas of the patient’s bladder muscle.
It can take 24-72 hours before the Botox takes effect, but in rare cases it may take longer.

About 6 out of every 100 patients require a catheter after the treatment. If this is needed, the doctor will discuss the catheter process including cleaning prior to treatment. This is a smaller catheter than those found in hospitals and can be easily hidden.

Side effects

Botox injections are generally well-tolerated, though it may burn or sting the first few times a patient urinates. Patients may also experience blood in the urine right after treatment.
The most common side effect of using Botox to treat incontinence or OAB is a UTI. Other side effects may include fatigue, painful or difficult urination, and temporary inability to empty the bladder.

Frequency of injections

Botox’s effects last approximately 6 months and then needs to be re-injected when the patient notices the benefits are wearing off. Patients must wait at least three months between treatments, but there is no limit on the number of times this treatment can be used.

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 (PTNS).

Below we highlight the pros and cons of Botox compared to other treatment options.

Oral medication

Botox injections reduce the need for a patient to take a pill every day. The downside to Botox injections is that patients do need to go to a doctor around every 6 months to get new injections.

Stimulating nerves

InterStim and PTNS are the two types of nerve stimulation treatments offered at Urology Associates. These treatments use electrical stimulation to the sacral nerve, which can alter bladder and bowel function.

A benefit of InterStim therapy over Botox is that it has the time commitment up front and does not require a lot of follow-up care.

Botox requires less of a time commitment than PTNS, since PTNS patients require an initial 12 weekly treatments.