BOTOX® Injections for Overactive Bladder
Did you know the number of people in Indianapolis with overactive bladder could fill Lucas Oil Stadium…twice?
Overactive bladder is a condition in which people feel a sudden urge to urinate and need to pee frequently. Often times it is also associated with nighttime voiding (nocturia) and urinary incontinence.
BOTOX® injections are one of many treatments available to treat these bothersome symptoms.
What Does Bladder BOTOX® Treat?
Overactive Bladder with symptoms of frequent urination and/or urinary urgency
Urinary Incontinence that is associated with a sudden urge to void
It is considered a “third line” treatment and is used after less invasive therapy (like dietary changes and medications) have failed to provide relief of the overactive bladder symptoms and urinary incontinence.
How Does BOTOX® Work?
Overactive bladder and urge urinary incontinence are often caused by an overactive bladder muscle. BOTOX® (onabotulinum toxin A) is a drug that temporarily paralyzes bladder muscle when the drug is injected. BOTOX® is a neurotoxin derived from the bacteria Clostridium botulinum. Acetylcholine is a natural chemical messenger of muscle contraction and BOTOX® stops the release of this chemical messenger and prevents the contraction of muscle cells.
Is BOTOX® for Urinary Incontinence Successful?
BOTOX® is often a successful treatment for urinary incontinence and often works for patients when other therapies have failed. Clinical trials show that the success rate of BOTOX® bladder injections is between 60 and 90 percent for urgency urinary incontinence (UUI) and the symptoms that go along with it – such as urinary frequency and urinary urgency. It is important to note that BOTOX® is not for urine leakage that is associated with laughing, coughing, or sneezing – called stress urinary incontinence.
How is BOTOX® administered?
BOTOX® is put in your bladder by a doctor – usually a urogynececologist or urologist. It is commonly administered in the doctor’s office and takes about 30 minutes. Sometimes your doctor will prescribe an antibiotic to take in the days surrounding the procedure.
Before the procedure, the doctor will apply a local anesthetic to slightly numb your bladder. It’s the same medication that a dentist numbs your mouth before filling a cavity. The anesthesia often wears down a few hours after the procedure.
To see the inside of the bladder, your doctor will use a small camera, called a cystoscope. The camera will pass through the urethra (the tube that you pee from) and into the bladder. With the camera in place, the doctor will insert a small needle used to inject BOTOX®. In total, there will be about 20 injections into the bladder muscle.
What should I expect after BOTOX® injections in my bladder?
Typically patients feel some bladder pressure and fullness for a few hours after the procedure and sometimes the urine has a pink color for about a day. Within about 4-5 days, most patients start to feel some relief from their bladder symptoms after BOTOX® injections. The effect seems to plateau about two weeks after the procedure and lasts for an average of about 6 months. Fewer than one in ten patients have difficulty emptying their bladders after BOTOX® injections, but your doctor may measure how well you’re emptying your bladder a couple of weeks after the procedure.
How long does BOTOX® last in the bladder?
Botox in bladder typically lasts for approximately six months after the treatment. This length is different for each patient, however, so it’s important to let your doctor know if you begin experiencing symptoms sooner than that.
What are the Side Effects of BOTOX® for Bladder Symptoms?
Most patients tolerate BOTOX® injections very well, but it is not without side effects. The most common side effects of bladder BOTOX® include:
Urinary Tract Infections
About 1 in 5 (18%) of patients who receive BOTOX® to treat overactive bladder symptoms will have a urinary tract infection (UTI) in the first 12 weeks after the procedure and patients with diabetes are at an even higher risk. If you have UTI symptoms, it is important to let your doctor know promptly so you can be treated.
Urinary Retention
About 6-7% of patients who receive BOTOX® injections will develop urinary retention (unable to empty the bladder completely). Your personal risk and the possible downsides of this will be a major topic of conversation when deciding if BOTOX® is right for you. If urinary retention does occur, then you may need to use a catheter. When this happened in drug studies, patients used a catheter for about two months. Patients with diabetes and multiple sclerosis (MS) were more likely to have urinary retention in clinical trials.
Who Shouldn't Get Bladder BOTOX® Treatment?
Tell your doctor or other healthcare professional about all your medical conditions, all the medicines you are taking (including prescription medicine and over the counter medicines), and any previous allergic reactions. Because BOTOX® injection is a “third line” therapy for overactive bladder and urinary incontinence, the decision to use it can be complex. BOTOX® should not be used if there is a current urinary tract infection or if you have had an adverse reaction to BOTOX® injections in the past. BOTOX® does contain albumin, a derivative of human blood, so some patients will choose not to have this treatment for religious reasons.
Where can I get BOTOX® for bladder control?
BOTOX® injections are usually performed in the office by a urogynecologist or urologist while you are awake. If you prefer that the procedure be done under more sedation, let your doctor know.
BOTOX® injection is typically reserved for folks who have tried prescription drugs for overactive bladder or urge urinary incontinence (including anticholinergic medication and/or beta agonists). If you have taken any of these medications without relief of your OAB symptoms, you may be a candidate for BOTOX® treatment or other advanced treatment options for overactive bladder.
- oxybutynin (Ditropan XL, Oxytrol)
- tolterodine (Detrol, Detrol LA)
- trospium (Sanctura)
- darifenacin (Enablex)
- solifenacin (Vesicare)
- fesoterodine (Toviaz)
- mirabegron (Myrbetriq)
- vibegron (Gemtesa)
Conclusion
BOTOX® injections are a “third line” treatment for overactive bladder and urinary incontinence associated with a sense of urgency. BOTOX® injection is not right for everyone, but it is a good choice for many women who suffer from bladder control symptoms. If you have recurrent urinary tract infection, urinary retention, difficulty emptying your bladder, or diabetes, BOTOX® may not be right for you. But there are other options for treatment including medications, pelvic exercises, and bladder pacemakers (both permanent and temporary).
Indianapolis urogynecologist, Dr. Ryan Stewart, at the Midwest Center for Pelvic Health would be happy to discuss treatment options with you. To discuss options, schedule a virtual visit and we can talk about your risks and benefits with ALL of the bladder control treatments available. Bladder leakage is not a normal part of aging, and it can often be treated. Call today.