Botox for Overactive Bladder


What is Botox?

Botulinum toxin (botox) is a natural toxin produced by the bacteria Clostridium botulinum. This toxin is actually the most potent known toxin and blocks neuromuscular signal transmission, resulting in muscle paralysis. It is the cause of food-borne botulism, which results when Clostridium botulinum contaminated foods (often canned goods) and people consumed these foods which contained the toxin. This was (is) a potentially fatal illness (as a result of paralysis of breathing muscles) and was more prevalent prior to modern canning techniques and the use of preservatives.

Botox sounds potentially dangerous. Why is it used as a treatment?

Botulinum toxin has many helpful applications. Botulinum toxin is produced by several pharmaceutical companies in controlled doses, allowing physicians to target specific muscles to help patients. Botox and Dysport are two brand names for botulinum toxin type A (there are actually 7 subtypes but only type A is widely used in medicine).

While Botox is more recently known for its use in cosmetics and overactive bladder, there are other uses that might surprise you. Excessive sweating, migraines, hand tremors, depression, muscle spasticity, and strabismus (crossed eyes) are some examples.

How does Botox help overactive bladder (OAB)?

The most common cause of OAB is bladder muscle overactivity (bladder spasms). When these spasms happen a variety of symptoms can occur, including urgency (rushing to the bathroom), frequency of urination, getting up at night, and urinary leakage. Because bladder muscle spasms are a cause of OAB, it makes sense that Botox could be a good treatment to control OAB.

How do I get Botox?

You will need to be evaluated by a specialist. In general, you will receive an evaluation to make sure that you have OAB and rule out other problems. Botox is considered a second-line therapy, meaning that it is offered after you have tried other therapies first. These therapies include medicines, pelvic floor exercises (like hfitness!), and nutrition counseling (like hfitness!).

Is getting Botox painful? What can I expect?

Botox is injected into the bladder muscle using a bladder camera (cystoscope). It is commonly done in the clinic after numbing the bladder with lidocaine (in liquid form) that is inserted with a catheter. Most patients describe it as mildly painful and quick (it can be completed in several minutes). It can be done under anesthesia if you request. You can return to work immediately. While a minor amount of bleeding and burning with urination are common, adverse events are generally infrequent and short-lived. Based on how Botox works, some patients will have difficulty urinating (the bladder is too relaxed) and may need to use a catheter for a short period of time.

Botox generally takes a bit of time to work (several days). It generally lasts about 9 months and can be repeated numerous times. As a result, Botox provides an excellent option for patients who have struggled with OAB.