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 .
Below we highlight the pros and cons of Botox compared to other treatment options.
Will I Have Side Effects If I Stop Using Botox
Stopping Botox treatment doesnt cause unique side effects. But as the amount of the drug in your body decreases, symptoms of the condition you were using Botox to treat may develop.
Botoxs effects usually wear off by about 12 weeks after your last dose. Sometimes this can result in your condition coming back. For example, chronic migraine headaches may get worse than they were prior to Botox treatment after you stop the drug.
If you have questions about stopping Botox, talk with your doctor. They can discuss how stopping treatment may affect your condition.
Learn more about some of the side effects that Botox may cause.
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How Do Bladder Botox Injections Work
Topics in this Post
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% of women and 3% to 11% 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.
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How Does It Work
Botox, yes, the same botulinum toxin that is injected into your forehead to smooth out wrinkles, is also FDA approved to treat overactive bladder, specifically for whats called urgency incontinence, which is when you cant control the urine. What Botox essentially does is partially paralyze and calm the bladder muscles. Doctors think it may also calm sensation in the bladder as well.
Botulinum Toxin: Mechanism Of Action Types And Fda Status
Botulinum toxin is a neurotoxin produced by Clostridium botulinum, which inhibits calcium-mediated release of acetylcholine from presynaptic, cholinergic nerve terminals resulting in neuromuscular blockade , . This blockade leads to temporary loss or reduction in muscle contraction and muscle atrophy at affected sites , . Furthermore, BoTA exerts inhibitory effects on stimulatory neurotransmitters, neuropeptides, and their receptors, which affect sensory nerve fibers and improves the sensation of urgency .
Although 7 antigenic subtypes of botulinum toxin exist , only A and B are commercially available and approved by the FDA for therapeutic use -. Specifically, they can be injected into the detrusor muscle, external urethral sphincter, or both depending on the indication. Of the two, botulinum type A is most commonly used given its increased potency and longer duration of action , . Dykstra et al described the first use of BoTA for a urologic indication in 1988 in a small study of SCI patients with detrusor sphincter dyssynergia , which noted improvement in PVR and urethral pressure following external urethra sphincter injection of BoTA . Since this study, others have sought to describe the potential benefits of BoTA for other indications, including benign prostatic hyperplasia, nonneurogenic overactive bladder, chronic pelvic pain, and NDO , .
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Can Botox Treat Stress Incontinence
Stress incontinence occurs when thepelvic floor muscles that support the bladder weaken. A weakened bladder allows urine to escape when you cough, laugh, sneeze, or engage in intense physical activity. Unfortunately, Botox is not a treatment for stress incontinence. Instead, doctors typically recommend bladder control exercises to strengthen the muscles and carefully monitorhydration levels. Surgical procedures, bladder training therapy, and medical devices may be used to treat the condition if these self-care interventions don’t produce results.
How Do Botox Injections Cure Bladder Continence
Botox is a type of toxin produced by the bacterium clostridium botulinum. When doctors inject it into specific muscles, it causes temporary paralysis, controlling the urinary bladder.
The injection is usually performed in the clinic by a qualified doctor who knows the bladders anatomy and lowers the urinary tract. The doctor injects small doses of botox into the bladder muscle to paralyze the muscle, reducing frequent and urgent urination problems.
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Treating An Overactive Bladder: Botox May Be More Than Cosmetic
As many as 33 million Americans may be struggling with symptoms of an overactive bladder.
But now, a minimally invasive procedure is giving some women their lives back.
Overactive bladder is a common problem, especially as we age. But its something that most of us probably dont want to talk about.
But a cosmetic procedure that is much better known for erasing facial lines is starting to gain ground among women who feel like they always have to use the bathroom.
For 65-year-old Karan Kipp, the doctors office used to be as far as she would venture from home. She was always racing to the restroom.
I have the feeling I have to go to the bathroom, and by the time I was moving, I was gushing, Karan said.
Karan tried medication, adjusted her diet, did Kegel exercises to strengthen weakened muscles. But nothing worked.
Urogynecologist Mark Ellerkmann suggested another option: a shot of Botox for the bladder.
Botox is a potent neurotoxin, and it basically is produced by a bacteria called clostridium, and in small amounts can be helpful at paralyzing the muscle, Ellerkmann said.
My grandma always called your area down there your Susie, and I thought Oh my god, my Susies getting Botox before my face, Karan said.
The procedure is done under light sedation using a tiny tool called a cystoscope.
Using a small camera and a scope, we fill the bladder up with water or saline, and then we take a very tiny needle and inject the Botox, Ellerkmann said.
RESEARCH SUMMARY
What To Expect With Botox For Migraine
For migraine management, youll typically receive Botox injections once every 3 months. During your injection visits, your doctor will give you multiple injections of the drug. Theyll typically inject Botox into muscles in the following areas:
- the area around your temples
- the back of your neck
Botox can help reduce the number of migraine attacks you have and how long they last. But the drug wont completely stop your migraine headaches. In addition, Botox doesnt work right away, and it doesnt work for everyone.
Some people start to see an improvement in their migraine headaches just 2 to 4 weeks after their first set of Botox injections. But it can take two sets of injections and up to 6 months of treatment before you get the maximum effect from Botox.
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How Does Botox Treat Bladder Problems
Botox treats certain bladder problems in adults and in children. To learn more about the specific conditions its used for, see the What are the bladder conditions Botox treats? section above.
Botox isnt a first-choice medication for treating bladder problems. Its used when anticholinergic drugs didnt work well enough for someones condition.
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 Are The Side Effects Of Botox
The lists below include some of the main side effects that have been reported in people using Botox. For information about other possible side effects of the drug, talk with your doctor or pharmacist.
You can also learn more about side effects from this in-depth Botox article or from the drugs medication guide.
Note: After the Food and Drug Administration approves a drug, it tracks and reviews side effects of the medication. If youd like to notify the FDA about a side effect youve had with Botox, visit MedWatch.
Who Is A Candidate For Botox Bladder Injections
This type of treatment is not for every patient. The procedure may be helpful for those who have bothersome OAB symptoms, such as urinary frequency , urgency and incontinence, and who have tried and failed with OAB medications. Botox bladder treatment may also be recommended for people who have medical conditions such as uncontrolled high blood pressure or glaucoma, or who have chronic constipation and therefore should not take OAB medications. The procedure is also approved for patients who have incontinence problems due to a neurologic condition, such as a spinal cord injury or multiple sclerosis .
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How Often Will I Get Botox Injections
How often you receive Botox injections may vary. Youll need to track the symptoms of your bladder condition so that your doctor can determine how often you need the injections.
The minimum period between injections is 12 weeks, but in some cases, people feel the effects of Botox for longer periods. This means that they may need injections less often.
If you have questions about how often youll need to get Botox injections for your condition, talk with your doctor.
What Bladder Botox Treatment Involves:
Botox injection treatment is administered in the office under local anesthesia. Local anesthetic is placed via a catheter and allowed to remain in the bladder for 20-30 minutes to provide numbing of the lining of the bladder. After 20-30 minutes, a small scope which is connected to a camera is placed into your bladder through the urethra and a series of injections of Botox solution are done into the muscle of the bladder using a small needle that is passed through the scope. The actual injection procedure takes about five minutes or less.
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Botox Is Used For Several Bladder Conditions
When most people think of Botox, they think about wrinkles, preventing aging and, after treatment, a face that is oddly expressionless. Ironically, though, Botox has been used for the treatment several bladder conditions. Originally a Step 5 treatment option, in 2014 it was reduced to a Step 4 treatment option for IC/BPS in the AUA Treatment Guidelines.
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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Bladder Botox: A Life
Mon 11, Sep 2017, Bridge Magazine
Botox Fast Facts
Suitable for all over active bladders
May cause urine retention
There is no bowel benefit
60-70% will need repeat treatment
If it fails, its recommended you wait 36 months for alternative treatment
Temporary 6-12 month effect
Not suitable for patients with neuromuscular disease
PBS-funded.
Michelle’s Story
After ten years of sleepless nights and embarrassing bladder accidents, Michelle who lives with Multiple Sclerosis found a life changing treatment – Botox. She speaks to Jodie Harrison.
Botox, the paralysing drug, more commonly associated with ironing out facial wrinkles, has become a life-changer for tens of thousands of Australians who suffer from overactive bladder conditions.
Since 2014, Botox has been available on the Pharmaceutical Benefits Scheme up to twice a year for people who have more than 14 incontinence episodes per week and have failed more conventional treatments.
After more than a decade of embarrassing accidents, Michelle, a 47-year-old South Australian woman, told Bridge that Botox has changed her life.
Michelle has struggled with severe bladder incontinence since being diagnosed with Multiple Sclerosis 14 years ago.
I had always avoided caffeinated coffee and tea as it has a diuretic effect. It was also suggested that I avoid drinking fruit juice before leaving home as acidic juices are thought to aggravate the bladder.
Who Shouldnt Get Botox Injections
While its a safe procedure, bladder injections of this sort arent for everyone. Your doctor may recommend against Botox if:
- Youre pregnant or nursing.
- Youve had recent surgery.
- Youve experienced side effects when using another botulinum toxin product.
- You have a condition that affects your muscles or nerves, like amyotrophic lateral sclerosis or myasthenia gravis.
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Inclusion Criteria And Exclusion Criteria
RCTs were identified if the following criteria were met: the patients with NDO or IOAB were confirmed patients > 18 year studies compared BTX-A with placebo or BTX-A at different dosages, which reported in English and Chinese.
Studies were excluded for the following reasons: stress incontinence duplicate studies for continuous outcomes, the standard deviations was still missing after contacting with the authors evaluated the clinical benefit of different injection sites only follow-up period was less than 1 week.
But Both Have Side Effects That May Affect Your Choice Researchers Say
TUESDAY, Oct. 4, 2016 For women with bladder incontinence who havent been helped by medications or other therapies, Botox injections may help control leakage better than an implanted nerve stimulation device, a new study suggests.
However, both treatments are effective, according to doctors who treat the condition.
In a head-to-head comparison, women given Botox saw their number of daily urgency incontinent episodes decrease by four, on average, compared to three for women who received the implant, called InterStim.
Botox patients also said they had a greater reduction in symptoms and were more satisfied with the treatment, the researchers said.
Many women suffer from urgency incontinence and find inadequate relief of their problem from medications or behavioral changes, said lead researcher Dr. Cindy Amundsen. Shes a professor of obstetrics and gynecology at Duke University in Durham, N.C.
Both therapies appear to be very good options for women, Amundsen said. The differences in effectiveness between Botox and InterStim were small, but statistically significant, she added.
Urgency incontinence causes a strong, sudden need to urinate, according to the U.S. National Institutes of Health. The condition is also called overactive bladder. Urgency incontinence is common. The problem affects about 17 percent of women over 45, and 27 percent of women over 75, the study authors noted.
These side effects didnt really influence how patients thought about Botox, she said.
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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
How Long Will It Take To Get The Full Effect Of Botox In The Bladder
After one botox injection, most people will notice some improvement in symptoms within four weeks. However, it can take up to three months to see the full effect. Usually, the improvement in symptoms will continue for 3-4 months after treatment. Still, there is a chance that it could last longer than that.
If the botox injection is given in combination with others, such as bladder instillations or neuromodulation treatment without a botox injection, it may take as long as 12-16 weeks for the full effect of therapy to be noticed.
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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 symptoms–like all drugs in its class–and 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 patients–in 11 percent of people the reactions are so severe, they stop using the patch.
If those drugs don’t work or you can’t 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.