Sunday, April 14, 2024

How Does Botox Work For Urinary Incontinence

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What Is Botulinum Toxin

When Would You Use Botox Bladder Injection for Urinary Incontinence?

Botulinum toxin is a natural, purified protein, which has the ability to relax the muscle into which it is injected. Botulinum toxin type A is produced by a bacteria similar to the way that penicillin is produced by a mould.

While there are many different types and brands of Botulinum toxin, Botox® is the brand that has been most widely researched for use in the urinary tract.

Botulinum toxin has been widely and safely used for over 20 years in other conditions such as the treatment of squint, muscle spasm, recurrent migraines and more recently by cosmetic surgeons in the treatment of facial wrinkles.

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 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.

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Is Botox For Urinary Incontinence Safe

There are many studies that support the efficacy and safety of Botox in the treatment of urinary symptoms regardless of the underlying cause.

Some of the potential complications of Botox include, but are not limited to, injury to the bowels, damage to the bladder, blood in the urine, and urinary tract infections . After injections, patients may experience pain with urination or temporary urinary urgency. In addition, about 25% of patients will get urinary retention, which is the inability of the bladder to fully empty on its own. If urinary retention occurs, patients may need to use temporary catheter placement or intermittent catheterization until the bladder recovers its strength. While rare, Botox can potentially be absorbed into the bloodstream, causing a loss of sensation or numbness.

As a rule, Botox should not be used in patients who have a known allergy to botulinum toxin. At the same time, patients who are allergic to any of the inactive components of Botox should refrain from using it. In general, Botox is only intended for adult patients of more than 18 years of age . Due to the lack of scientific literature on the topic, Botox should not be injected in pregnant and breastfeeding women unless it is medically justified to use the injections.

Talk to your doctor about whether Botox for incontinence is right for you.

Financial And Insurance Assistance

Can Urinary Incontinence Cause UTIs? Short answer

If you need financial support to pay for Botox, or if you need help understanding your insurance coverage, help is available.

Allergan, the manufacturer of Botox, offers the Botox Savings Program, which may help lower the cost of your treatment. For more information and to find out if youre eligible for support, call 800-44-BOTOX or visit the program website.

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How Do Bladder Botox Injections Work

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 percent of women and 3 to 11 percent 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. With an overactive bladder you may feel a sudden urge to urinate that is difficult to control, experience incontinence as soon as you feel the need to urinate, urinate frequently , or wake up two or more times in the night to urinate.

Its important to understand that urge incontinence and overactive bladder are not caused by physical activity or movement, such as when you cough, exercise or sneeze. That type of incontinence would be classified as stress incontinence. It is possible to have stress and urge incontinence at the same time.

The good news is that most people get symptom relief quickly in as short as a few days. The treatment results last about six months, and you can have additional injections. One possible side effect is urine retention, and it is not recommended for males with a risk or history of enlarged prostate.


How Is Botox Treatment Performed

Botox is injected directly into the bladder muscle through an instrument placed into the bladder called a cystoscope. After being positioned on an examining table, anesthetic jelly is passed into the urethra, then a catheter is passed into the bladder, and the urine is drained. Through this catheter, a local anesthetic solution is placed into the bladder to numb its lining. A small flexible needle is then introduced through the cystoscope to perform the injections. Anywhere from 10 to 30 injections are made into the bladder, and at each site a small amount of Botox solution is injected.

The procedure is usually performed on an outpatient basis, meaning that no overnight hospital stay is required. In most cases, only local anesthetic is required however, some doctors may also give sedative medication, and some prefer to perform the procedure with the patient under spinal or general anesthetic depending on the situation. Typically, the procedure takes only 10 to 30 minutes. Antibiotics are given before the procedure.

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When Do You Need To Call Your Physician

Do contact your physician if you notice any of the following symptoms:

  • Worsening pain and swelling around the injection site
  • Bleeding or fluid drainage from the site
  • The occurrence of any symptom that causes uneasiness such as nausea, vomiting, or constipation
  • Experiencing difficultly or pain while urinating
  • Presence of blood in urine
  • Signs of an infection
  • Side effects of the injection including muscle weaknesses and swallowing/speaking/breathing difficulties

What Are The Factors That Influence How Long A Muscle Relaxer Stays In Your System

Botox For Bladder Incontinence

There are some factors that can influence how long the muscle relaxer stays in your system:

  • Age and weight of the person taking muscle relaxers
  • Your genetics and metabolism rate
  • Whether there was any food intake before taking muscle relaxers The severity of your overall health condition
  • Amount of dosage consumed

So these factors have strong influences on a persons system after taking muscle relaxers. There are ways that can affect how long muscle relaxers last in your system that you should know about. For example, it is important to have a full stomach before taking this medication because having food in the digestive tract will slow down the absorption of the medicine into the bloodstream, which means it will take longer for the drug to work.

Note: this article does not cover all possible directions, side effects, or precautions. Please consult a doctor before taking muscle relaxers.

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Alcohol Use With Botox

There arent any known interactions between getting Botox injections and drinking alcohol.

Keep in mind that drinking alcohol could cause your risk for certain side effects of Botox to be higher, including:

If you drink alcohol, talk with your doctor about how much is safe for you to drink during Botox treatment.

What Should I Expect After Treatment

You should not experience significant pain during or after the Botox treatment, although it may sting or burn when urinating the first few times. You may also see some blood in the urine initially after the treatments.

It may take several days for the effect of Botox to be known. Initially, you may not notice any change in your urinary symptoms, but over several days to a week or so, you should begin to experience relief of sudden urges to urinate, and a lessening of the frequency and severity of leakage episodes. You will be able to hold your bladder for longer periods of time between urinations, and will wake up less frequently to empty your bladder. If you are taking medications by mouth to relax the bladder, you may be able to wean yourself off of these once the Botox treatment begins to take effect, and your doctor will advise you about this. We usually recommend cutting the dose in half after 1-2 weeks, then trying to stop altogether by 2-4 weeks.

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How Does Botox Treatment Work

Botox is a neuromodulator, which means that it can safely block nerve communication between the nerves and the bladder muscles for a series of months without damaging the nerve tissue. When used to block nerve signals to the detrusor muscle, Botox can effectively eliminate bladder spasms that may cause urinary leakage or the sudden urge to urinate without any warning.

Overactive bladder or bladder spasticity often occurs in older women, or women who may have suffered nerve damage as a result of childbirth or trauma. Botox can provide 6 to 8 months of relief and may be re-injected once the effects have worn off and have proven to be successful as a female incontinence treatment. An additional benefit of detrusor muscle Botox injections is that female urinary incontinence patients typically experience an increase in bladder capacity once the muscles no longer spasm or contract involuntarily.

Am I A Candidate For Botox

Botox for Overactive Bladder in Multiple Sclerosis

You may be a candidate for Botox treatment if you have a particular type of urinary incontinence called urge incontinence, and if you have tried other medications for this, called antimuscarinics, without success. Urge incontinence is also associated with frequent urination and night-time urination. Botox is NOT effective for the treatment of another common type of urine leakage called stress incontinence. If this is the principle cause of your incontinence, your doctor will not likely discuss Botox treatments with you.

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Are There Other Treatments For Overactive Bladder That Doesnt Respond To Medications

There are two other treatments, both with benefits and drawbacks:

  • Sacral Nerve stimulator. This can be considered a pacemaker for the bladder. It is implanted during a surgery and stays in the body. Not all patients respond and a trial procedure is required. This treatment can provide long lasting benefits without retreatment needed until the battery needs to be replaced, which may five years or longer.
  • Posterior tibial nerve stimulation. This treatment uses small acupuncture type needles that are placed behind the ankle. Light electrical stimulation is then applied to the needles. For some patients, this option is attractive as it is the least invasive approach. It however requires weekly 30 minute treatments over 12 weeks with subsequent future follow up treatments as necessary and like the other options, not all patients respond.
  • If you suffer from overactive bladder, make an appointment with a urologist. To learn more about the USC Institute of Urology, visit

    To speak with someone at USC Verdugo Hills Hospital, call .

    What Is Botox And How Does It Work

    Botox® is a pharmaceutical preparation of the botulinum toxin type A produced by the bacterium Clostridium botulinum, which has muscle relaxant properties. It is usually used in MS for two reasons.

    The first reason is for the relief of focal muscle spasticity and is usually used in conjunction with stretching and physiotherapy.

    The second reason Botox is helpful in MS, is for the treatment of urinary incontinence due to overactivity of the detrusor muscle in the bladder. There are strict criteria to guide selection of the most suitable patients for this procedure, where clinical trials have shown significant improvements in quality of life and incontinence episodes.

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    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 . 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 patients 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.

    What Are Some Alternative Choices For The Procedure

    Botox in the bladder for Urinary Incontinence treatment

    Some of the alternatives to Botox Treatment for Overactive Bladder include the following measures:

    • Administration of medication to relax or contract the bladder muscles
    • Nerve stimulation through minimally-invasive procedures
    • Surgery to increase urinary bladder volume using graft tissue from other parts of the body
    • Reconstructive surgical procedures for urinary bladder, for severe OAB

    Alternatives to Botox for Overactive Bladder may be considered in individuals who do not tolerate Botox injections.

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    Botox Should Not Be Used In Patients With

    • Myasthenia Gravis, Eaton Lambert Syndrome or Amyotropic Lateral Sclerosis
    • Known hypersensitivity to and ingredient in the formulation
    • In the presence of urine infection
    • In conjunction with aminoglycoside antibiotics e.g. gentamicin or other drugs that interfere with neuromuscular transmission.
    • During pregnancy or breast feeding.
    • Haemophilia or other bleeding disorders

    Adverse Effects And Complications

    Systemic effects are rarely observed with lower urinary tract injection of botulinum toxin. However, due to its paralytic mechanism, theoretical concerns for systemic effects do exist. Possible side effects may include generalized weakness, dysphagia, diplopia, and blurred vision. Weakness has been reported in 2 to 6 percent of patients treated with 1000 U Dysport®, but were also reported with 750 U Dysport® and with 300 U Botox®. The reported duration of such symptoms varies from two weeks to two months. Wyndaele and Van Dromme reported two cases of severe generalized muscle weakness after injection of botulinum toxin in the detrusor muscle for neurogenic bladder overactivity. However, to date there have been no reports of respiratory paralysis after lower urinary tract injection of botulinum toxin. Most documented severe cases of respiratory paralysis from Botox® treatment have occurred after cosmetic uses due to incorrect dilution of high-potency research formulations.

    In a systematic review of the literature regarding intra-detrusor Botox® injections in adults with NDO, Karsenty et al. found that the most common reported complaints after treatment appeared to be pain at the injection site, procedure-related urinary tract infections , mild hematuria , and an increase in post-void residual volume potentially resulting in urinary retention or de novo intermittent self-catheterization .

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    Can It Be Repeated

    Yes, after 3 months at the earliest. About 5% of patients lose their response to Botox® over time because they develop antibodies to the Botox®. This is more likely if injection treatments are given more frequently than every 2-3 months. Currently there is no evidence that repeated injections causes damage to the bladder but this is a new treatment and the long term effects of repeated injections is not fully investigated.

    Who Is A Candidate For Botox Bladder Injections

    Botox Approved for Overactive Bladder Treatment

    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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    Onabotulinumtoxina For The Treatment Of Overactive Bladder

    Accepted for publication 5 June 2014

    21 July 2014Volume 2014:6 Pages 7989

    Supplementary video showing injection technique.

    Views: 2356

    Lindsey Cox, Anne P Cameron Department of Urology, University of Michigan, Ann Arbor, MI, USA Abstract: OnabotulinumtoxinA injection is a safe and effective treatment for adults with refractory overactive bladder. There is sufficient level 1 evidence to support offering onabotulinumtoxinA injections as a second-line treatment to patients who have failed behavioral therapy and oral medications such as antimuscarinics and 3 agonists. An intradetrusor injection of 100 U of onabotulinumtoxinA is likely the optimal dose to balance risks and benefits, and this is the dose approved by the US Food and Drug Administration. Improvement in urgency urinary incontinence episodes, as well as symptom scores and quality of life, were seen in around 60%65% of patients, and were significantly improved compared with those on placebo. Most studies have reported a duration of symptom relief ranging from 6 to 12 months, with repeat injections being safe and efficacious. Overall, the risk of urinary retention was around 6% across the study populations. Keywords: urgency urinary incontinence, urinary retention, nocturia, frequency


    Results for onabotulinumtoxinA in OAB

    Injection technique

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