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Botox For Overactive Bladder Urgency Incontinence And Neurogenic Lower Urinary Tract Dysfunction:

Treating Urinary Leakage with Botox with Urologist Dr. Timothy Hlavinka

Botox injection into the bladder is a well-established treatment for overactive bladder and urgency incontinence, including urgency incontinence associated with neurological disease. It is usually used when behavioral and exercise therapies and medications have not been effective in treating symptoms. Botox has been shown to produce dramatic improvements in symptoms and quality of life in women who have not responded to or could not tolerated other treatments. At the Center for Women’s Pelvic Health at UCLA, our physicians did some of the pioneering work on use of Botox for overactive bladder and incontinence over the past 15 years. In most cases Botox can be done in an office setting with local anesthesia instilled into the bladder.

What Are Botoxs Mild Side Effects

The mild side effects of Botox can vary depending on the condition its being used to treat. Some side effects also differ between adults and children using the drug.

Mild side effects reported in people using Botox for overactive bladder symptoms include:

Mild side effects reported in people using Botox for detrusor overactivity* linked with a neurological condition include:

  • UTI
  • urinary retention

Mild side effects reported in children using Botox for detrusor overactivity linked with a neurological condition include:

  • UTI
  • bacteria in the urine
  • leukocytes in the urine

In many cases, mild side effects from the drug can be temporary. Some side effects may be easy to manage, too. But if side effects last for a longer time, or if they bother you or become severe, talk with your doctor or pharmacist.

* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.

What Happened After I Got Botox Injections In My Bladder

Editors note: The following is based on an individuals experience and shouldnt be taken as medical advice. Please consult your doctor before going on or off medication.

A year after having a lumbar fusion at the L5-S1 level of my spine, I began to urinate more frequently than usual. At first, my doctor explained it was from fibromyalgia. Like the 10 years of low back pain that led to the surgery, my symptoms of overactive bladder crept up on me. After a while, I realized there was a problem. When youre not working and youre not going anywhere socially, making 20 trips to the bathroom goes unnoticed. Without meaning to, Id slipped into a state where obsessing over my health had been normalized. Because I was removed from everyday social interaction, Id lost all sense of perspective, and the frequent trips didnt seem unusual.

Friends and family encouraged me to revamp my social life, and as I did, friends told me I went to the bathroom more frequently than anybody they knew. At that point, I used a journal to track how often I was going, and then later, how much was coming out. I drank eight glasses of water a day, the generally accepted recommended daily amount.

The hard part was that even though I drank enough water, not much would come out during urination. I would have to squeeze to get a little bit to trickle out. Previously, Id never paid attention to how much was being released. As long as I felt relieved, I was OK.

Thinkstock photo via DenBoma.

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What Is The Typical Dosage For Botox

Below are commonly used dosages of Botox for bladder conditions. But your doctor will determine the right dosage to fit your needs.

For OAB symptoms in adults, the recommended dose is 100 units of Botox. This is also the maximum recommended dose for treating this condition.

For use in adults with detrusor overactivity caused by a neurological condition, the recommended dose is 200 units of Botox. This is also the recommended maximum dose for treating this condition.

Childrens dosage

Botox is used in children ages 5 years and older with detrusor overactivity caused by a neurological condition. For this purpose, the Botox dose is determined based on the childs weight:

  • For children who weigh at least 75 pounds , the dose is 200 units of Botox.
  • For children who weigh under 75 pounds, the recommended dose is 6 units of Botox for every kilogram of body weight. Your childs doctor will calculate the appropriate dose for them.

Note: Botox has other uses in addition to treating bladder problems. The dosage may be different for these other uses. To learn more, talk with your doctor.

How Botox For Bladder Control Works

Botox In Malaysia: Top 13 Botox Questions Answered With ...

Botox relieves symptoms of urge incontinence by calming the nerves that overstimulate your bladder. It relaxes bladder muscles, allowing the bladder to store larger volumes of urine and reducing overactive bladder episodes. The benefits last from 6-12 months, and the procedure can be repeated if successful. A major study found that men and women given Botox used the bathroom 1 to 2 time less often after treatment.

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How Do Botox Injections Work For Bladder Incontinence

A urologist can inject Botox into your bladder to treat urge incontinence or overactive bladder. This helps the muscles relax, which will give you more time to get to the bathroom when you feel the need to urinate. The injections are done in the clinic, and most patients tolerate the injections well.

The Botox Preparations Contains Albumin A Derivative Of Human Blood

Based on effective donor screening and product manufacturing processes, it carries and extremely remote risk of transmission of viral diseases or Creutzfeldt-Jacob disease. No cases of transmission of viral diseases have ever been identified for albumin. It may not be suitable for people who are a Jehovahs witness.

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Do You Need Anesthesia For Bladder Botox Injections

Botox bladder injections are performed as an outpatient procedure. You do not need general anesthesia for Botox injections in the bladder, but your doctor will administer a local anesthetic to temporarily numb your bladder so you will not feel the injections, similar to how a dentist numbs your mouth before filling a cavity. The local anesthetic generally wears off within one hour of completing the injections. Because Botox bladder injections do not require general anesthesia, you can drive yourself to and from your treatment.

Comparing Bladder Botox To Similar Treatments

Urinary Retention | Fairbanks Urology

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.

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Side Effects Of Botox For Urinary Incontinence

Like any medical procedure, there are some side effects of using Botox to treat bladder leakage. After treatment, there is a greater risk of urinary tract infections and urinary retention. Patients are advised to wait at least 12 weeks between treatments to reduce the chance of side effects.

Dont let yourself or a loved one suffer with urinary incontinence without treatment. Schedule an appointment at the Incontinence Institute today by using the contact form or calling our discrete, medical concierge.

Try Other Approaches First

Doctors recommend Botox for female urology patients who have tried but received no benefit from at least one anti-spasmodic medication as well as simple stuff like modifying their fluid intake, eliminating caffeine and practicing pelvic floor exercises, Dr. Vasavada says. Until people have tried these steps, doctors dont generally recommend a procedure.

But when those methods dont work, Botox is frequently effective as long as patients repeat the treatment roughly once every six months, he says. It does wear off. Otherwise its pretty well-tolerated and works a good majority of the time.

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Bladder Botox: A Life

Mon 11, Sep 2017

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


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 was fed up with going to the toilet all the time and wetting my pants and feeling dirty. I would change my heavy duty incontinence pants five to six times a day. I needed to get up around six times during the night, said Michelle who was advised to stop drinking fluids after 6pm.

How Long Do Bladder Botox Injections Last For

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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.

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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.

When Should You Take A Muscle Relaxer

Muscle relaxers should not be taken on a regular basis but rather periodically to counteract muscle spasms. Muscle relaxers are often prescribed for individuals that have had an injury or accident and need additional pain relief from tightness or tension. Many celebrities, such as Madonna and Jerry Seinfeld, have taken this drug during various performances to help loosen up their muscles.

However, if someone needs to take a muscle relaxer regularly, it could indicate that the person needs to seek professional advice from a doctor regarding their condition.

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What Are The Risks Of Botox

Botox acts to decrease the strength of the bladders natural contraction. It eliminates bladder spasm by this method. One potential side effect of this is urinary retention. In other words the Botox works to well and patients cannot void on their own, or they have some residual urine in their bladder that does not pass with normal urination. Some residual urine does not cause much problem, but if this residual urine is high, or a patient cannot void a catheter has to be placed or a patient has to peridocially pass a catheter in order to drain their bladder. This complication is rare in patients with overactive bladder, because we limit the amount of Botox we inject.

In patients with neurogenic bladder from conditions like multiple sclerosis or spinal cord injury we use much more Botox than in a patient with overactive bladder. The reason for this is patients with neurogenic bladder often are dependant upon catheterization to start with. In these patients the goal is to inject enough Botox so the bladder does not contract at all. This will eliminate leakage from bladder spasms and patients often are dry in between catheterizations.

There have been very few instances of Botox ever causing systemic weakness. This is a risk of Botox therapy, but extremely uncommon.

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What Other Warnings Should I Know About

Botox in my Bladder?? My Experience and WHY

In addition to the boxed warning described above, Botox has other warnings. If any of the following medical conditions or other health factors apply to you, talk with your doctor before using Botox:

  • if you have a history of side effects from any botulinum toxin product
  • if you have a condition that affects your muscles or nerves, such as amyotrophic lateral sclerosis or myasthenia gravis
  • if you currently have or have a history of breathing problems, such as asthma or emphysema
  • if you currently have or have a history of problems with swallowing
  • if you currently have or have a history of bleeding disorders
  • if you have a urinary tract infection
  • if you have trouble emptying your bladder on your own
  • if you have surgery scheduled
  • if youre pregnant or breastfeeding
  • if youve had an allergic reaction to the drug or any of its ingredients

Botox injections may interact with other medications youre taking. Tell your doctor about all drugs youre using, including prescription and over-the-counter products.

Also, tell your doctor if you:

  • have received other botulinum toxin products or injections in the past
  • have recently received antibiotics by injection

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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.

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

Repeat injections

Long-term use

Complications and their management


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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

Risks And Side Effects

Botox and Dysport

Botox is a very safe prescription medication and the FDA has approved its use for the treatment of incontinence. However, there are some mild temporary side effects that may occur after the procedure.

These reactions are typically reported in the 12 weeks following the procedure. The side effects may include:

  • Urinary tract infections
  • Urinary retention
  • Hematuria

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

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.

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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What Happens During Botox Treatment

During Botox treatment for incontinence, the Botox is injected directly into the muscles of the bladder. The procedure can be performed in as short a time as one hour, and can be administered directly in the urologists or urogynecologists office.

The injection process involves using a cystoscope, which is a thin, lighted tube that helps with visibility inside the bladder. The physician will first administer an anesthetic such as lidocaine in order to numb the bladder for a less painful experience. The Botox is then injected directly into the muscles of the bladder in multiple areas.

After treatment, the patient should not experience any significant pain, though blood might be present in the patients urine and there may be a slight burning or stinging sensation during the first few instances of urination after the procedure.

The Botox injections themselves take approximately 10 minutes, while the prep time beforehand should take about 20 minutes. The assessment of the results after the injections should take approximately 30 minutes.

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