Urology
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Botox® for Urinary Incontinence
What is botox bladder injection?
While Botox is best known for its cosmetic use as a treatment for lines and wrinkles on the face, it has been FDA-approved for a number of uses including treatment of overactive bladder (OAB). Botox essentially paralyzes the bladder muscle so that it no longer spasms. Botox injections also interfere with the way muscles and nerves talk to each other. The medication disrupts any inappropriate signals going from the bladder to the brain, which might be telling the brain that the bladder is full when it's really not.
OAB is a common problem in men and women as they get older. Women in particular may have OAB symptoms associated with pregnancy and menopause.
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 (having to go often), urgency (having to go suddenly) 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 (neurogenic bladder dysfunction).
Botox bladder treatment options
Your doctor (a urologist or urogynecologist) will review your medical history and perform a physical examination to rule out other conditions that might cause urinary incontinence, such as pelvic organ prolapse, bladder infection, kidney stones or bladder stones.
If you are a candidate for Botox bladder treatment, the procedure will be done on an outpatient basis. You do not need anyone to drive you to and from the procedure and there is no advance preparation needed. When you arrive for your appointment, you will have a urine check to ensure there is no active infection (urinary tract infection). If there is no infection, you will receive medication (anesthesia) to numb the bladder and urethra. You will then be asked to sit for 20 to 30 minutes to allow the anesthesia to take effect.
To begin the procedure a tiny tube with a camera is inserted through the urethra, the natural opening where urine comes out. A needle is passed through and into the bladder where a series of small injections are made. The numbing medication prevents you from feeling pain although you may feel some discomfort. The injection part of the procedure takes approximately four minutes.
The entire visit usually takes about 45 minutes to one hour. You will be asked to empty your bladder before you leave to make sure you're able to urinate properly after the procedure. You'll also be asked to come in for a follow-up within the next month to make sure your bladder is emptying and everything is okay. Thereafter, the injections are done approximately twice a year depending on how long you experience relief. The relief from daily leakage episodes should last from six to nine months.
Keep in mind that it may take several weeks for the medication (injection) to calm the bladder down and to experience relief from incontinence.
In clinical trials, the majority of patients receiving Botox had at least a 50 percent reduction in leakage. Approximately one in four participants reported their leakage episodes stopped completely.1
Risks of botox bladder injections
As with any medical procedure, there are some potential risks and temporary side effects. There is some risk of damage caused by passing the scope through the urethra to the bladder. There is also a risk of urinary tract infection and not being able to empty the bladder completely. Patients with difficulty emptying their bladders may need a catheter for urination for a short time period (a week or so) after the procedure. Patients may experience some pain or discomfort with urination for the first few days and there may be some blood in the urine. There is a very minor risk of blood clotting.
As with any Botox procedure, there is also a minor concern about the Botox spreading beyond the treated area and affecting other parts of the body. Your doctor will discuss the risks and benefits of Botox for incontinence and help you decide whether this is an appropriate treatment option for you.
1 Botox for Overactive Bladder. Accessed August 24, 2018.In clinical trials, only 6.5 percent of patients treated with Botox for incontinence needed to use a catheter after treatment.1
Are Botox bladder injections covered by insurance?
Botox is covered by most insurance plans, including Medicare. However, insurance carriers vary as do individual patient needs. Before receiving Botox bladder injections, be sure to check with your insurance provider about coverage. Eligible patients can save on out-of-pocket costs not covered by insurance.