Botox Treatment for the Bladder
Botox (Botulinum A toxin) is a powerful drug that acts to temporarily paralyze muscles when it is locally injected. Botox is known for its popular use in cosmetics, but it actually has far reaching medical applications. It is commonly used for diverse conditions like muscle spasticity, headaches, as well as the treatment of urinary incontinence.
Botox is a well-tolerated treatment and the application of this therapy ranges from simple conditions like overactive bladder to treatment of severely spastic bladders from neurologic disease. In many instances, Botox can be injected in a short procedure in our clinic. The therapy last for six to eight months and then is re-injected. There is no limitation to the duration of using this type of therapy.
How does Botox treat urinary incontinence?
Botox has been used to treat urinary incontinence for many years. It acts to decrease the muscular contractions of the bladder. These bladder “spasms” can arise from routine overactive bladder, which commonly occurs in women with aging or they can be more serious in patients with neurogenic bladder from neurologic disease or injury. Bladder spasticity has a lot of different names; it is also called overactive bladder, detrusor overactivity, detrusor hyperreflexia, and neurogenic bladder.
How is Botox administered?
Botox needs to be injected into the muscle of the bladder. This is done in the clinic or operating room. First the bladder is flushed with a local anesthesia, via a catheter, which is allowed to thoroughly numb the bladder. Then a scope is passed up the urethra (urine channel) into the bladder. A small needle is placed through the scope and several injections are made into the bladder designed to spread Botox throughout the muscle of the bladder. Most patients tolerate this procedure well.
Figure: Onobotulinum toxin A is injected with a small needle, through a cystoscope, directly into the wall and muscle of the bladder.
How quickly does Botox work and how long does it last?
Botox begins to work at about 1 week, but the full effect of the medicine may take up to two weeks. Botox is not permanent and will last about six to eight months in the bladder. Botox has a prolonged effect in the bladder compared to other muscles where it may only last a few months.
What are the risks of Botox?
Botox acts to decrease the strength of the bladder’s 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.
Botox is a well-tolerated treatment and the application of this therapy ranges from simple conditions like overactive bladder to treatment of severely spastic bladders from neurologic disease. In many instances, Botox can be injected in a short procedure in our clinic. The therapy lasts for 6-8 months and then is re-injected. There is no limitation to the duration of using this type of therapy.
William O. Brant, MD FACS FECSM, is a board-certified urologist, specializing in sexual dysfunction, disorders of the penis, Men's Health, Peyronie's disease, male urinary incontinence, scrotal and testicular problems, and prosthetic surgery. He attended Dartmouth College (undergraduate) and the University of Washington, Seattle (graduate) and then... Read More
Dr. Hotaling has significant training in both the clinical aspects of male fertility and genetic epidemiology and he is currently the only fellowship trained male infertility/andrology expert in Utah. He completed a 6 year residency in urology at the University of Washington, elected to pursue a year of sub-specialty training in male infertility ... Read More
Richard is a board certified Physician Assistant. His clinical emphases include men’s health and general urology as well as clinic procedures for hypogonadism, erectile dysfunction, incontinence and Peyronie’s Disease. He works closely with the physicians of the Men’s Health Clinic, including pre-operative and postoperative care. He is a member of ... Read More
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Dr. Lenherr is a urologist who focuses on treatment of female incontinence and management of bladder dysfunction. She received her medical degree from the University of Chicago and completed a 6-year residency in urology at the Lahey Clinic outside of Boston. She then elected to pursue two years of sub-specialty clinical training in female pelvic m... Read More
Bladder Augmentation, Chronic Urinary Tract Infections, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Female Incontinence, Incontinence, Mesh Erosion, Neurogenic Bladder, Pelvic Dysfunction/Incontinence, Trauma and Reconstructive Urology, Urology, Vesicovaginal Fistula
Dr. Myers completed specialty training with Dr. Jack McAninch at University of California, San Fransisco. His fellowship was in trauma and urologic reconstructive surgery. In his practice, Dr. Myers treats a variety of conditions. These include conditions like urethral strictures, ureteral scarring from previous surgery or congenital development... Read More
Bladder Augmentation, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Female Incontinence, General Urology, Mesh Erosion, Neurogenic Bladder, Pelvic Fractures and Urethral Injury, Radiation Injuries, Trauma and Reconstructive Urology, Ureteral Stricture, Urethral Stricture, Urinary Diversion, Urinary Strictures and Fistula, Urology, Vesicovaginal Fistula
Kelley is a board-certified adult-gerontology acute care nurse practitioner (AG-ACNP). She has been with the University of Utah Department of Urology since 2014. Prior to this, her educational emphasis was adult urology. Clinical emphases include men’s health and male infertility as well as clinic procedures for hypogonadism, erectile dysfunction, ... Read More