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.

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.

Summary:

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.

James M. Hotaling, MD, MS, FECSM

Patient Rating:

4.6

4.6 out of 5

Dr. Hotaling is a fellowship-trained urologist specializing in Male Infertility and Men’s Health. He completed his undergraduate work at Dartmouth, graduating magna cum laude with a double major in history and biophysical chemistry.  He then went to Duke for medical school and completed a 6-year residency at the University of Washington, where he t... Read More

Specialties:

Andrology, Erectile Dysfunction, Male Infertility, Men's Health, Urology, Vasectomy, Vasectomy Reversal

Locations:

South Jordan Health Center 801-587-1454
University Hospital 801-587-1454
Utah Center for Reproductive Medicine 801-587-1454

Sara Lenherr, MD, MS

Patient Rating:

4.6

4.6 out of 5

Dr. Lenherr is a urologist who focuses on treatment of female incontinence and management of bladder dysfunction caused by neurologic disorders or prior surgeries. She also cares for patients with urethral diverticuli, vesicovaginal or urethral fisutlas and mesh complications in the bladder or urethra. She preforms many procedures in the clinic inc... Read More

Jeremy B. Myers, MD

Patient Rating:

4.8

4.8 out of 5

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

Specialties:

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, Transgender Health, Trauma and Reconstructive Urology, Ureteral Stricture, Urethral Stricture, Urinary Diversion, Urinary Strictures and Fistula, Urology, Vesicovaginal Fistula

Locations:

University Hospital
Urology
801-213-2700

Specialties:

Adrenal Cancer, Bladder Augmentation, Bladder Cancer, Complications of Spinal Cord Injury, Complications of Urologic Surgery, Endourology, Erectile Dysfunction, Female Incontinence, General Urology, Kidney Cancer, Laparoscopy, Male Incontinence, Male Infertility, Men's Health, Mesh Erosion, Neurogenic Bladder, Pelvic Fractures and Urethral Injury, Penile Cancer, Peyronie's Disease, Radiation Injuries, Robotic Cystectomy and Diversion, Robotic Kidney Surgery, Robotic Prostatectomy, Robotic Ureteral Reconstruction, Robotic Ureteral Reimplant, Stone Disease, Testicular Cancer, Ureteral Stricture, Urethral Stricture, Urinary Diversion, Urinary Strictures and Fistula, Urologic Oncology, Urology, Vasectomy, Vesicovaginal Fistula

Locations:

A location has not yet been added by this physician.

Kelley E. Taylor, NP

Patient Rating:

4.7

4.7 out of 5

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

Specialties:

Erectile Dysfunction, Hypogonadism- Low Testosterone, Male Infertility, Men's Health, Nurse Practitioner, Peyronie's Disease, Urology

Locations:

Farmington Health Center 801-587-1454
South Jordan Health Center 801-587-1454
Utah Center for Reproductive Medicine 801-587-1454
University of Utah Hospital
3rd Floor, Room 3A100
50 N Medical Drive
Salt Lake City, UT 84132
Map
Appointments
801-213-2700
Farmington Health Center 165 N. University Ave.
Farmington, UT 84025
Map
801-213-2700
South Jordan Health Center 5126 W. Daybreak Parkway
South Jordan, UT 84009
Map
801-213-2700