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Overactive bladder is urinary frequency with sudden, uncontrollable urge to urinate, which can lead to the involuntary loss of urine, called urge incontinence. Botox works by relaxing the bladder muscle and inhibiting the unstable bladder contractions. It is has been FDA-approved to treat urinary incontinence due to overactive bladder related to nerve damage from conditions such as multiple sclerosis and spine injury as well as non-neurogenic causes of OAB.
Botox in my bladder? How do you do that?
Botox is injected into the bladder muscle using a specialized scope and needle injection set. The Botox is suspended in normal saline and then injected under the mucosa throughout the bladder wall. The procedure takes about 15 minutes or less and can be done under local anesthesia, sedation or general anesthesia. In the vast majority of patients, it is done under local anesthesia in an office setting and is tolerated very well.
During the procedure, a slight stinging with each injection can be felt. There may be some blood in the urine for a few days following the procedure. Antibiotics to prevent infection are prescribed. Pain is minimal if any at all afterwards.
The amount of Botox used for the first injection is usually 100u. Dosage can then increase to a maximum of 300u, and will be titrated based on the patient's prior dosage and response.
It takes about 10 days for the full effect to set in. The onset is gradual, so you should not expect to be able to notice any difference right away.
Goals of Bladder Botox Injection:
Botox has been used successfully in the cosmetic world but now it has crossed into the medical treatment of many muscular conditions. Botox has now been FDA approved to treat the
involuntary contractions of the bladder muscle in OAB and neurogenic bladder. Dramatic benefit is seen in patients who have a neurologic etiology, such as stroke, Parkinson's disease or spinal cord injury, and have demonstrable bladder spasticity on urodynamic testing. These patients have been previously resistant to medical management.
The benefits usually last for 6-9 months, and then the procedure may need to be repeated if successful. Studies have shown that about 70% of patients benefit from Bladder Botox management.
Risks of the Procedure:
The risks include blood in the urine, which may last several days after procedure, and urinary tract infection. The effect of the Botox on the bladder muscle may vary between individuals and also depends on the dosage used. The initial dose is 100u because we want the maximal benefit with the least amount of drug.
The objective is to decrease bladder overactivity, which allows increased storage capacity and ultimately less frequency and urine leakage events. Every bladder is different and the response to treatment may be too. One person may have little change in bladder symptoms while another may have a dramatic change. So good in fact that they may have a difficult time emptying. Difficulty with urination or urinary retention is relatively rare and usually short-lived. The risk of urinary retention increases with the dose which is used. This is why usually only 100 units of Botox is injected initially. At this starting dose, only between 1-3% people will experience this and it will typically last less than 2 weeks.