Botox Injection For Urinary Incontinence
WHAT IS BOTOX?
Botox is the brand name for Botulinum Toxin Type A (BTX-A). It is used to relax muscular tissue in the
bladder by blocking a portion of the muscle contractions of the bladder, usually for a time period ranging from 4
to 9 months. This happens because Botox exerts its paralyzing effects by inhibiting the release of acetylcholine
from the motor nerve into the neuromuscular junction. For those receiving treatment, this means they will no
longer have severe, uncontrolled bladder contractions. This treatment is not for everyone, but it does offer some
relief for those who have to deal with very severe bladder hyperreflexia.
WHO IS A CANDIDATE FOR BOTOX?
Candidates for Botox injection may include men or women with overactive bladder (OAB) or detrusorsphincter dyssynergia (DSD). It has also been known to be effective treatment for interstitial cystitis (IC),
urinary retention, and diverse prostatic conditions.
Prior to treatment, a full urodynamic evaluation should be done to confirm a diagnosis of OAB or IC. You will
also have your bladder capacity checked to confirm a normal sized bladder. Botox should not be given to
anyone who does not have a normal bladder size. Typically, people with OAB due to detrusor instability or a
neurologic problem such as multiple sclerosis or a stroke are suitable, provided the above conditions have been
met. Patients on blood thinning medications such as aspirin, ibuprofen, Aleve, naproxen, Coumadin, or
warfarin will be required to stop these medications at least 1 week prior to surgery. You will be able to restart
these medications a few days after surgery. This should be managed by the primary doctor or cardiologist who
prescribed your blood thinners and will not be managed by this office.
HOW IS BOTOX GIVEN?
You will not be allowed to eat or drink for 5 hours before your procedure. No
other special preparation is necessary. Botox can be given under either general or
local anesthesia. Prior to your procedure, approximately 100cc of lidocaine, a
numbing agent, will be instilled into your bladder and allowed to sit until the
inside of your bladder is numb. After this, a cystoscopy (looking at the inside of
the bladder with a small camera) is performed and the bladder is examined
carefully. Botox is injected into the bladder wall through a special needle passed
through the scope directly. The bladder is emptied afterwards. Sometimes, a
catheter is placed to do this.
WHAT IS EXPECTED AFTER BOTOX?
There should be a reduction in urinary urgency and frequency about 5 days after Botox has been given. If
leakage occurred before Botox, there should be no leakage afterwards. The maximum benefit is obtained about
2 weeks after the administration of Botox, and the total effect lasts between four to nine months.
You may be given a prescription for an antibiotic to take for 3 days following the procedure. You will need to
return to our office one week after the procedure for a bladder scan, to make sure you are emptying your
bladder when you urinate.
SIDE-EFFECTS OF BOTOX AND POSSIBLE COMPLICATIONS?
There are few reported side effects from the Botox injection. There is a risk of urinary retention (inability to
empty the bladder completely) in approximately 6% of the patients for the first 2 months. If you have Diabetes
Mellitus, the risk is about 12%. This may require a catheter to be inserted, or for you to be taught how to insert
a catheter intermittently until this side effect subsides. You may notice blood in your urine after your injection,
as a needle penetrates the bladder wall. The blood may appear for a few days and then should subside. There is
a chance that an infection may develop in the urine, but antibiotics are given to avoid this.
Allergic reactions are reported, but again these are very rare. Very rarely, if Botox is injected directly into a
blood vessel, anaphylaxis may occur. This would not occur immediately, but would be noticed slowly over a
few weeks after the injections, usually within time to act. Appropriate treatment would be administered.
CONTRAINDICATIONS OF BOTOX?
There are several medical conditions that may mean you are not a candidate for Botox injection. Some of these
are Myasthenia Gravis, Eaton-Lambert Syndrome, Amyotrophic Lateral Sclerosis (Lou Gehrig Disease),
breastfeeding, pregnancy, and the concomitant use of agents that potentially act at the level of neuromuscular
transmission such as Aminoglycosides. Also, some of the formulations of Botox may include stabilizers such
as albumin, derived from human blood, which may be of religious or cultural importance.
COST OF BOTOX?
Botox is FDA approved for use in the bladder as treatment for specific diagnoses. Insurance companies are
requiring the procedure be preauthorized. Some insurance companies will cover the physician cost and/or
outpatient surgery cost, but will not cover the medication.
Updated 9/18/13 leb
2500 E. Capitol Dr. Ste. 2600
Appleton, WI 54911
920-739-3537 / 800-529-9908