Botox® injections for overactive bladder

Overactive bladder is a common condition that includes urinary urgency (a sudden, intense need to pee), frequency (needing to empty the bladder often), and sometimes incontinence. Urinary incontinence involves the involuntary loss of urine, which can occur due to activities like coughing or laughing (stress incontinence), urgency that leads to leaks (urge incontinence), or a combination of both.
The condition affects one in three women and is more common after menopause, but it can impact people of all ages. Yet, too many people wait years before seeking treatment. Some feel it’s just a normal part of aging. Others may feel too embarrassed to talk about it.
The good news is that overactive bladder is treatable. Whether you can’t seem to control when you pee or feel like you’re constantly getting up at night to run to the bathroom, discussing your symptoms with your doctor or urogynecologist is the first step to developing a personalized treatment plan.
How Botox® helps overactive bladder and urge urinary incontinence
Botox® injections are an FDA-approved treatment option when other types of therapies are not effective. Suitable for people of all ages, the procedure is safe and has an overall 80 to 90 percent success rate.
“The first line of treatment includes a discussion about lifestyle changes, pelvic floor exercises, bladder training and healthy bladder habits,” says urogynecologist Isuzu Meyer, MD. “Then we move to oral medications, which are about 30 to 50 percent effective, if medications are a viable option for the patient. If these are ineffective, we can discuss Botox®, or onabotulinumtoxinA, injections.”
How it works, and how long it lasts
Botox® injections affect the muscle-nerve connection. Because it decreases spasms and helps the muscle to relax, it can also be used for other issues like chronic migraine and other disorders. For overactive bladder, Botox® works by blocking the nerve signals so that the bladder muscle stops contracting too much. This relaxation helps reduce frequency, urgency and urine leakage related to urinary urgency.
The injection procedure is minimally invasive, using a topical, numbing medication right in the clinic. Botox® is then directly injected into the bladder muscle using a tiny, catheter-sized scope inserted through the urethra. Injections takes less than a minute, and are spread throughout the bladder to help it relax and reduce spasms.
The effects last an average of six months or so. Because Botox® wears off over time, the injections can be repeated.
What to expect after treatment, and potential side effects
After treatment, you’ll be asked to empty your bladder. Once you’re ready, you can drive home and resume normal activities.
The speed at which results are noticed can vary from person to person. “Some people notice a significant difference within hours, while others take a couple of days to a week or two for continued improvement,” adds Dr. Meyer. “Don’t be disappointed if you don’t see improvement immediately.”
Minor bleeding or mild cramping is possible for a few days after the procedure, but typically disappears quickly. No long-term side effects are known.
“Side effects are rare but can include urinary tract infections (UTIs) or temporary urinary retention (difficulty fully emptying your bladder) in some patients,” says Dr. Meyer. “To mitigate these, we screen for UTIs beforehand and provide prophylactic antibiotics. Urinary retention is uncommon, affecting fewer than 1% of patients who require temporary catheterization. Overall, the procedure is well-tolerated.”