Up to 50% of patients with female urinary organs have some issue with bladder control, which can begin as early as their 20s. Those who have had multiple pregnancies or are overweight are at higher risk.

Overactive bladder consists of at least two of the following: an urgent need to urinate right away; urinating at least eight times during the day, or more than twice at night; frequently leaking urine.

For patients with overactive bladder or urge incontinence who have tried diet and behavioral changes and medications without success, Botox remains an excellent treatment option.

Botox is one of three third-line treatments for overactive bladder, with or without incontinence. The others, sacral nerve modulation and percutaneous tibial nerve stimulation, also are effective. Patients can choose which option works best for them based on their risk profile.

Botox is highly effective, with a very good response in most people with urinary incontinence and overactive bladder symptoms. For patients who have failed to improve with medications, insurance typically covers Botox.

Administration and effectiveness of Botox for overactive bladder

Botox is a muscle paralytic, inhibiting the detrusor muscle contraction by blocking the release of the neurotransmitter acetylcholine. This gives patients more time to get to the bathroom.

Botox injections are straightforward. They are done in the office in a 30-minute procedure. No sedation is required. The bladder is numbed with lidocaine, and Botox is injected into the bladder via cystoscopy. The injection itself only takes five minutes, and patients can go home right after receiving the procedure.

Botox starts working very quickly, usually within a few days, and patients tell me all the time how happy they are with the procedure.

The treatment typically lasts six to nine months before the patient requires another injection.

A comparison of Botox and sacral nerve stimulation done by the Pelvic Floor Disorders Network found both to be highly effective. Botox did slightly better, with 3.9 fewer leakages per day versus 3.3 fewer leakages per day for sacral nerve stimulation.

With Botox, a rare but significant side effect is that the toxin works too well, and patients are unable to void. In the study comparing Botox with sacral nerve stimulation, the rate of catheterization was 8% and 2% at one and six months with Botox. I’ve only had one patient in the last three years who experienced this side effect.

When this happens, patients temporarily need to use a catheter to void. For this reason, only patients who are willing to insert a catheter or have someone who can help them with the catheter qualify for a Botox treatment.

Urinary tract infections are a common side effect, affecting about 25% of people who receive Botox injections. They are treated with antibiotics. Patients also may feel short-term discomfort likened to a period cramp.

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