Botox injection into the bladder is a well-established treatment for overactive bladder and urgency incontinence, including urgency incontinence associated with neurological disease. It is usually used when behavioral and exercise therapies and medications have not been effective in treating symptoms. Botox has been shown to produce dramatic improvements in symptoms and quality of life in women who have not responded to or could not tolerated other treatments. At the Center for Women's Pelvic Health at UCLA, our physicians did some of the pioneering work on use of Botox for overactive bladder and incontinence over the past 15 years. In most cases Botox can be done in an office setting with local anesthesia instilled into the bladder.
Botox injection treatment is administered in the office under local anesthesia. Local anesthetic (lidocaine) is placed via a catheter and allowed to remain in the bladder for 20-30 minutes to provide numbing of the lining of the bladder. After 20-30 minutes, a small scope (about the size of a catheter used to drain the bladder) which is connected to a camera is placed into your bladder through the urethra and a series of injections of Botox solution are done into the muscle of the bladder using a small needle that is passed through the scope. The actual injection procedure takes about 5 minutes or less.
The expected benefits of successful Botox treatment include: reduction or elimination of episodes of urinary incontinence, reduction or elimination of severe urgency, reduced number of times you urinate during the day and night, reduction in or elimination of pad use for urinary incontinence and improved quality of life. Approximately 70-75% of patients experience significant reduction in symptoms and improvement in quality of life.
There are two side effects associated with Botox injection in the bladder. The first is an increase in post-void residual, or the amount of urine left in the bladder after voiding. In most cases, this does not cause any symptoms and does not need to be treated. However, in some patients (about 6% in clinical trials) it can be a problem and may require the temporary use of a catheter to help empty the bladder. When this happens, patients are taught to catheterize themselves from once to several times a day because of problems associated with an increase in post-void residual such as a complete inability to urinate (urinary retention). In the small number of people that this occurs in, the need for catheterization usually lasts for 2-6 weeks. The other side effects include bleeding in the urine or a urinary tract infection which can occur with or without an elevated post void residual.
The dose of Botox is determined by your doctor based on your condition and response to prior Botox treatments. Usual dosing is 100-200 units.
The effect of Botox in the bladder is not permanent. In most patients the effects last 6-12 months (about 7.5 months on average). When the effects wear off, repeat injection is necessary to maintain the clinical effect.
Botulinum toxin has been FDA approved for the indication of overactive bladder since January 2013. However, botulinum toxin has been used to treat symptoms of overactive bladder for over 20 years.