Botox for the Bladder?

I’m a woman in my 50s and have been battling overactive bladder for a few years. No treatment seems to help much. I’ve heard that Botox can work on stubborn cases like mine. Is it worthwhile?

– July 23, 2012

Overactive bladder, also called “urge incontinence,” is the frequent occurrence of sudden and strong urges to urinate and is more common in women than in men (as is stress incontinence, the leakage of urine associated with laughing, sneezing, coughing or exercise). Urge incontinence is due to involuntary contraction of the bladder’s detrusor muscle more frequently than normal and at inappropriate times, such as when the bladder is only partially full. Women with this condition typically need to urinate eight or more times per day and get up two or more times a night.

The cause of overactive bladder is unknown, but the disorder has been linked to drug side effects, nerve damage, stroke, multiple sclerosis, and Parkinson’s disease. Other possible causes are urinary tract infections, bladder cancer and, in men, benign prostatic hyperplasia (BPH). Some evidence suggests that overactive bladder is more common in people with depression, anxiety, attention deficit disorder, fibromyalgia, and irritable bowel syndrome.

In 2011, the FDA approved injections of Botox to treat some patients with severe overactive bladder who haven’t been helped by lifestyle measures such as weight loss and biofeedback, or by prescription drugs, including Ditropan. Botox works by relaxing the bladder muscle to prevent or ease the contractions that lead to the feelings of urgency and the leakage of urine.

The treatment involves injecting Botox into 15 to 20 different sites in the bladder muscle. This is done via cystoscopy, a procedure using a scope mounted on a tube that is passed through the urethra. This technique allows doctors to see inside the bladder and use a small needle passed through the scope to administer the injections. The bladder is flushed out and numbed to prevent pain before the procedure. (Sometimes, a general anesthesia is used.) The entire treatment is usually is done in a doctor’s office or in a hospital operating room. Reportedly, patients begin to feel the effects in about a week and the full benefit in two weeks; results can last up to a year.

A side effect of using Botox for overactive bladder is urinary retention – meaning that not all the urine in the bladder passes when you urinate. If the amount of residual urine is high, patients may need to use a catheter to empty the bladder fully. Other side effects can include urinary tract infection, fatigue and problems sleeping.

Before resorting to Botox, I recommend exploring other approaches that may help you control bladder problems. Here’s where you can find my recommendations for treating overactive bladder.

Andrew Weil, M.D.

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