Does it feel like your bladder is controlling your life? Frequent urination or urinary urgency with little warning, or even having urinary accidents might mean you have an overactive bladder (OAB). Also known as urge incontinence, OAB is common, but you don't have to live with constant worry and disruptions.
Bladder Botox is an effective treatment, both for people undergoing treatment for prostate, colon, cervical or uterine cancer and those with an underlying health condition that causes frequent urination.
"We don't want people to just accept OAB as a side effect of cancer treatment or any other condition," says Dr. Rose Khavari, a urologist at Houston Methodist. "With bladder Botox, you can get back to activities like traveling or going to a movie without concern."
It's a short and safe procedure, and it can greatly improve your quality of life. Dr. Khavari shares what those with OAB should know about bladder Botox.
Overactive bladder isn't a 'normal' part of aging
"We see OAB in about 30% of men and up to 40% of women," Dr. Khavari says. "Most people think it's a normal sign of aging, but it's not."
The prostate condition associated with aging is benign prostatic hyperplasia (BPH), which is caused by an enlarged prostate gland. OAB is caused by malfunctioning nerves.
In a healthy bladder, the muscles and nerves are flexible — so urine can collect until the time is right. When you reach the toilet, your brain signals the bladder muscles to release the urine.
"With an overactive bladder, the bladder muscles are too tight," Dr. Khavari explains. "The nerves send insistent 'gotta go, gotta go' signals to your brain before it's the right time and place. The bladder muscles start to spasm, and you're unable to hold back the urine."
Symptoms of overactive bladder aren't painful, but they are uncomfortable and worrisome:
- A need to use the restroom more than eight times a day
- Frequent nighttime trips to the bathroom
- Little or no warning before the urge to urinate
- Barely making it to the toilet before urinating
OAB is sometimes a symptom or side effect of another health condition. For example, it's common among patients who have radiation or surgery for prostate, colon, cervical or uterine cancer. It's also associated with nerve or muscle disorders, such as multiple sclerosis or Parkinson's disease, as well as spinal cord injuries. OAB has also been linked to type 2 diabetes and hormone changes such as those experience through menopause.
Botox can relax the nerves that signal urgency
The term Botox is short for onabotulinum toxin. This is actually a poisonous protein produced by the bacterium called Clostridium botulinum — but when this protein is isolated and used in small doses, it can be used to help relax muscle and nerve cells.
"It's the same type of compound used in cosmetic procedures to relax the muscles that cause facial wrinkles," Dr. Khavari says. "Urologists use it to temporarily calm the muscles and nerve endings in the bladder."
After Botox injection, the bladder has a larger capacity to hold urine longer — helping give a person time to make it to make it to the toilet without an accident.
"Interestingly, on brain MRI, we can clearly see the difference in the brain before and after a Botox bladder Botox injection," Dr. Khavari explains. "It helps with the bladder nerves, as well as how the brain interprets signals from those signals nerves."
(Related: Urinary Incontinence Causes, Diagnosis & Treatment)
Botox therapy is safe and effective
While it may sound dangerous to use a toxin as a medical treatment, decades of research shows that Botox therapy for OAB is highly successful and safe, with few side effects.
"Botox has been approved for different types of OAB for nearly 15 years," Dr. Khavari says. "We have ample data to recommend it to our patients, and it's extremely well tolerated."
People who benefit most from Botox are those who have tried dietary changes, pelvic floor therapy and/or oral medications without success.
"One of the biggest benefits of bladder Botox is that it's localized," explains Dr. Khavari. "We're injecting it only into the bladder. That means you don't get the side effects of an oral medication that works throughout the whole body."
You may not be eligible for bladder Botox if you take blood thinners or if you get frequent urinary tract infections. If you're unsure, your urologist will consult with your care team to determine if the procedure is feasible.
(Related: How Diet Affects an Overactive Bladder)
Bladder Botox is a short, outpatient procedure
Nearly all bladder Botox procedures take place in the urology clinic. Your urologist will ask you to be well hydrated when you arrive for your appointment.
When you are in the procedure room, you will lay on a typical exam bed. Your urologist will first apply local anesthesia — a lidocaine jelly in the urethra and a lidocaine liquid inside the bladder. The urethra and bladder will be completely numb within about 10 minutes, so you will feel no pain.
"The procedure is very short — less than one minute," Dr. Khavari says. "We use a tiny endoscopic camera to guide the placement of the injections. You can even watch what we do on the monitor if you wish. We'll explain what we're seeing and exactly what we're doing."
Because there is no general anesthesia, you do not need a companion with you at your appointment, and you can drive home afterwards.
Following the procedure, you may feel a little bit of soreness in the urethra or in the bladder. You may also see a bit of blood in your urine. These effects wear off within an hour or so, or after one or two urination voids.
"If it's your first time getting Botox, we usually schedule a follow-up about two weeks after your procedure," Dr. Khavari notes. "Our nurse practitioner or physician assistant will make sure you can fully empty your bladder and confirm there is no infection."
Treatment results are long-lasting
Bladder Botox doesn't provide immediate relief. But with one to two weeks following their procedure, most people notice an improvement in their symptoms.
"When the Botox starts kicking in, you can just forget about your bladder for several months," Dr. Khavari says. "It's a radical change in symptoms and a huge improvement in quality of life."
But unlike cosmetic Botox, which wears off after about three months, the treatment lasts significantly longer in the bladder. Most patients have a remission of their symptoms for six to nine months. Some may need repeat injections only once a year.
"I really encourage patients to talk to their physician about overactive bladder," says Dr. Khavari. "We really have the power and knowledge to tailor the treatment to each individual patient and their specific symptoms."
