Greater Boston Urology Blog

Bladder Botox: What You Need to Know

Most people have probably heard of cosmetic Botox for treating wrinkles and frown lines. But did you know Botox can be used in the bladder? It's true!

Below, we invited Dr. Angel Marie Johnson, our urogynecologist and Director of our Women's Health Care Centers in Dedham and Hyannis, to answer bladder Botox FAQs.

As with all content on Greater Boston Urology's blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.

First, what exactly is Botox?

 Dr. JOHNSON: Botox is a brand name for botulinum toxin products made from a bacterium called the Clostridium botulinum. Other brand names exist, including Dysport and Xeomin. But Botox is the name everyone recognizes because it was the first injectable botulinum toxin.

Most people are probably familiar with Botox being used for cosmetic reasons. But Botox can also be used for certain bladder conditions.

What bladder conditions does Botox treat?

Dr. JOHNSON: Botox is FDA approved for overactive bladder (OAB), urge incontinence, and neurogenic bladder. The latter involves neurologic conditions, such as multiple sclerosis or Parkinson's disease. With neurologic conditions, the nerves to the bladder don't always function properly.

At GBU, I treat only women, but bladder Botox is available for men as well. Men, of course, should reach out to their GBU urologist to discuss whether Botox is right for them.

How does bladder Botox work?

Dr. JOHNSON: Botox temporarily paralyzes and weakens the muscle. So, in this case, Botox works on the bladder or detrusor muscle to allow it to function normally. Botox prevents the muscle from spasming or becoming overactive, which gives people time to make it to the bathroom. This means they experience less frequency and less urine leakage.

How is bladder Botox administered?

Dr. JOHNSON: Bladder Botox can be administered as an in-office procedure or in an operating room. In my practice, I administer Botox in the office.

One of the benefits of an office procedure is that patients can drive themselves home. Plus, they don't need to fast. So it's much less cumbersome than having it done in an operating room. And patients typically tolerate the procedure very well in the office.

How long can patients expect relief from their symptoms?

Dr. JOHNSON: Botox isn't permanent. The benefit lasts six to nine months. At that point, we need to repeat the procedure. I explain to my patients that it's like going to the dentist. You need to go twice a year, but you don't have to worry about taking a pill every day. Plus, you get the freedom of having a functional bladder. Imagine living a life without the limits of urine leakage. Botox can provide that.

What about bladder Botox side effects?

 Dr. JOHNSON: No treatment is 100% perfect. The downside is that there is a small risk of developing a urinary tract infection (UTI). I give my patients a short course of an antibiotic after the procedure to prevent the UTI.

There's also a one in 10 risk of overcorrection and developing what's called urinary retention, where you have difficulty emptying your bladder. Fortunately, this is temporary, and it's rare, but it's important for people to be aware of the possibility.

Is bladder Botox covered by insurance?

Dr. JOHNSON: Yes, bladder Botox is covered by insurance.

Who's a good candidate for bladder Botox?

Dr. JOHNSON: Bladder Botox is a third-line treatment. First-line treatment involves lifestyle modifications, such as eliminating caffeine, or pelvic floor physical therapy. Second-line treatment involves medications. Third-line treatments include Botox or neuromodulation, depending on the patient's specific symptoms.

Sacral neuromodulation is FDA approved for the treatment of overactive bladder, but it is also approved for the treatment of urinary retention and fecal incontinence. So, for example, if a person has overactive bladder, but also difficulty emptying their bladder, then bladder Botox wouldn’t be my first choice because I wouldn't want to make the condition worse. Instead, I'd opt for sacral neuromodulation. Your urogynecologist or urologist will guide you on your best options, depending on your situation.

Thanks, Dr. Johnson!

If you're a woman dealing with urinary issues, make an appointment with Dr. Johnson. Your quality of life matters. Let us help!

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