With a Vengeance

Pete Health Guide
  • It's funny how this works sometimes.


    As many readers of this blog know, I have access to intravesical Botox injections  every six months or so to control my urge incontinence.  


    Botox is derived from Clostridium botulinum, a gram-positive anaerobic bacterium that produces the botulism toxin. The Botox disables the nerves in the posterior bladder wall, reducing spasms and the corresponding leaking that can occur.


    Victims of botulism poisoning can take several weeks or even months to fully recover. Because of this, one would think that intravesical Botox would wear off somewhat slowly, but for me, it does not.

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    That's why I entitled this post "With a Vengeance." This is the way I describe the return of my urge incontinence!


    I go from almost having to wear almost no protection to needing to change once or twice a day. This usually occurs over the span a few weeks, sometimes less.


    My UI sort of has two forms. The first is the "classical" form, where a sudden, uncontrollable spasm can lead to leakage. The second is more subtle (insidious is the word I sometimes use to describe this) and takes the form a minor contraction that will not subside for several minutes. Because I have lost my internal urinary sphincter, I have to depend on my external sphincter and pelvic muscles to control this. The means sometimes I have to make a conscious effort not to tinkle on myself!


    While the Botox is active, I have to be very careful to not become complacent. I have described the effects of the Botox to my urologist as a true feeling of freedom. I actually tend to forget about my bladder and the incontinence problems. I still have to wear protection because I have some stress incontinence as well. If my bladder gets fairly full, I can start leaking just from the internal pressure, even if there are no spasms. This is actually the third form of incontinence, called overflow incontinence.


    Sometime before I actually start having spasms, I start becoming very aware of my bladder, and how full it is. I also become very aware of what types, and how much fluid I take in. I start reducing caffeine intake, as it does irritate a little, increasing my tendency to spasm.


    I do have some good news, though! My doctor scheduled a repeat of the Botox procedure some months ago, and I'm due to have this done next week! I know it seems strange to be "excited" by an invasive medical procedure, (and that my friend "Foley" will probably come for a visit) but it improves my quality of life so much, I actually look forward to it!


Published On: July 19, 2009