Botox for the Bladder

  • We have all heard about Botox used to reduce signs of aging and as a temporary wrinkle reducer. Do you actually know what Botox is? Botox is short for botulium toxin, the neurotoxin responsible for botulism. Botulism is a muscle paralysis disease we can get from eating affected foods. It can be deadly and many years ago, in the late 1800's and early 1900's was a source of a real public health crisis. Now, I am not trying to scare you, because I think the medical community has made great advances by taking advantage of the toxin and harnessing its uses for good instead of evil. There are different forms of the botulinum toxin, some are deadly, and some are useful as you will see below.

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    Like I mentioned before, probably the most widely recognized use is in the plastic surgery and aesthetics world to reduce lines and wrinkles on one's face. Botox works like this: the toxin is injected into the superficial muscles under the facial skin paralyzing the muscles, therefore creating a smooth appearance. The toxin wears off after about three months and therefore the effect is only temporary and needs to be repeated. In small amounts, it is not dangerous to the human body and very, very, very rarely has there been a report of systemic spread and problems.


    One of the first real medical uses that have been adopted by the medical community has been for the treatment of headaches. Chronic headaches account for a major portion of health care dollars and can be quite debilitating. Migraines are vascular in nature, meaning related to the blood vessels within the skull, and would not be treated with Botox. Stress headaches are often attributed to tense and spastic back and neck muscles. When these areas in the body are injected with the substance, many people attain great relief from their headaches. It has really changed the treatment protocol in many headache and pain clinic.


    I could go on and list a multitude of uses for Botox in many different fields of medicine, but I am sure at this point you are wondering why I am describing all of this in an incontinence SharePost. Well, let me tell you why. First of all, I see many people with overactive bladders (OAB). Some have an obvious reason like a spinal cord injury or multiple sclerosis. Some have OAB because they had bladder outlet obstruction from an enlarged prostate and they bladder "learned" to become overactive. Then there are other people with terrible OAB and we never find a good reason for it.


    The first line of treatment is with a class of medications called anticholinergics. I have discussed these medications before in a previous SharePost and thay can be an excellent way to control OAB. But like all medications, they are not without their side effects. To explain very simply how they work, they basically decrease the "squeeze" of the bladder by blocking a specific chemical receptor in the bladder. The same type of receptors also exists in other areas in the body, like the colon and in salivary glands too. Some people therefore experience constipation and dry mouth. Many people find the side effects not so bad especially when they have bladder control. Some people find the side effects intolerable. Others don't get the response in the bladder that they were hoping for.


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    Here is where Botox comes into play. We can use Botox in the bladder to paralyze part of the bladder muscle to treat OAB as well as urge incontinence! Botox is easy injected into the bladder muscle through a small needle passed through a cystoscope, or a small telescope that is passed into the bladder through the urethra. This is an outpatient procedure and in some instances, can be done in the office.


    Only a small portion of the bladder is injected, but it is usually enough to alleviate the OAB and urge incontinence. Unfortunately, like mentioned before, it only lasts about 3 months so the procedure needs to be repeated that often. This many be a good thing too, because sometimes, although rarely, the bladder get too paralyzed and a person will get urinary retention, and they can't urinate at all. I find I get very good results from this and it is definitely a good option for some people. Of course, you need to see a urologist and have an appropriate work up to determine if you are a candidate for this type of treatment, but I wanted to let you know there are options other than daily medications. See your urologist if this sounds like something you would benefit from.

Published On: October 23, 2007