A UVA Heart & Vascular Center Initiative

Overactive Bladder? Botox Treatment May Offer Relief

Posted August 08, 2017

If you feel like your bladder is in the driver’s seat – forcing you to take detours to the bathroom multiple times during the day and night – you’re not alone. As many as 40 percent of women in the U.S. live with the symptoms of overactive bladder (OAB), according to the Urology Care Foundation. However, that estimate only includes those who report their symptoms — the true count is likely much higher.

“Overactive bladder is actually more common than many realize,” says urogynecologist Elisa Trowbridge, MD, division director for University of Virginia Women’s Center for Continence and Pelvic Surgery and Associate Professor within the Department of Obstetrics, Gynecology and Urology. “Fortunately, there’s a lot we can do now to correct the problem, so women no longer have to just learn to live with it.”

Is It OAB?
OAB or urge incontinence causes the sensation of urgency so that women feel the need to urinate more frequently, often in excess of eight times per day. The cause: errant signals from the nerves to the bladder that force it to contract.

“Urge incontinence is an electrical problem,” says Trowbridge. Some women (approximately 50 percent) may benefit from medication and lifestyle changes. Others may be candidates for a fairly new alternative: Botox® injections.

Recent studies suggest that Botox injections into the bladder — once considered a third-line therapy for OAB — are safe and effective enough that the treatment should be considered soon after an initial medication therapy has failed. The American Urogynecologic Society (AUGS) and the American Congress of Obstetricians and Gynecologists (ACOG) have recommended that Botox injections may be an appropriate second-line therapy option.

How It Works
The Botox procedure is performed in an ambulatory surgical center, under mild sedation. It takes about ten minutes to complete. Doctors perform a cystoscopy (entering the bladder through the urethra with a lighted tube), partially fill the bladder with saline, and then administer about 10 injections into the dome of the bladder. The bladder is then emptied and the procedure is over. Patients need to empty their bladders before they go home, and take antibiotics for the next three days.

In studies, 18 percent of patients developed a UTI after the procedure, which is why antibiotics are recommended. In about 6 percent of cases, patients initially have trouble emptying their bladders completely and will need to use a catheter for 7-10 days after the procedure.

Botox loses its effect after about six months, but the procedure can be repeated twice a year as necessary. Medicare and other major insurers cover Botox as a treatment for overactive bladder if medication has been ineffective.

Who Is Eligible
Women who are good candidates for Botox treatment include those who:

  • Have failed multiple medications
  • Have not found relief with lifestyle modifications
  • Have urinary urgency and frequency (more than 10 voids per day), as well as urinary leakage associated with urgency

“These are women who have to go to the bathroom all the time, day and night, and nothing works for them,” says Trowbridge. For patients like these, she adds, Botox has been “a game changer.

On the flip side, patients who are not good candidates for Botox treatment are those with chronic urinary tract infections and those who have trouble with incomplete emptying of the bladder.

Learn more about treatment options available for urinary incontinence.