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Botox is a popular botulinum toxin type A injectable that is most popular for its ability to temporarily reduce the appearance of crow’s feet, forehead lines, and glabellar lines. Unknown to many, Botox is also indicated for a range of medical conditions such as urinary incontinence (caused by overactivity related to neurologic conditions such as multiple sclerosis), cervical dystonia, and spasticity. Doctors also commonly use it for poorly-managed axillary hyperhidrosis (excessive sweating), strabismus, and blepharospasm (related to dystonia). Apart from that, Botox is also effective in treating overactive bladder (OAB). In fact, FDA included overactive bladder as 1 of the approved indications of Botox in 2013. Botox injections are able to provide symptomatic relief, helping to alleviate urinary frequency, urgency, and incontinence. It is especially useful in adult patients who respond inadequately (or are intolerant) to conservative treatments such as anticholinergic agents.
Overactive bladder (OAB) is not a disease. It is a collective term that encompasses a wide range of symptoms associated with abnormal bladder function. This includes urge incontinence (involuntary urine loss right after an urgent need to urinate), frequent urination (at least 8 times in a day), nocturia (awaken at least 2 times at night to urinate), and an uncontrollable/sudden urge to urinate. In particular, symptoms such as nighttime urination and unexpected frequent urination can disrupt a patient’s life and have an impact on their quality of life. If adequately treated, an overactive bladder can lead to complications such as interrupted sleep cycles, sleep disturbances, depression, emotional distress, anxiety, and sexual problems.
Botox injection contains botulinum toxin type A as its active ingredient.
Botox is able to block the release of acetylcholine (ACh) from the presynaptic nerve terminals, subsequently causing full (or partial) paralysis. At the same time, it acts to weaken the overactive muscles. It is believed that Botox has an inhibitory effect on axonal expression of certain proteins and vesicular release of excitatory neurotransmitters.
While generally safe and well tolerated, Botox is associated with a small risk of certain side effects.
Be aware that this is not an exhaustive list of all the possible adverse effects of Botox. Some patients may experience side effects that are not listed in this article. Those who experience unexpected side effects should see a doctor right away. Patients should ask the doctor if they have any questions about the side effects of Botox. Keep in mind that all medications come with side effects. For example, anticholinergic tablets (which are 1 of the common treatments for overactive bladder) have a higher risk of causing mouth dryness compared to Botox injections.
Botox treatment is typically performed at a clinic. Using a sterile needle, Botox is injected into the bladder muscle. Patients will be asked to wait in the clinic for about half an hour, or until they urinate. This is to ensure adequate tolerance to the neurotoxin. Botox injections are well tolerated in most cases.
Patients are advised against injecting themselves, as this could cause severe complications. As with other injectables, Botox should only be administered by a qualified medical professional.
Botox is not known to cause any downtime. In most cases, patients are able to resume normal activities a few hours after a Botox treatment.
Designed to deliver durable results, Botox can last for up to 6 months. Repeat treatments may be required to maintain the therapeutic results. While there is no limit to how much Botox can be used for overactive bladder, it is recommended to have a 12-week gap between each treatment session.
As with most injectables, it takes some time for Botox to fully exert its pharmacological effects. Most patients will start to notice an improvement of symptoms 2 weeks after the first injection. Studies have suggested that Botox has an equivalent (or superior) efficacy to anticholinergic agents in the treatment of urinary incontinence. According to these studies, Botox injections offer better control of urinary incontinence than other conservative therapies.
It is important to check the medical history (including medication history) of the patient before starting a Botox treatment. Patients who have a hypersensitivity to botulinum toxin (or any other botulinum toxin preparations such as Dysport and Xeomin) should refrain from using Botox. In addition, Botox should not be injected into an infected area. Botox injections are intended for adult patients of more than 18 years of age.
Botox can cost up to $15 or more per unit.
Being safe and efficacious, Botox gives hope to patients who fail to achieve satisfactory treatment outcomes with conventional treatments. Ask your doctor to find out more about Botox for the treatment of an overactive bladder.