Botox for Incontinence

Botox is a type of botulinum toxin injection that has both aesthetic and clinical uses. It has been extensively used in aesthetic medicine to correct lines and wrinkles. In particular, Botox has shown remarkable results in the treatment of moderate to severe glabellar lines that are results of procerus or corrugator muscle activity, forehead lines caused by frontalis muscle activity, and lateral canthal lines (more commonly known as crow's feet). Apart from that, Botox has also been used by medical practitioners for scrotum and penis enhancement. Despite being in the market for merely fifteen years, Botox has obtained global cult status. Indeed, since 2012, more than 10.9 million vials of Botox injections have been sold in the US alone. Botox has been approved for cosmetic use in more than 75 countries around the world.

Clinically, Botox is used for treating a wide range of medical conditions, including spasticity caused by cerebral palsy/spinal injuries, overactive bladder, hyperhidrosis (excessive sweating), blepharospasm caused by dystonia, and cervical dystonia. Plus, Botox is indicated for the treatment of urinary incontinence related to neurologic diseases, such as multiple sclerosis. It is highly effective in treating severe bladder symptoms. This includes urinary sphincter spasm, failure to delay urination, and severe urgency.

What is urinary incontinence?

Urinary incontinence refers to the involuntary loss of urine, which is often resulted from a lack of bladder control. Urinary incontinence is one of the major symptoms of an overactive bladder. Statistics have shown that 37% of patients with overactive bladder suffer from urge incontinence (wetting accidents) apart from frequency and urgency. Physiologically, urinary incontinence is caused by detrusor overactivity, which is the involuntary contraction of the bladder. Some of the main symptoms of urinary incontinence are enuresis (accidental leakage while sleeping) and nocturia (the uncontrollable, sudden urge to urinate at night).

There is another form of incontinence called stress incontinence. This occurs when the urethra is too weak to stop the urine from escaping as the bladder pressure increases due to an increased abdominal pressure. As a result, even the slightest amount of stress caused by lifting, exercising, laughing, sneezing, and coughing can lead to leakage. Females are especially susceptible to urinary incontinence after menopause and vaginal childbirth. Some of them may need to wear diapers or pads. Stress incontinence is distinctly different from overactive bladder, which has different causes and symptoms, so it requires different treatments.

It is not uncommon that patients have both an overactive bladder and stress incontinence. For patients with mixed symptoms, each condition will need to be treated separately, as there is currently no single therapy that can treat both of them.

How does Botox for incontinence work?

Botox contains botulinum toxin type A, a type of neurotoxin, as its active ingredient.

Essentially, Botox works on one simple principle: the inhibition of muscle contraction. Once injected, Botox attaches itself to the motor neurons, thereby preventing the release of acetylcholine (ACh) from the presynaptic cholinergic nerves. ACh is a type of neurotransmitter that modulates muscle contraction. Through its muscle-relaxing effects, Botox effectively reduces muscle activities and stiffness. At the same time, it helps to block the communication between the nerves and sphincter of the bladder muscles. Botox is particularly effective in treating patients who fail to adequately manage their condition with conservative treatments (e.g. behavioral therapy or medicines). In addition to urology, Botox is also used in colorectal surgery, orthopedics, and ophthalmology to treat conditions that are unresponsive to other medicines or conventional therapies.

What happens during the procedure?

When treating urinary incontinence with Botox, practitioners will need to use a cystoscope (a small telescope) to examine the bladder. Then, Botox is injected into the bladder wall. The doctor may choose to use a general or local anesthesia. The recommended dose of Botox for urinary incontinence ranges from 100 units to 300 units.

Keep in mind that Botox injections are not interchangeable with any other botulinum toxin formulations, such as Xeomin and Dysport. The units of Botox are specific to its manufacturing process and are therefore not comparable to units of biological activities of other botulinum toxin injections, which are produced with different methods. There is currently no universally-recognized conversion ratio for different botulinum toxin formulations.

How long does it take to complete the treatment?

In most cases, it takes about 20 minutes to complete the injection. Botox injection for incontinence is considered an outpatient procedure; therefore, the patient will be able to return to their routines immediately.

When will Botox start to work?

Generally, it takes about a week after the Botox injection to see the treatment results. Patients may not be able to see the results immediately after the treatment.

How effective is Botox for incontinence?

While it is unlikely to cure the condition completely, patients can expect a 50% improvement in urinary symptoms after Botox injections. This improvement means less incontinence, less nighttime urination (nocturia), and longer intervals of holding urine.

How long can the results last?

Usually, the results can last for three to nine months. The actual duration of effects varies greatly depending on a number of factors. Keep in mind that Botox is not designed to deliver permanent results. Patients are required to repeat the injections once the effects wear off.

Is Botox for urinary incontinence safe?

There are many studies that support the efficacy and safety of Botox in the treatment of urinary symptoms regardless of the underlying cause.

Some of the potential complications of Botox include, but are not limited to, injury to the bowels, damage to the bladder, blood in the urine, and urinary tract infections (UTIs). After injections, patients may experience pain with urination or temporary urinary urgency. In addition, about 25% of patients will get urinary retention, which is the inability of the bladder to fully empty on its own. If urinary retention occurs, patients may need to use temporary catheter placement or intermittent catheterization until the bladder recovers its strength. While rare, Botox can potentially be absorbed into the bloodstream, causing a loss of sensation or numbness.

As a rule, Botox should not be used in patients who have a known allergy to botulinum toxin. At the same time, patients who are allergic to any of the inactive components of Botox should refrain from using it. In general, Botox is only intended for adult patients of more than 18 years of age (except when indicated for the treatment of lower limb spasms). Due to the lack of scientific literature on the topic, Botox should not be injected in pregnant and breastfeeding women unless it is medically justified to use the injections.

Talk to your doctor about whether Botox for incontinence is right for you.