Solving Bladder Problems with Botox

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Once believed to be only useful for filling fine lines and wrinkles, Botox is now used to treat a number of medical conditions from migraines to muscle spasms. For many women living with overactive bladder, Botox has been able to provide welcome relief. When injected into the bladder, Botox is able to relax the muscles and reduce impulses and incontinence for a long period of time. We consulted board-certified urogynecologist Dr. Nathan Kow with AdventHealth Medical Group Urogynecology to learn more about this helpful treatment.

Who are the best candidates for Botox bladder injections?

Overactive bladder syndrome (OAB) is diagnosed in women who suffer from urinary urgency, with or without urinary incontinence, who usually have frequency of urination during the day and throughout the night, says Dr. Kow.

He explained that your physician may start with simple first-line treatments like lifestyle and behavioral changes to try to improve OAB. These might include changing your fluid intake (type and amount), food habits, and voiding patterns, as well as pursuing bladder retraining and pelvic floor muscle exercises.
If first-line treatments don't help, second-line treatments typically involve medication. Finally, the third line treatments include Botox.

We call Botox bladder injections, InterStim Neuromodulation (which can be viewed as a pacemaker for the bladder), and Percutaneous Tibial Nerve Stimulation (which is acupuncture-like therapy) third-line treatments or advanced therapies. They are used to treat OAB in women who cannot tolerate the first- and second-line treatments or did not find them effective.

Women who are unable to empty their bladder well or who have recurrent urinary tract infections (UTIs) may not be good candidates for this treatment because the injections can worsen the voiding dysfunction and result in more UTIs.

How safe is it?

Botox (Botulinum Toxin Type A) is a powerful drug that can temporarily paralyze muscles when it is locally injected.

Botox bladder injections have been studied in multiple scientific trials since 2000, said Dr. Kow. The medication is safe and was approved by the FDA in 2013 for the indication of idiopathic overactive bladder disorder. When dosed appropriately, it is successful in up to 70 percent of women with OAB, slightly better than pharmacotherapy treatment.
The effects of Botox may last between 6 to 9 months.

What's recovery like?

A Botox bladder injection is typically an outpatient, non-surgical procedure, meaning you are it is performed in the office and does not require any sedation or anesthesia. A small telescope is inserted into the bladder through your urethra in order for your doctor to examine the area. The Botox injection is administered through a needle that is inserted through the telescope.

Immediately after the procedure, some women may experience a short period of bladder discomfort and see blood in their urine. Botox injections begin to work within 1-2 weeks after the procedure, Dr. Kow explained.

Unless otherwise stated by your doctor, you can eat and drink after the treatment, and can return to normal activities the same day.

With the approval of Botox to treat OAB, women now have another option for relief. If you've been struggling with overactive bladder or incontinence, we're here to help. To request an appointment or learn more about our treatments and services, please visit or call Call407-303-1380 .

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