In women who suffer from bladder spasms the bladder muscle is overactive & has difficulty staying relaxed as the bladder fills. This can cause frequent urination, urgency, leakage prior to making it the bathroom, incomplete emptying, & having to get up at night to void. We initially try conservative therapy with a combination of going to the bathroom on a regular schedule, avoiding things in your diet which can irritate the bladder, medications which help the bladder muscle to relax, & often pelvic floor muscle therapy. About 70-80% of women will have some improvement with these treatments. In women who do not meet their goals for improvement or who have side effects to the medications, Botox is an option.
Botox, or onabotulinatoxin A, is a potent neurotoxin which blocks the release of chemicals in the bladder muscle which cause the bladder to contract. It is injected directly into the bladder muscle through the urethra using a small cystoscope with a camera attached to a video screen. Botox has been used for many years to help patients with severe bladder spasms due to spinal cord injury. The FDA approved Botox in 2013 for patients with bladder spasms without neurologic conditions.
When is Botox a treatment option for bladder spasms?
If bladder spasms do not improve with bladder training, pelvic muscle therapy, & medication, Botox may be an option. Usually, at least 2 different medications are tried before we consider Botox as an option. Botox is not dangerous, but we always try less invasive treatment first. Botox is contraindicated in patients with severe neuromuscular disorders, such as myasthenia gravis or amyotrophic lateral sclerosis ("Lou Gehrig's disease"). It may be used in patients with multiple sclerosis or Parkinson's disease.
Many studies have shown that Botox significantly improves bladder spasm symptoms in most patients. Most patients void less often, the amount urine voided increases, they have less leakage, & they get up fewer times to empty overnight. Improvements may last for months or a year or more, & 75% of patients choose to get another treatment. Studies have shown that Botox is less expensive than medications over time.
What problems can occur after Botox?
The most common finding after Botox is that the amount of urine left in the bladder after voiding increases in 70% of patients. This is not a problem for most patients who are satisfied with the improvement in their symptoms, & it is rarely medically significant. Only 3-5% of patients have so much left in their bladder that they have to use a catheter to empty. This usually improves with time. Because of the low risk of not being able to empty after Botox, we only perform the treatment in women who are able to learn how to empty their bladder with a catheter. While this does seem pretty intimidating, most women can learn to empty their bladders with a small catheter very quickly & with minimal discomfort. This is usually only necessary for a week or two in the small number of patients who can't empty after Botox..
We will have you take oral antibiotics for 1 day prior to treatment & a 2 days afterwards, to reduce the risk of bladder infection. It is very rare for someone to be allergic to Botox. Very rarely, generalized weakness can occur, but this has mainly been seen in children with spasticity.
We perform Botox in our office under sterile conditions in our bladder testing lab. We start by placing some fluid with local anesthetic into your bladder, which makes the treatment more comfortable. We then inject small amounts of Botox into the bladder muscle at several locations using a cystoscope. This takes about 5 minutes. The treatment usually takes a few minutes, & is usually not very painful.
It may take some time for Botox to work as it needs to spread throughout the bladder. This may take up to 2 weeks. We will see you back at 2 weeks to make sure your bladder is emptying normally. We hope that you get a long lasting or even permanent improvement. We will usually see you back in 6 months to see how you are doing.
Can I get another Botox treatment?
Yes- although we hope that would not be necessary. The average duration of improvement following Botox in studies was 19-24 weeks. If your symptoms have not improved to your satisfaction, another treatment can be performed after 12 weeks. Some patients need to have repeat treatments every year or more as kind of a booster treatmetn. Sometimes, if your bladder spasms do not improve as much as you want with Botox, bladder spasm medications may now be more effective. If Botox does not work, sacral neuromodulation ("Interstim") may be an option.
Yes. Since Botox is FDA-approved, the cost is covered by insurance & Medicare. It often does require preapproval, but our billing staff will help arrange that.