Botox injections are one of the many treatments available for incontinence today. Actually, Botox detrusor muscle injections emerged years ago as a somewhat therapeutic option for specific types of urinary incontinence, including overactive bladder and urgency incontinence. It’s generally presented as an option when behavioral and exercise therapies and medications fail to do the trick. But does it work? Here’s what to know about Botox injections and their efficacy in treating incontinence.
How Do Botox Injections Improve Incontinence?
Botox injections work by inhibiting the release of acetylcholine, a neurotransmitter responsible for muscle contractions. In the treatment of urinary incontinence, Botox is injected directly into the detrusor muscle of the bladder to prevent involuntary contractions that contribute to symptoms such as urgency, frequency, and leakage. While the injection procedure itself takes about five minutes, local anesthetic is used to numb the lining of the bladder. It’s placed via catheter and takes about 20 to 30 minutes to fully numb the lining in preparation for the Botox injections.
Numerous clinical studies have demonstrated the efficacy of Botox injections in treating overactive bladder (OAB) and neurogenic detrusor overactivity (NDO). Until the Botox wears off, patients often experience a reduction in urinary frequency, urgency, and incontinence episodes following the procedure.
Now for the drawbacks. Not only is Botox temporary, meaning effects typically last for several months at most, it has a few other limitations worth knowing upfront:
- Urinary retention. Botox injections can lead to urinary retention in some patients, requiring the use of intermittent catheterization. This potential complication can be distressing for people who seeking relief from urinary incontinence, so careful patient selection is important to minimize this risk.
- Pain during injections. The procedure itself involves injecting Botox directly into the detrusor muscle of the bladder using a cystoscope or other specialized instruments. The cystoscope is a thin tube with a camera that allows the urologist to visualize the inside of the bladder. The injections are typically done through the cystoscope. While the injections are not typically described as extremely painful, some patients may experience discomfort or a sensation of pressure during the procedure. Local anesthesia is used to minimize any pain or discomfort associated with the injection process.
- Cystoscopy generally required. In most cases, Botox injections for urinary incontinence are performed using a cystoscope. The cystoscope allows the urologist to visualize the interior of the bladder, identify injection sites, and ensure the precise delivery of Botox. The use of a cystoscope provides real-time guidance and enhances the accuracy of the injections. While this adds a level of invasiveness to the procedure, it is considered necessary for the effective and safe administration of Botox injections into the bladder. While cystoscopy itself is generally considered a safe and well-tolerated procedure, there is a small risk of complications, including the potential for urinary tract infection (UTI). The risk of developing a UTI after cystoscopy is generally low, but it can occur, especially if proper sterile techniques are not followed during the procedure.
- Best for specific types of incontinence. Botox injections are most effective in patients with specific types of urinary incontinence, such as OAB and NDO. They may not be as effective for other forms of incontinence, such as stress urinary incontinence, which is characterized by leakage during physical activities, coughing, or sneezing.
- Adverse effects. While generally considered safe, Botox injections can cause side effects such as urinary tract infections, hematuria (blood in the urine), and muscle weakness. These adverse effects may impact the tolerability of the treatment and influence the patient’s decision to continue with subsequent injections.
- Cost considerations. The cost of Botox detrusor muscle injections, including the procedure itself and potential follow-up treatments, can be a limiting factor for some patients. Insurance coverage may vary, and the financial burden could impact accessibility to this form of therapy
The decision to undergo Botox detrusor muscle injections, the choice of anesthesia, and the inclusion of a cystoscopy are typically made based on individual patient factors, clinician preferences, and specific clinical context. Patients are encouraged to discuss any concerns about pain or discomfort with their healthcare provider before the procedure, and healthcare providers will work to ensure the patient’s comfort and address any questions or anxieties they may have.
While Botox injections have demonstrated a partial effectiveness in managing certain types of urinary incontinence, they have their limitations. Most notable is the temporary nature of Botox for treating incontinence, which may make it difficult to justify the other drawbacks. At this point, more research is necessary to explore alternative treatments and enhance our understanding of the optimal use of Botox injections, particularly during an era in which sacral neuromodulation (SNM) appears to offer greater effectiveness with a simple procedure that lasts 15 years or more.
Ready to learn more about treatments for incontinence, including SNM? Contact The Continence Center at Nevada Surgical today, and let’s discuss your options.