Botox for Incontinence: Can It Help?

You may know of Botox as a cosmetic treatment that reduces facial wrinkles. But this potentially deadly toxin has uses that go much deeper than the skin's surface.

Botox, which paralyzes the muscles where it's injected, can also help with urinary incontinence. In certain types of urinary incontinence, the muscle that enables you to urinate overtightens, causing urine to leak. Botox helps this muscle relax.

What Is Botox?

Botox (onabotulinumtoxinA) is a prescription medication made from a substance called botulinum. Botulinum is a toxin produced by a bacterium called Clostridium botulinum. Although this is the same toxin that produces food poisoning, in small doses, it has many uses.

Specifically, the Food and Drug Administration (FDA) has approved Botox to treat:

• Blepharospasm (eyelid twitching or uncontrollable blinking)
• Cervical dystonia
• Crossed eyes
• Excessive armpit sweating
• Muscle spasticity
• Neurogenic detrusor overactivity (overactive bladder caused by nerve conditions)
• Overactive bladder
• Urinary incontinence due to certain nerve conditions, such as spinal cord injury or multiple sclerosis

Botox is also approved to soften wrinkles in some regions of the face temporarily and to prevent migraine headaches.

Off-Label Uses

In addition to its FDA-approved uses, Botox is sometimes prescribed to treat conditions different from what the drug was initially approved to treat. This is called off-label use.

Botox is sometimes used off-label to improve scar healing and to treat the following:

• Dyshidrotic eczema
• Facial flushing
• Hair loss
• Nerve pain caused by shingles
• Oily skin
• Psoriasis
• Rare skin conditions (some)
• Raynaud's phenomenon

Botox for Urinary Incontinence

Urinary incontinence is a condition in which you cannot control your bladder or urination. Several conditions can cause urinary incontinence, including:

• Diabetes
• Kidney stones
• Brain disorders, such as Alzheimer's disease
• Nerve conditions, such as multiple sclerosis or spinal cord injury
• Overactive bladder
• Weak pelvic floor muscles

Botox is only approved to treat urinary incontinence due to an overactive bladder or a nerve condition.

Botox: How Does It Work?

When Botox is injected, it spreads through nerve endings in the area where it's injected. It then binds to the nerve endings and prevents the release of the neurotransmitter acetylcholine from nerve cells. Without acetylcholine, the muscles in the area become temporarily paralyzed.

Treating Incontinence With Botox

To treat incontinence with Botox, a healthcare professional injects the medication into the detrusor muscle. This is the muscle that lines your bladder. The detrusor muscle contracts (tightens) to help you urinate and relaxes to hold your urine.

With conditions such as overactive bladder and certain nerve disorders, the bladder muscle tightens uncontrollably, causing urine to leak. Botox helps keep the bladder muscle from contracting.

Botox Procedure for Bladder

To receive Botox injections for bladder incontinence, you'll need to go to your provider's office or other healthcare facility.

Your healthcare provider will have you take an antibiotic one to three days before your Botox procedure, on the day of the injection, and for one to three days after you receive the injections. This is to lower your risk of having a urinary tract infection (UTI) during or after your Botox procedure.

If you take a blood thinner (anticoagulant), your healthcare provider will have you stop taking it at least three days before receiving your Botox injections. This is to reduce your risk of bleeding during the procedure.

Before receiving your Botox injections, a healthcare team will give you anesthesia to numb your bladder area.

The recommended Botox dosage for urinary incontinence related to overactive bladder is 100 units (10 milliliters) divided into 20 injections. For this use, your healthcare provider will inject 0.5 milliliters (mL) of Botox into 20 different sites of your bladder muscle.

After you receive your injections, your healthcare team will monitor you for 30 minutes. They'll need to know that you can urinate before you leave the office.

The recommended Botox dosage for urinary incontinence due to nerve conditions is 200 units (30 mL) divided into 30 injections. Your healthcare provider will inject 1 mL of Botox into 30 different sites of your bladder muscle.

After receiving the injections, your healthcare team will monitor you for 30 minutes before you leave the office.

How Quickly Will It Work?

In studies of people who received Botox for overactive bladder, improvements in urinary incontinence were seen in about two weeks after receiving Botox injections. However, it may take about 12 weeks to see the full effects of the medication.

If you're receiving Botox to treat incontinence due to a nerve condition, you may start to notice less urine leakage about two weeks after receiving your Botox injections. The full effects of the medication are typically seen after six weeks.

After receiving Botox injections for bladder incontinence, the effects can last up to six months. Your healthcare provider will let you know how often you should return for Botox treatments. However, it's not recommended you receive Botox bladder injections less than three months apart.

How Effective Is It?

The American Urological Association recommends using Botox bladder injections for people with incontinence or overactive bladder who have tried other medications. The organization supports using Botox when other medications for incontinence or overactive bladder have not worked or have caused unbearable side effects.

A study found that people with overactive bladder who received Botox bladder injections experienced significantly decreased incontinence four weeks after receiving Botox treatment. These effects lasted up to six months.

Another study of people using Botox for incontinence due to nerve conditions found that people who received Botox injections had fewer incidents of urine leakage six weeks after receiving Botox.

Side Effects

Botox can cause side effects in some people. These can differ based on the condition you're using Botox to treat or the area where you receive the injections.

If you're using Botox for urinary incontinence, side effects to be aware of include:

• Blood in the urine
• Effects from the spread of botulinum toxin, such as muscle weakness and trouble breathing
• Pain when urinating
• Serious allergic reaction
• Urinary retention
• Urinary tract infection (UTI)

Precautions

A healthcare professional must give Botox injections at a clinic or other healthcare facility. Botox may not be suitable for everyone. Below are a few precautions to be aware of before you receive this treatment.

Breathing Problems

Botox can weaken muscles needed for breathing. Botox may make breathing more difficult if you have a nerve condition that causes breathing problems.

Talk with your healthcare provider about your health history before starting Botox treatment. They'll only recommend Botox if it's safe for you to use.

Autonomic Dysreflexia

Botox can also increase your risk of autonomic dysreflexia. This is a potentially life-threatening reaction in which your nervous system overreacts to stimulation. Symptoms of autonomic dysreflexia can include:

• Excessive sweating
• Irregular, fast, or slow heartbeat
• Muscle spasms
• Throbbing headache
• Very high blood pressure

Autonomic dysreflexia is more likely to happen if you're using Botox for urinary incontinence caused by a nerve condition. This side effect is a medical emergency. If you have symptoms of autonomic dysreflexia, seek emergency medical care immediately.

Urinary Problems

Urinary retention is a common Botox side effect. With urinary retention, you're unable to empty your bladder fully. Urinary retention with Botox can happen because the medication weakens the muscle that contracts to help you urinate. This may cause problems emptying your bladder.

Due to this risk, before your Botox procedure for bladder incontinence, your healthcare provider will talk with you about the possibility of temporarily using a urinary catheter if needed. Within two weeks of receiving your Botox injections, your healthcare team will monitor your bladder's urine amount. If they determine that your bladder is not emptying as it should, they'll likely use a urinary catheter to drain the urine.

Botox increases your risk for UTI. To lower this risk, your healthcare provider will prescribe an antibiotic for you to take up to three days before your Botox procedure, the day of the procedure, and up to three days afterward.

Before starting Botox treatment for urinary incontinence, let your provider know if you have frequent UTIs. They'll only prescribe Botox for you if the benefits of the procedure outweigh the risks.

Potential Interactions

Certain medications may interact negatively with Botox. Some may increase the effects of Botox, which may lead to serious side effects. Others can increase your risk of having urinary retention.

Let your prescriber know if you take:

• Antibiotics known as aminoglycosides, such as gentamicin
• Anticholinergic medications, such as Oxytrol (oxybutynin)
  
• Muscle relaxers, such as Zanaflex (tizanidine)
• Other medications with botulinum toxin, such as Botox Cosmetic (onabotulinumtoxinA)

Alternative Treatment Options

Botox is approved to treat urinary incontinence after other treatments have not worked. So, your healthcare provider may prescribe other medications to treat bladder incontinence before you receive Botox injections.

These can include:

• Detrol (tolterodine)
• Myrbetriq (mirabegron)
• Oxytrol (oxybutynin)
• Vesicare (solifenacin)

In addition to medications, there are also steps you can take to help manage urinary incontinence. For example, it may be helpful to:

• Avoid smoking.
• Be mindful of your liquid intake.
• Limit your alcohol and caffeine intake.
• Maintain a healthy weight.
• Schedule regular bathroom breaks.
• Stay physically active.
• Take steps to prevent constipation.

Your healthcare provider may also recommend additional treatments, such as bladder retraining and exercises to strengthen your pelvic floor muscles.

Summary

Botox (onabotulinumtoxinA) is a prescription injection with several FDA-approved uses. These include treating overactive bladder and urinary incontinence due to nerve conditions, such as multiple sclerosis or spinal cord injury.

Botox is made from a toxin called botulinum. It works for urinary incontinence by weakening your bladder muscle to keep it from contracting. This helps prevent urine leakage. Botox injections are given by a healthcare provider at a clinic or other healthcare facility.

Botox is typically used as a last resort if other treatments for overactive bladder and urinary incontinence haven't worked or have caused undesirable side effects. Your provider will likely recommend different methods to treat incontinence before trying Botox. Talk with your healthcare provider to learn more about Botox for urinary incontinence. They can help you decide whether this medication is safe and effective for your condition.