WebMD Medical News
Oct. 4, 2012 -- Injections of Botox may be as good as pills for putting the brakes on an overactive bladder.
Overactive bladder is marked by a sudden, uncontrollable urge to urinate, which can lead to the involuntary loss of urine, called urge incontinence. Botox works by relaxing the bladder muscle. It is already FDA-approved to treat urinary incontinence due to overactive bladder related to nerve damage from conditions such as multiple sclerosis and spine injury.
But doctors are allowed to use their own judgment to prescribe Botox "off-label" to treat overactive bladder from other causes.
Medications called anticholinergics are also used for overactive bladder. They work to relieve symptoms by relaxing the muscles of the bladder.
In a new study of nearly 250 women who had urge incontinence, a one-time Botox injection in the bladder worked as well as daily pills at reducing episodes of urinary incontinence at six months. Fully 70% of women in both groups reported an average of three leaks a day at the six-month mark compared to an average of five a day at the start of the study.
What’s more, twice as many women who received the Botox reported that their incontinence went away.
Still, much like with wrinkles, the effects of Botox on the bladder don’t last forever. Women will likely need another injection within nine months to a year to keep their bladder symptoms under control.
The findings are published in the Oct. 4, 2012, issue of the New England Journal of Medicine and being presented at the annual meeting of the American Urogynecologic Society in Chicago.
“Both Botox and medicine reduced daily bladder leakage,” says researcher Anthony G. Visco, MD. He is the chief of the urogynecology and reconstructive pelvic surgery division at Duke University Medical Center in Durham, N.C. “Botox as another option and if it is FDA-approved for this, it will expand the choices that women have.”
If Botox gets broader FDA approval for overactive bladder, insurance will likely begin to cover the cost, which can be up to $1,000 per treatment.
Both the oral medications and the injections can have side effects. In the study, some women complained that the pills caused dry mouth, while the shot led to urine retention, and increased the chance of needing a catheter to drain the bladder. Twice the number of women in the Botox group got urinary tract infections compared to the pill group.
Botox injections to the bladder are performed in a doctor’s office and are not as painful as they sound, Visco says. Doctors often use a numbing agent as well. “Most women tolerate it very well and some don’t feel it at all.”
Overactive bladder is more than just a nuisance. “People minimize it and think it just means that you have to constantly run to the bathroom,” he says.
It can be much worse.
“Our bladders are lined by muscle and when we void, the muscle contracts and empties out our bladder and this is good when it works properly,” Visco says. With overactive bladder, the contractions occur randomly and leakage can be drips or the full contents of bladder.
“It is unpredictable, and can occur at work, in a store, or on an airplane,” he says.
“Overactive bladder is a very humbling and embarrassing condition that can affect a woman’s professional, personal, and intimate life,” says Linda Brubaker, MD. She is a co-author on the study and the dean of Loyola University Chicago Stritch School of Medicine. “They have to wear bulky pads and undergarments and carry or keep spare clothing in their bags, car, or place of work.”
Botox injections can be tried before medications, she says. “This study shows us that we could try Botox first. It is an appropriate first-line treatment that has pros and cons just like all other treatments.”
This option may be especially important for women who don’t like to take pills, Brubaker says.
Robert Moldwin, MD, says the new study does mean that Botox may be another option for women with overactive bladder. He is a urologist at the Arthur Smith Institute for Urology, part of the North Shore-Long Island Jewish Health System in New Hyde Park, N.Y.
But, as with oral medications, Botox does have side effects. “Another downside to Botox is that it is a done deal and you have to live with the results,” he says. This is great if you like the effects, and not so great if you don’t or develop side effects like recurring infections.
SOURCES:Visco, A.G. New England Journal of Medicine, 2012, study received ahead of print.Linda Brubaker, MD, dean, Loyola University Stritch School of Medicine, Chicago.Robert Moldwin, MD, urologist, the Arthur Smith Institute for Urology, North Shore-Long Island Jewish Health System in New Hyde Park, N.Y.Anthony G. Visco, M.D. chief, Urogynecology and Reconstructive Pelvic Surgery Division, Duke University Medical Center, Durham, N.C.
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