It is most often used as a beauty treatment to reduce the appearance of fine lines and wrinkles or even to stop you sweating, yet Botox can also be used to treat urinary incontinence.
Botox has been a popular method of treating overactive bladder for the past 20 years and has had some great clinical results.
Around 60-80% of patients see an improvement in bladder symptoms following treatment, and approximately 70-75% of patients experience a significant reduction in symptoms and improvement in quality of life.
To get the lowdown on treatment, we sat down with Mr Jai Seth, a Consultant Urological Surgeon who specialises in assessing and managing urinary continence issues and asked him all the questions about bladders and Botox — so you don’t have to.
“It's exactly the same,” Mr Seth told Jude. “So Botox has mass, widespread use around the body for a whole range of different reasons. Most people will have heard of the cosmetic indication for foreheads.
“But essentially, Botox is quite a powerful muscle relaxant, and it works by relaxing tense muscles. And so you have small doses in the face which are to deal with muscles that are causing wrinkles, whereas, in the bladder, we're using it to relax the bladder muscle.”
Botox can also be injected into the armpits for hyperhidrosis, or excessive sweating, as well as into the head for migraines, into the eye for muscle twitches and into the arms and legs for muscle spasms,” Mr Seth said.
He added that the delivery of the Botox is performed initially via a cystoscopy — a camera examination of the bladder — before an injection is delivered under local anaesthetic and that, in most cases, the entire process can take up to 10 minutes.
In rare cases, if the patient is very anxious, Mr Seth said that they can be sedated for the procedure.
It has a high clinical success rate.
It's most commonly performed under local anaesthetic — meaning no overnight stays in hospital.
Benefits start to occur between 1-7 days after the injection and can last between 6 to 12 months. After that, the injections have to be repeated.
Some patients experience side effects, namely, urinary tract infections (UTIs). However, in rare cases, it can result in self-catheterisation.
The procedure cannot be reversed and only fades once the Botox fades.
Mr Seth, who has co-authored over 40 peer-reviewed publications and teaches on Royal College of Surgeons courses at St George’s University London Medical School, said that Botox can help relieve the “debilitating” symptoms of an overactive bladder.
“This means that they’re having desperate sensations of urgency from their bladder, or desperate sensations of urinary frequency,” he said. “Some of these patients may be weeing up to 30 times a day or up to ten times at night.
“Others might be having wetting episodes where they’re having leakage of urine. This can mean that they lose control of their day — and their freedom — because they’re having unpredictable incontinence episodes and Botox is used to treat the condition.”
Mr Seth said having an overactive bladder can be “really distressing”, and many patients have “managed to just live a life based around being near a toilet all the time to avoid leaking”. “An overactive bladder can either be with or without incontinence, and Botox can be used for both kinds of patients — either those with more severe overactive bladder symptoms or those overactive bladders and urge incontinence.”
“It's not a perfect treatment,” Mr Seth warned. “I think it's important for people to be aware that it's a brilliant treatment — and one of the most successful treatments that we have — but it's not perfect.”
He said that when Botox is injected into the bladder, the clinician will start with a low dose and eventually tailor the right dose for each patient over time. However, he added that Botox makes the bladder “very good at holding onto urine” and, as a result, “can compromise how well you can release it”.
Up to one person in six may have difficulty emptying their bladder following Botox injections. One person in ten people might get cystitis, a urinary infection, in the first few days after the treatment which can “linger for a few weeks afterwards ”.
Mr Seth also said that in other rare cases, some patients may need a catheter to train themselves how to empty their bladder. “It really depends on the dose of Botox,” he said. “The higher the dosage, the higher the chance that the patient will need to be self-catheterised for a period of time afterwards.”
In this case, it happens because Botox is so effective that it can become difficult to pass urine after having the injections. This usually happens between 1-2 weeks after the initial injections and is extremely rare (around five out of 100 patients). For these patients, they will need to self-catheterise until the Botox wears off and they can start passing urine naturally again — a process which can take between 6-12 months.
He added that the slightest drop of blood in urine after receiving the injection is normal and that it should be “Ribena-coloured” — “just so people know what to look out for!”
“Patients tend to say that their life and their freedom has been restored,” Mr Seth said, “because, after the Botox injections, they can go about their day with confidence that they’re not going to wet or embarrass themselves.”
“Everything that we've spoken about is based on factual evidence from previous medical studies,” Mr Seth said. “But I’d be kind of cautious to sell it as a wonder treatment. It can have a profoundly brilliant result on people's freedoms — but it's not a perfect treatment. So it's about getting that middle ground across.”
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