For over 20 years, Botox has been safely used to manage frustrating urgency symptoms for thousands of women when other treatment options, like lifestyle changes, pelvic floor physiotherapy, and medication, haven't provided relief.
If you’ve been struggling with overactive bladder (OAB) or urge incontinence, and nothing seems to help, your urologist may suggest bladder Botox.
In this article, we walk you through how it works, who it’s for, what to expect, and how to decide if it’s something worth exploring.
What Is Bladder Botox And How Does It Work?
Botox is short for Botulinum toxin type A, a muscle relaxant. When injected into the bladder wall, it blocks the nerve signals that trigger those sudden, uncontrollable contractions that make you rush to the toilet.
Who’s a good candidate?
You may be a candidate for bladder Botox if you experience any of the following, especially after trying other treatments like bladder training, or medications without sufficient relief:
Urgency: That intense "need to go" feeling caused by an overactive bladder (OAB).
Frequent urination: Peeing more than eight times a day or waking at night to urinate.
Urge incontinence: Leaking due to a sudden, strong urge to pee (not stress incontinence, which is leaking caused by pressure on the bladder from activities like sneezing, laughing, or lifting).
According to UCLA Health, around 70–75% of women who try bladder Botox notice a big improvement in their symptoms, with many experiencing an improved quality of life as well.
Because Botox relaxes the bladder muscles, it can sometimes make it more difficult to empty your bladder completely. While this doesn’t happen to everyone, you would need to use a catheter (tube inserted into your bladder) temporarily until you regain control.
Before the treatment, your nurse or specialist will show you how to do it so you’re prepared. While most patients don’t end up needing it, it’s good to know what to expect.
Who shouldn’t have bladder Botox?
If you have stress incontinence: There are different types of urinary incontinence. Stress incontinence is leakage caused by pressure on the bladder (like when you sneeze, cough, laugh, exercise or lift something heavy) due to weakened pelvic floor muscles—not bladder spasms. Botox won’t help here, but pelvic floor exercises (Kegels), pessaries or, in some cases, surgery might.
If you have overflow incontinence: Overflow incontinence is when the bladder doesn't empty properly and leaks as a result. Since Botox can reduce bladder contractions, it could worsen your overflow incontinence. If this is the case, you should address the underlying cause, such as bladder obstruction or weak bladder muscles.
If you have a urinary tract infection (UTI): Any kind of infection needs to be treated before you can receive Botox.
If you have bladder or pelvic pain syndromes: While Botox is sometimes trialled in these cases, it's not a standard or reliable treatment for pain-focused conditions without symptoms of urgency.
If you are pregnant or planning a pregnancy soon.
If you have a history of complications or an allergy to Botox.
What Does The Treatment Involve?
Bladder Botox injections are straightforward and usually performed as an outpatient treatment.
Pre-procedure
Before you’re booked in, your specialist will:
Do a urine test to make sure there’s no infection.
Go over the benefits, risks, and possible side effects.
Teach you how to self-catheterise, so you’re prepared if needed later.
The procedure
There are no cuts, no general anaesthetic, and no need to stay overnight.
Local anaesthetic: In most cases, there’s no need for general anaesthesia. A local anaesthetic gel is applied to the urethra through a catheter and left for 20–30 minutes to numb the area to ensure you don't experience significant pain. Many women report that the injections feel like a slight prick, similar to a mild period cramp.
Cystoscopy: A small camera is passed into the bladder through the urethra so the physician can see inside.
Injections: Using a fine needle, the physician makes 10–20 tiny injections of Botox into the bladder wall. The whole process takes about 5–10 minutes.
After the procedure
Once the treatment is done:
You’ll be asked to pass urine before going home.
Your bladder will be scanned to make sure it’s emptying properly.
You might be given a short course of antibiotics to prevent infection.
You can typically go home the same day and resume normal activities soon after, with a follow-up appointment arranged within 10–14 days to check how you’re doing.
Possible Side Effects Of Bladder Botox Injections
Most tolerate bladder Botox well, but like any treatment, there are a few things to be aware of:
Common (usually mild and short-lived)
A slight burning feeling when you pee (usually gone in a day or two).
A bit of blood in your urine, which tends to settle within 48 hours.
Cramping that feels a bit like period pain.
Less common
Some find it harder to fully empty their bladder, known as urinary retention. If that happens, you might need to use a small catheter for a short time.
You may get a urinary tract infection (UTI), which is treatable with antibiotics.
Some report flu-like symptoms or a bit of fatigue for a day or two.
Rare
A very small number of patients experience side effects that go beyond the bladder. This might include general muscle weakness, but it’s extremely rare.
In a few cases, difficulty emptying the bladder can last longer than expected. Your medical team will keep an eye on this, and if it does happen, they’ll support you with the right tools and follow-up care.
Tips To Help Recovery Go Smoothly
There are a few simple things you can do to support your recovery:
Drink plenty of water: Staying hydrated helps flush your bladder and lowers the risk of urinary tract infections.
Watch for signs of a UTI: If you notice any burning, needing to go more often, cloudy pee, or a temperature, consult your GP or specialist immediately.
Pay attention to how easily you’re emptying your bladder: If it starts to feel tricky, don’t ignore it.
Reach out to your GP or clinic
Reach out to your GP or specialist if you notice:
You're struggling to pee or not going as much as usual
Signs of infection (burning, fever, feeling unwell)
Your leakage is getting worse instead of better
Anything that just doesn’t feel right, especially new muscle weakness
FAQs
Can you drive after Botox in the bladder?
Yes, most patients can drive themselves home after the procedure, especially if it’s done under local anaesthetic (which is usually the case). You might feel a bit of pressure or cramping, but nothing that should stop you from getting behind the wheel. That said, if you feel unwell or are unsure, arrange for someone to come with you.
What are the side effects of Botox in the pelvic floor?
Injecting Botox in the pelvic floor muscles, which is a different procedure than bladder Botox, isn't a common practice. In rare cases, it's used to treat symptoms of pelvic pain or muscle spasms.
Does Botox increase bladder capacity?
Botox works by calming the overactive muscle in your bladder, so the muscles don’t contract too soon or too often. This means you can go longer between toilet trips. In other words, it doesn’t physically enlarge the bladder, but it increases functional bladder capacity.
How long does bladder Botox last?
The effects begin within 3–14 days and reach full strength by week three. However, it's not permanent, and most women find it lasts 6 to 9 months on average, up to 12 months in some cases.
When your symptoms return, you can book another injection, which is common and safe.
Is Botox in the bladder worth it?
If you've tried natural treatment options with little success, Botox in the bladder may be worth it. In fact, according to one study, the treatment can result in a 60-80% decrease in urinary incontinence symptoms. However, it's best to consult your GP or urologist to assess whether you'll be able to benefit from bladder Botox.
Final Thoughts
Bladder Botox is a well-established treatment that could be worth considering if you’ve tried, bladder training, or medications, and your bladder is still calling the shots. It’s particularly helpful for women dealing with overactive bladder and urge incontinence.
Around 70–75% of those who try it report noticeable improvements: fewer leaks, better sleep, and more confidence to get on with life without always thinking about where the nearest loo is.
If you’re thinking about bladder Botox, you’re not alone, and you don’t have to figure it all out on your own, either. Join Jude and Friends, our private Facebook group, where you can chat with other women who’ve had the treatment, ask questions, and get real-world insight into what it’s actually like.
