Bladder Botox injections

Botox is the drug company name for Botulinum Toxin Type A. Botox is a neurotoxin that blocks nerve impulses to any muscles into which it has been injected. Botox works for the bladder by relaxing the muscle of the bladder wall (the detrusor muscle), reducing urinary urgency and urge incontinence. Following treatment, the toxins’ effects last for several months after which the muscles return to their normal strength (between three and nine months, occasionally longer).

Botox injections into the bladder are recommended by NICE for patients with severe urgency, frequency and urge-incontinence that are unresponsive to other treatment, such as bladder retraining and medications. Prior to treatment, a urodynamic investigation is performed to confirm the diagnosis.

The operation takes approximately ten minutes and is done as a day-case procedure. It is usually well tolerated under local anaesthesic, but for some women a general anaesthetic may be the preferred option. A very fine needle is inserted into the bladder through a cystoscope (small telescope), and the diluted Botulinum toxin is then injected as 20 divided small doses in the bladder wall.

This is a short procedure that requires no incisions or stitches. Most women will be able to go home the same day after passing urine.

You may see some of these complications following this procedure:

• Blood in the urine initially after the procedure. Significant bleeding is extremely rare.
• Urinary tract infection is reported in about one in 12 cases, but this can be easily treated with antibiotics.
• Urinary retention: Between three and ten per cent of patients may require temporary self-catheterisation to help empty the bladder. The risk of this happening is minimised using a lower dose of Botulinum toxin, but the effect may not last as long.

Other very rare risks include: allergic reaction including anaphylaxis, erythema multiforme (a severe skin rash) and generalised weakness.

The procedure is performed as a day-case, usually in our outpatient treatment facility. Some women may experience discomfort when passing urine for 24–48 hours following the operation and may find traces of blood in the urine. A small number of patients (one in 100) will develop a urinary tract infection, which can be treated with a course of antibiotics. Drinking plenty of fluid after the operation should prevent such problems.

Prior to having this treatment, Clean Intermittent Self-Catheterisation (CISC) will be taught in case urinary retention develops.

The latest evidence suggests that this treatment may cure incontinence or improve symptoms by 70–90%. Most women find this treatment ‘life changing’. The effects can last for up to 12 months. However, the procedure needs to be repeated after the effect of the toxin wears off (on average every six to nine months).