If you’re one of the 46 million plus American adults with overactive bladder (OAB), you’re tired of suffering from urinary frequency, urgency, urge incontinence, and nocturia (waking to urinate at least twice per night). Luckily, clinical trials revealed that a seemingly unlikely procedure relaxes the bladder muscle and increases its storage capacity while reducing urinary incontinence episodes.
The onabotulinumtoxin A (Botox®) cosmetic treatment that plumps facial wrinkles can perk up your bladder as well. In 2013, the Food and Drug Administration (FDA) approved Botox injections into the bladder via cytoscopy. This method allows doctors to view the inside of the bladder while instilling the drug. They use the same toxin type as plastic surgeons but deliver it in lower strengths and larger amounts for OAB treatment. Multiple recent studies have confirmed that Botox injections relieve OAB’s aggravating and inconvenient symptoms.
Understanding Bladder Anatomy
Your bladder contains nerves, muscles, and connective tissue. Its most important muscle is the detrusor. Under normal circumstances, your bladder walls can expand to hold urine. But when the volume increases, this stretching can trigger a nerve response to initiate urination. This reaction loosens the sphincter in the neck of your bladder that connects to your urethra and contracts your detrusor muscle so urination can begin. Some people can override this response to prevent urination at inopportune times and places.
Involuntary bladder nerve or muscle dysfunction, most commonly the detrusor muscle, can cause overactive bladder. Your detrusor may contract inappropriately, regardless of how much urine your bladder is storing. Common conditions such as urinary tract infections, kidney and bladder stones, and bladder tumors can cause detrusor overactivity, resulting in overactive bladder. Nervous system conditions including diabetic neuropathy, stroke, multiple sclerosis, spinal cord injury, dementia, and Parkinson’s disease can increase OA susceptibility. When no cause is evident, you have idiopathic overactive bladder.
Botox Reduces OAB Symptoms
Two large clinical trials found that repeated Botox treatment provided sustained improvements of overactive bladder symptoms in women. The multicenter studies found that Botox treatment continued to decrease women’s frequency and urgency complaints for a median of 2.4 years. In about 63-72 percent, incontinence episodes dropped by at least 50 percent during an extended study. But researchers noticed improvement after just 12 weeks.
Subjects who received Botox treatment needed to urinate 1-1.7 times fewer per day on average. They experienced urinary incontinence an average of 1.6-1.9 fewer times per day than patients who received the placebo. Investigators who followed the women for a median 2.4 years beyond their participation reported that they tolerated it well. These trials established that Botox is a safe and effective therapeutic option for long-term OAB symptom relief, according to Dr. Tomasz Rechberger of the Medical University of Lublin in Poland.
Women who completed the placebo-controlled, multicenter phase III studies received the option of entering a three-year, open-label extension study. Participants with a mean age of 60 had experienced OAB symptoms for more than six years. The new round would provide additional Botox intradetrusor injections upon request and as necessary at least 12 weeks apart to maintain symptom control. Each treatment consisted of 20 injections that researchers administered via a scope they inserted through the urethra into the bladder.
Extended Therapy Brings Greater Results
According to Dr. Rechberger’s interim analysis of the supplemental research, women started the study with a mean of 11.6 urinations, 8.4 urgency episodes, and 5.6 urinary incontinence incidences per day. Investigators saw consistent symptom reductions after just one to five treatments. They checked all endpoints against the baselines 12 weeks after each treatment. Daily urinary incontinence episodes dropped by 3.3 after the first treatment cycle, 3.7 following the second, 3.9 after the third, and 3.2 following the fourth and fifth therapeutic sessions.
Mean urination reductions varied from 2.4 to 3 over the first five treatment cycles, and mean urgency episodes fell between 3.6 and 4.2. Investigators noticed a consistent increase in voiding volume per urination. Botox reduced incontinence episodes by at least 50 percent in approximately 63-72 percent of patients across the treatment cycles. The median time between treatment sessions ranged from 24 to 33 weeks, significantly longer than the 12-week minimum.
Patients Prefer Single Botox Infusion
Other scientists have found that Botox can replace surgery and additional invasive treatments for stubborn OAB cases. Their study compared Botox delivery through 20-30 needle injections to one infusion directly into the bladder with a catheter. Many patients preferred the single dose to repeated injections, according to study author Dr. Michael Chancellor, director of neuro-urology at Oakland University-William Beaumont School of Medicine in Michigan.Four weeks later, urinary frequency and urgency had declined significantly without increasing the urine volume remaining in the bladder after voiding.
Seeking OAB Treatment
If you prefer more traditional treatment, VESIcare (Solifenacin) can help control your bladder muscle to ease your symptoms. Broaching the subject can be difficult or embarrassing. So if you feel uncomfortable bringing up your bladder issues, consult the Doctor Conversation Guide first.
Lifestyle changes also encourage symptom relief. Kegel exercises help strengthen the muscles supporting your bladder. Lower your caffeine consumption. This natural diuretic acts as a bladder stimulant, increasing sudden urges to rush to the bathroom. Other beverages and foods can cause bladder irritation, which makes you need to go more often. Help your treatment work better by limiting carbonated drinks, artificial sweeteners, spicy foods, citrus fruits/juices, and tomatoes.