Overactive bladder is a condition that causes the bladder to contract in small, abrupt “puffs” of activity at irregular intervals. The involuntary contractions may occur because these muscles are overly sensitive and receive signals to contract when they shouldn’t. Or it could be that signals from the spinal cord to those muscles are going haywire, by being received too often or too late. The result is the same: more frequent trips to the bathroom than you need. Overactive bladder can affect one part of your urinary tract (the bladder) or both sections (bladder and urethra).
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Read on to learn more about Is Botox For Overactive Bladder Safe, When and Why To Consider BTX-A and How Do Bladder Botox Injections Work?
Is Botox For Overactive Bladder Safe
OnabotulinumtoxinA (BTX-A) is commonly used to treat overactive bladder. Injecting BTX-A into the bladder muscle can reduce episodes of urge incontinence, although urinary retention and urinary tract infection (UTI) are possible side effects.
Studies have reported a high level of safety and effectiveness of BTX-A injections, but none specifically in patients age 80 and older, until now.
“The U.S. has a growing population of aging yet active adults who may benefit from BTX-A injections,” says Cleveland Clinic urologist Howard Goldman, MD. “Our practice regularly provides BTX-A to older adults.”
To better understand the treatment’s effect on patients age 80 and older, Dr. Goldman led a retrospective study of men and women treated at Cleveland Clinic between 2007 and 2017. Results were presented at the 2018 American Urological Association meeting by Patricia Zahner, MD, a urology fellow at Cleveland Clinic’s Glickman Urological & Kidney Institute.
Rates of complication and satisfaction
An elderly cohort of 62 patients, aged 80 to 94, was compared to a younger cohort of 68 patients, aged 50 to 70. Following BTX-A injection, 11 percent of elderly patients experienced urinary retention, compared to 4 percent of the younger patients. In addition, 6 percent of elderly patients experienced UTI, compared to 7 percent of younger patients.
“Complication rates were low for both cohorts,” says Dr. Zahner. “Yet satisfaction rates with the treatment were relatively high — 47 percent of the elderly cohort and 53 percent of the younger cohort. There was no statistically significant difference in the safety and efficacy of BTX-A injections between age groups.”
BTX-A injection is a viable treatment option for all patients with overactive bladder, regardless of age, she adds. Physicians do not need to avoid offering it to elderly patients due to risk of complications.
When and Why To Consider BTX-A
Conservative treatments for overactive bladder include pelvic floor physical therapy, bladder training, reducing fluid intake and decreasing caffeine. Daily medications, such as anticholinergics and beta-3 agonists, are other first-line therapies.
“The risks of these treatments are minimal, yet patients must continue treatments indefinitely and may still need to wear incontinence pads or undergarments,” says Dr. Zahner. “Effectiveness of physical therapy, dietary modifications and medications are similar, providing about 50 percent improvement in overactive bladder symptoms.”
When conservative measures aren’t enough, or where polypharmacy is a concern, physicians and patients consider advanced therapies, namely BTX-A injections, sacral neuromodulation and percutaneous tibial nerve stimulation (PTNS).
Unlike sacral neuromodulation, which requires surgical implantation of an electrical nerve stimulator, BTX-A injection does not require surgery or general anesthesia. Unlike PTNS, BTX-A injection does not require weekly treatments or regular maintenance visits. BTX-A can maintain effectiveness when injected only two or three times annually. Patients require only local, if any, anesthesia.
“BTX-A injection may be preferred by any patient with an active lifestyle — even elderly patients,” says Dr. Zahner. “Eighty-year-olds today are healthier and more active than they were 30 years ago. These patients can be good candidates for BTX-A, considering that overactive bladder is associated with high comorbidities and immobility. The likelihood of overactive bladder compromising their quality of life is much higher than that of BTX-A causing complications.”
How Do Bladder Botox Injections Work?
Botox injections are not just for wrinkles on your face. They also can be used to help if you have ongoing bladder continence issues. Botox is one option to treat urge incontinence or overactive bladder in people who have not had success with other treatment options.
Urinary incontinence is common and can impair your social, physical or mental well-being. Approximately 17% of women and 3% to 11% of men suffer from urge incontinence at some point in their lives.
Urge incontinence is the unintentional loss of urine caused by your bladder contracting.
With an overactive bladder you may:
- Feel a sudden urge to urinate that is difficult to control.
- Experience incontinence, which is the involuntary loss of urine, as soon as you feel the need to urinate.
- Urinate frequently — up to eight or more times per day.
- Wake up two or more times in the night to urinate.
It’s important to understand that urge incontinence and overactive bladder are not caused by physical activity or movement, such as when you cough, exercise or sneeze. That type of incontinence would be classified as stress incontinence. It’s possible to have stress and urge incontinence at the same time.
A urologist can inject Botox into your bladder to treat urge incontinence or overactive bladder. This helps the muscles relax, which will give you more time to get to the bathroom when you feel the need to urinate. The injections are done in the clinic, and most patients tolerate the injections well. They do not “hurt” as you may expect, but you may have some short-term discomfort. Many patients have compared it to a period cramp.
The good news is that most people get symptom relief quickly, in as short as a few days. The treatment results last about six months, and you can have additional injections. One possible side effect is urine retention, and it is not recommended for males with a risk or history of enlarged prostate.
While incontinence is more common as we age, it is not a normal part of aging. Unfortunately, too many people wait too long to talk to their health care team about their symptoms. There are many different treatment options available, which can have a positive impact on the quality of your life. Don’t hesitate to discuss them with your health care provider.
When considering Botox injections, ask for a referral from your primary care provider or search for a health care professional who is experienced with these types of treatments. Injections need to be precisely placed to avoid side effects.