Botox: For A “Gladder” Bladder

Andrew Siegel MD   12/19/15


You are probably aware of Botox used for improving the cosmetic appearance of facial wrinkles. When injected into frown lines Botox paralyzes facial muscles resulting in creases, furrows and grooves disappearing and presto, you look a decade younger! Botox has numerous medical uses that go beyond improving one’s appearance. It is commonly used to improve internal body functions, e.g., injecting it into the bladder muscle to improve symptoms of overactive bladder (OAB).

Making Lemonade From Lemons

Botox is derived from the most poisonous substance known to man—botulinum toxin. This neurotoxin is produced by the Clostridium bacterium, responsible for botulism. Botulism is a rare but serious illness that can result in paralysis. Botulinum toxin, when used in minute quantities in a derivative known as Botox, is a magically effective and powerful potion.

How It Works

Botox is a neuromuscular blocking agent that weakens or paralyzes muscles. Beyond cosmetics, it can be beneficial for a variety of medical conditions that have in common some form of localized muscle over-activity. Its uses generally involve conditions with muscle spasticity, involuntary muscle contractions, excessive sweating and eyelid or eye muscle spasm.

Botox For The Bladder

Overactive bladder (OAB) syndrome consists of the symptoms of urinary urgency (the sudden desire to urinate), with or without urgency incontinence (urinary leakage associated with urgency), usually accompanied by frequent urination during both awake and sleep hours. OAB has been described as the “bladder squeezing without your permission to do so.”

When injected into the muscle of the bladder,  Botox treats the “wrinkles,” the thick muscle bands known in medical jargon as trabeculation, which are typically present in conditions that cause obstruction to the outflow of urine or bladder overactivity.  By temporarily paralyzing a portion of the bladder muscle, OAB symptoms can improve dramatically. 

Botox can be used in both genders.  It is usually a second line treatment for those who have not responded well or have been intolerant to oral bladder relaxant medications.  The goal of Botox is to  effectively treat persistent and disabling urinary urgency, frequency and urgency incontinence.  Botox is FDA approved in the USA in a 100 unit dose for overactive bladder and  200 unit dose for overactive bladder associated with neurological conditions.

Bladder Botox injection is a brief office procedure usually done under light sedation. It involves placing a cystoscope into the bladder and injecting  Botox into numerous sites in the bladder via a needle that fits through the cystoscope. The entire procedure takes 10 minutes or so.

Preparing for Bladder Botox/ Expectations 

  1. Stop blood thinner medications one week before Botox.
  2. Antibiotics are started 2 days before and continued for 2 days after.
  3. You may experience blood-tinged urine, burning with urination and pelvic pain for a day or so after the procedure.
  4. You may experience difficulty urinating and feel that you are not emptying completely; if so, this may require a catheter or temporarily learning how to do self-catheterization.
  5. It may take a week or two to notice improvement. Although Botox is highly effective, it is not so in everyone.
  6. Follow up urinalysis and check of the post-void residual volume (how much urine is left in the bladder after voiding) in two weeks.
  7. Botox should last 6-9 months or so. After the improvement wears off, the injection can be repeated. If ineffective or only partially effective, the Botox dosage can be increased.

Bottom line: Botox, a  neurotoxin produced by Clostridium that causes paralysis, can be beneficial when injected into virtually any muscle in the body that is in a state of hyper-contraction and spasticity.  It has found utility for a variety of medical conditions, particularly for the treatment of overactive bladder symptoms.

Wishing you the best of health,

2014-04-23 20:16:29

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Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: or Amazon.

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