Botox for Incontinence: Treatment, Risks, and Side Effects

A sign for a washroom with a man and woman on it

Urinary incontinence is a medical issue that is characterized as a loss of bladder control, and it can be a symptom of many conditions. It affects both men and women, though women are more commonly afflicted by it.

There are a number of different categories of incontinence, such as stress incontinence, urge incontinence, overflow incontinence, functional incontinence, and mixed incontinence, and each type has a difference cause.

Incontinence can comprise an issue as small as minor leakage during a sneeze or a laugh, or as major as frequent or unexpected urination. In the most basic terms, urinary incontinence is caused by either weak or overactive muscles in the bladder, stress or loss of support in or around the organs supporting the bladder, or interference in the nerve signals that control the bladder.

One of the main causes of these symptoms, regardless of the type of incontinence, is age. As our bodies age, muscles in the bladder and urethra weaken, and we are not able to sustain as much control over them. Other factors that may cause incontinence include:

  • Pregnancy and childbirth
  • Menopause
  • Hysterectomy
  • Enlarged prostate
  • Prostate cancer
  • Obstruction or blockage
  • Neurological disorders such as multiple sclerosis, Parkinson’s disease, or stroke
  • How does Botox for incontinence work?

    There are many treatment options available for individuals experiencing urinary incontinence. These include behavioral techniques, muscle exercises, medications, and medical devices.

    Botox treatment for incontinence was approved by the Food and Drug Administration (FDA) in 2013 as an interventional therapy to temporarily prevent incontinence and other symptoms of overactive bladder syndrome. Botox is typically only recommended to patients who have not responded satisfactorily to more traditional medications and treatments for incontinence.

    Botox is an effective treatment for incontinence because it works to temporarily paralyze muscles upon injection. It contains botulinum toxin type A, a neurotoxin that blocks chemical signals between the muscles and the brain. When these signals are interrupted, the muscles that have been injected with Botox are effectively paralyzed and do not contract. With Botox injections, muscle spasms are temporarily stopped and the muscles relax.

    In the case of incontinence, this means that the muscles that contract too frequently or unexpectedly no longer respond this way. Botox injections effectively give patients temporary relief from incontinence.  

    What happens during Botox treatment?

    During Botox treatment for incontinence, the Botox is injected directly into the muscles of the bladder. The procedure can be performed in as short a time as one hour, and can be administered directly in the urologist’s or urogynecologist’s office.

    The injection process involves using a cystoscope, which is a thin, lighted tube that helps with visibility inside the bladder. The physician will first administer an anesthetic such as lidocaine in order to numb the bladder for a less painful experience. The Botox is then injected directly into the muscles of the bladder in multiple areas.

    After treatment, the patient should not experience any significant pain, though blood might be present in the patient’s urine and there may be a slight burning or stinging sensation during the first few instances of urination after the procedure.

    The Botox injections themselves take approximately 10 minutes, while the prep time beforehand should take about 20 minutes. The assessment of the results after the injections should take approximately 30 minutes.

    Risks and side effects

    Botox is a very safe prescription medication and the FDA has approved its use for the treatment of incontinence. However, there are some mild temporary side effects that may occur after the procedure.

    These reactions are typically reported in the 12 weeks following the procedure. The side effects may include:

    • Urinary tract infections (UTIs)
    • Urinary retention (inability to empty the bladder entirely)
    • Hematuria (blood in urine)
    • Fatigue
    • Insomnia
    • Muscle weakness
    • Vision problems
    • Dizziness

    If the patient experiences urinary retention, they may have to use a catheter. Any patients experiencing urinary retention should contact their physician as soon as they notice this reaction.

    There are some more serious, though rare, side effects that may occur, including difficulty breathing, speaking, or swallowing. If the patient experiences these reactions, they should contact a medical professional immediately.

    How long does treatment last?

    The effects of Botox treatment are not immediately noticeable, and optimal results will be felt by the patients approximately two weeks after the injections are administered. The duration of the results will vary by patient, though Botox typically lasts anywhere from three to six months. It is recommended that patients receiving Botox for incontinence receive injections once every six months. Botox, and other botulinum toxin products, should not be administered at a frequency greater than once every three months. 


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