Up until now, those with urinary incontinence due to neurological conditions, including multiple sclerosis and spinal cord injuries, had limited choices when it came to treating the embarrassing and life-limiting condition. Their only options were to live with it, take medication daily or have major surgery. But with the recent Food and Drug Administration approval of Botox for incontinence, people with this type of incontinence can now be treated effectively and with minimal downtime.
“It’s very exciting to have another way to treat patients with this condition,” says Dr. Victor Nitti, Vice Chairman, Department of Urology, New York University Langone Medical Center, who was involved in the clinical trial program. “The procedure is easy to do, and Botox is well tolerated and extremely effective. These patients with neurological conditions are already suffering so much; they really deserve this new breakthrough.”
While the FDA approval is only for treatment of urinary incontinence due to neurological conditions, Botox is currently being studied for treatment of stress incontinence and overactive bladder, says Dr. Nitti. If it does receive approval, it will affect a much broader group of patients, and many more people would be able to use Botox for incontinence, he adds.
Prior to the approval, most who had bladder incontinence due to neurological conditions were treated with an anticholinergic medication, but a majority of people — 71 percent — stop taking the medication within a year. “Either the pills don’t work well enough or the patients are not satisfied with results,” says Dr. Nitti. If chronic urinary incontinence isn’t treated, it can lead to skin irritation, ulcers, urinary tract infections and even kidney infections, not to mention the emotional side effects and limitations of always having to be near a bathroom and/or using an adult diaper.
About the Botox Procedure for Incontinence
Botox is injected directly into the bladder via a scope that is inserted through the urethra. Two hundred units of Botox are injected into the bladder through several small injections. (The average cosmetic injection for treatment of the “11” forehead wrinkles between the eyes is 20-30 units.) The procedure is generally done in a urologist’s office under local anesthesia. “At most, it feels like a small pin prick,” Dr. Nitti says. The Botox takes a few weeks to begin working.
The Botox paralyzes the bladder resulting in lower bladder pressure and fewer involuntary bladder contractions, which are the underlying causes of incontinence due to neurological disorders, says Dr. Nitti. The results from the FDA approval process are convincing: within six weeks those who had been treated with Botox had approximately 20 fewer urinary incontinence episodes than those who were treated with a placebo. The results last nine months, and when the effect wears off, patients can be retreated.
There are limited risks associated with the procedure — the most common is that one could experience bleeding or get a urinary tract infection after the initial procedure, say Dr. Nitti. A small percentage of patients may experience difficulty completely emptying their bladder.
“For the most part patients are very happy with results,” says Dr. Nitti. “It really changes their quality of life. Patients that are going to receive injections are patients that are highly impacted by their problem. Most of them who have a successful treatment don’t hesitate to be retreated.”
If your urinary incontinence is due to a neurological condition, ask your primary care doctor or neurologist for a referral to a qualified urologist.
Dysport, an alternative neurotoxin to Botox, is also being studied for incontinence treatment.
Other Approved Uses of Botox
Botox also has FDA approval for the treatment of forehead wrinkles, specifically the glabellar lines (the “11” that sometimes appears between the eyebrows); excessive sweating; excessive migraines; muscle stiffness in elbow, wrist and finger muscles associated with muscle spasms; cross-eyes; eye spasms; and the abnormal head position and neck pain that happens with cervical dystonia.