Botox for Overactive Bladder in Multiple Sclerosis

An effective alternative to medications and other strategies

In This Article

Botox (onabotulinumtoxin A) is an injectable medication that is frequently prescribed to treat overactive bladder (OAB) in people with multiple sclerosis (MS). Derived from the bacterium Clostridium botulinum, Botox is a toxin that works by paralyzing muscles in areas where it is injected.

While it may seem odd that a medication that erases crow's feet and frown lines can also bring relief to people with a disease as debilitating as MS, research has found Botox to be highly effective in doing just that.

What to Expect Receiving Botox for Overactive Bladder
Verywell / JR Bee

Evidence

In one large study, for example, after 12 weeks of being treated with Botox, MS patients experienced urinary incontinence about 1.5 fewer times per day than those who received a placebo injection. They also voided approximately 86 milliliters more urine each trip to the bathroom than the participants who underwent placebo treatment.

It's results like these that prompted the U.S. Food and Drug Administration (FDA) to approve Botox for treating urinary incontinence in 2011.

How Botox Works

In multiple sclerosis, lesions block key nerves in the brain and spinal cord that are involved in controlling the flow of urine from the bladder. This impacts the functioning of the detrusor muscle, which contracts to release urine from the bladder, and the external sphincter muscle, which relaxes to allow urine to flow out of the bladder, through the urethra, and out of the body.

OAB occurs when the detrusor muscle contracts unnecessarily (i.e., when there's little urine in the bladder to hold in), creating urinary urgency—the sensation of desperately needing to pee even when the bladder isn't full.

Also called spastic bladder, detrusor overactivity, detrusor hyperreflexia, or neurogenic bladder, the condition can lead to a need to get up a lot at night to urinate (nocturia) or involuntary loss of urine known as urge incontinence.

Botox works by causing the detrusor muscle to stop spasming, allowing the bladder to relax and be able to hold more urine, thereby reducing symptoms of urinary urgency, frequency, and incontinence.

The first-line treatments for MS-related bladder problems include lifestyle interventions (limiting caffeine and alcohol, for example); wearing absorbent pads or (for men) a condom catheter to manage leaks; and medications called anticholinergics that are linked to a variety of unpleasant side effects and aren't always effective.

When these methods, all of which have drawbacks, aren't sufficient, Botox may be used.

Preparing for Treatment

If you decide to try Botox for overactive bladder, a urologist or urogynecologist will perform the procedure. He or she will have you do a few things in preparation:

  • Stop taking antiplatelet medications such as aspirin or Plavix (clopidogrel) at least three days before your Botox treatment.
  • Begin taking antibiotics one to three days beforehand to help prevent infection of your urinary tract (UTI).
  • Learn how to use a self-catheter in case you have issues with urination afterward (which are usually temporary)

What to Expect

Botox injection is an outpatient procedure, which means it doesn't require an overnight stay. Although it may take place in an operating room of a hospital or clinic, it also can be performed in a urologist's office.

When you arrive, you'll be asked to empty your bladder and your urine may be tested for infection. You'll put on a hospital gown.

Once there's an all-clear to proceed, you will lie down on your back on an exam table with your feet in stirrups and your knees bent. You may be given a sedative to help you relax; rarely is general anesthesia used.

A local anesthetic such as lidocaine will be used to numb your urethra and then the doctor will ease a thin, flexible tube with lights and lenses—a cystoscope—into your urethra. Through this, your bladder will be filled with a numbing agent.

Once the anesthetic has taken effect, the doctor will insert a needle for injecting Botox into around 30 different sites on the detrusor muscle. In studies, a total of 200 units of Botox injected into 20 different sites has been effective. Typically, a total of 100 units to 300 units is used. This will take 15 to 20 minutes. The cystoscope will then be removed.

After the procedure, you can get dressed, but you will need to stay at the doctor's office or hospital for a half hour to make sure the anesthesia wears off and that you're able to empty your bladder.

It will take from seven days to two weeks for Botox to take effect. Although it's not a permanent fix, it should last for six to eight months before needing to be repeated.

Side Effects

There are two types of side effects associated with Botox when it's used to treat OAB—those caused by the procedure itself and those associated with the medication.

For 24 hours afterward, you may experience a slight burning sensation when you urinate and see a small amount of blood in your urine. You may also feel the need to urinate frequently, even though the amount you produce each time may be low.

Most Common Side Effects

  • Urinary tract infections
  • Painful or difficult urination (dysuria)
  • A temporary inability to urinate: In clinical trials, about 30 percent of people who received Botox for overactive bladder caused by a neurological condition had this side effect and needed to use a disposable catheter temporarily.

Special Concerns for People With Neurological Issues

It's unusual for Botox to cause serious side effects. However, there is important safety information for people with overactive bladder caused by a neurological condition such as MS:

Botox carries a boxed warning about the potential for serious, even life-threatening side effects like problems swallowing, speaking, or breathing due to the weakening of muscles. The botulinum toxin also may spread to other areas of the body and cause serious symptoms such as generalized muscle weakness or vision problems.

Note also that Botox isn't recommended for women who are pregnant or breastfeeding.

A Word From Verywell

Bladder problems are common in MS, affecting more than 80 percent of patients who have the condition, studies show. They're responsible for secondary medical conditions such as urinary tract infections, not to mention psychological and social issues ranging from social isolation to low self-esteem. Most people will benefit from some sort of treatment. If you feel you've tried everything else and are still having problems, ask your doctor if Botox might be an option for you.

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