What is Botox and how does it work?
It is a drug company name for Botulinum Toxin Type A, a protein extracted from bacteria. When injected into the bladder, it relaxes the bladder wall muscle, thereby reducing urinary urgency and incontinence. The effect of treatment can last for anything between 3 and 12 months, after which the muscles return to normal.
Am I candidate for Botox?
You may be a candidate if you have overactive bladder symptoms (frequency, urgency with or without urgency incontinence) and you have tried pelvic physiotherapy and medications. Prior to offering this treatment, you may be offered a test of bladder function called urodynamics to confirm the diagnosis. You may also need a cystoscopy to exclude other causes, although this is most commonly done at the same time as injceting the Botox.
What does the procedure involve?
Botox can be injected under local anaesthesia with a flexible telescope passed into your bladder or with a rigid telescope under general anaesthetic. It depends entirely on your preference and to some extent on the risk from an anaesthetic. When performed under local anesthesia only, you may feel minor pricking sensation with some discomfort as the injections are made, however it should not be painful. Following the procedure, you will be asked to empty your bladder, you can then return home.
What should I expect after the procedure?
You can get minor burning, stinging or even a bit of blood when passing urine after the procedure. Botox does not work immediately but can take upto 2 weeks. You will start to notice a reduction in urgency and urine leakage. There is a small chance that you may not be able to pass urine altogether. This is because the Botox paralyses the muscles of the bladder which can reduce the ability of the bladder muscle to contract and empty.You may then be able to empty your bladder by passing a small catheter into your bladder 3-4 times a day. This is usually temporary and as the effect of the Botox wears off, you will start to pass urine normally again.