BOTOX & Overactive Bladder (OAB)

By: Nicole DeSouza Massie, M.D

Overactive Bladder (OAB) is a clinical diagnosis characterized by bothersome urinary symptoms.  The International Continence Society defines OAB as the presence of urinary urgency, usually accompanied by frequency and nocturia.  There are four components: urgency, frequency, nocturia and urgency incontinence. 

There are several treatment options that can help.  The American Urological Association (AUA) recommends First-Line Treatment as behavioral therapies; bladder training, bladder control strategies, pelvic floor muscle training and fluid management.  Second-Line Treatment includes the addition of an oral medication. If the patient does not respond or cannot tolerate the side effects, the Third-Line Treatments include sacral nerve stimulation, peripheral tibial nerve stimulation and most recently added intradetrusor onabotulinumtoxinA (Botox). 

Botox was approved in the fall of 2011 for Neurogenic Bladder and in January of 2013 was approved to treat OAB symptoms, urge urinary incontinence, urgency and frequency in adults 18 years and older when an oral medication does not work well enough or cannot be taken. 

Botox can be used to treat an overactive bladder in both men and women.  Botox is believed to work in two ways.  It reduces activity in the bladder muscle by reducing bladder contractions, which can help reduce leakage, increase bladder capacity and decrease pressure in the bladder which can help protect the kidneys.  Secondly, it is believed to reduce nerve signals from the bladder telling the nervous system that the bladder is full.  Calming these hypersensitive nerves may also help reduce leakage. 

Botox is a procedure where an injection of Botox (100-200 Units) is injected into the detrusor muscle through the bladder wall with a cystoscope.  It can be done as a hospital outpatient procedure or in the office, which is where I treat the majority of my patients and it only takes me about 10 minutes or less to perform. I have found that the majority of the patients tolerate this procedure very well. 

Botox has given patients suffering with OAB a new option.  No longer do the patients have to take numerous oral medications with unsatisfactory results.  Now the patient can have a minor procedure once or twice a year with the potential to dramatically improve their quality of life.

 

Urology Centers of Alabama

www.urologycentersalabama.com