Botox effectively treats incontinence

By Jan Jarvis

A national study that includes UT Southwestern Medical Center has found that injecting Botox into the bladder is as effective as medication for treating urge incontinence, a condition that afflicts about 16 percent of women nationally.

Dr. Joseph Schaffer

Urge incontinence causes a sudden, intense urge to urinate and involuntary urine leakage due to abnormal bladder muscle contractions. 

The study could change the way an overactive bladder is treated by giving women an alternative to medication, said Dr. Joseph Schaffer, Professor of Obstetrics and Gynecology and head of female pelvic medicine and reconstructive surgery.

“Instead of taking medication every day, women could come to their doctor’s office once or twice a year and get an injection,” Dr. Schaffer said. “It’s  a three-minute office procedure.”

The study, published in the October issue of The New England Journal of Medicine, found that both the Botox therapy and medications reduced the number of daily overactive bladder episodes from five to one or two. A key difference though appears to give the Botox treatment option an edge: Researchers discovered that women injected with Botox were twice as likely as those in the medication group to report that their urinary leakage stopped completely within six months.

Botox has been used to treat urinary incontinence, but currently is only approved for women with neurological disorders such as multiple sclerosis. However, in the clinical trial conducted at UT Southwestern, women with moderate to severe urge incontinence without neurologic disease were treated. Botox was found to be safe and effective. 

With this procedure, Botox is injected into the muscles of the bladder during cystoscopy, a procedure performed under local anesthesia that involves inserting a tube into the urethra.

Both treatments had side effects. Within two months of treatment, 5 percent of women who received the injections had trouble emptying their bladders and 33 percent experienced urinary tract infections. Among those who took the oral medication, 46 percent developed dry mouth.

One year after they received the Botox injection, 38 percent of the women reported the condition was still under control. For those in the medication group, one year after treatment 25 percent reported their symptoms were controlled.

The study is the first to compare the effectiveness of Botox versus medication in this population of women, Dr. Schaffer said. UT Southwestern was one of 10 institutions that participated in the National Institutes of Health clinical trials network study from Feb. 2, 2010, to May 22, 2012, involving nearly 250 women.

Although Botox is best known as a wrinkle reducer, it also is used to treat a variety of medical conditions, including migraines, excessive underarm sweating, and eyelid twitching.

Urinary incontinence is a common condition in the United States that mainly afflicts women over age 45.

Anticholinergic medications commonly are used to reduce contractions in the bladder. While some women may prefer taking a pill, others may find the medication side effects troublesome and prefer a once- or twice-yearly injection, Dr. Schaffer said.

“The new study shows that an even larger population could benefit from the use of Botox,” he said.  “It could revolutionize the way overactive bladder is treated.”

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Dr. Schaffer holds the Frank C. Erwin Jr. Professorship in Obstetrics and Gynecology.

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