A Urologist Explains Exactly How Botox Works for Overactive Bladders

Honestly, every time a new use for Botox (aka onabotulinumtoxinA) comes out, Botox’s range seems broader than Mariah Carey’s vocal register. It’s used for cosmetic procedures to reduce wrinkles and fine lines, to stop headaches in their tracks, to treat hyperhidrosis (excessive sweating), and, believe it or not, conditions like overactive bladder, according to Aleece Fosnight, MSPAS, PA-C, CSC-S, founder of the Fosnight Center for Sexual Health and medical advisor of Aeroflow Urology. How exactly does this work? We asked experts to explain where Botox fits in urology medicine.

What is overactive bladder?

When you pee, according to the Mayo Clinic, your bladder and pelvic floor engage a series of contractions and relaxations in order to release urine from your body. In a person who has the condition of overactive bladder (OAB), the bladder and brain connection is interrupted for a number of reasons. When this happens, the bladder muscle can often contract, signaling the urge to pee frequently and urgently. This can cause incontinence or significantly disrupt the lives of people who have OAB. Not only that, waking up to pee is dangerous for elderly folks because of the high risk of falling and incurring more serious injuries.

How does Botox work for overactive bladder?

“Botox is a neurotoxin that aids in blocking muscle contraction,” says Fosnight. “Botox has long been used for facial aesthetics; however, it is now more broadly used for other medical conditions such migraines, muscle spasticity, and urge incontinence (OAB).” Botox can be a useful longer-term treatment for overactive bladder, and it’s often used on top of pelvic floor therapy and bladder training, Fosnight explains. While it’s not a permanent solution, it does give patients six to nine months of relief without needing to take daily oral medications.

“Bladder Botox is the same Botox used cosmetically; it’s a botulinum toxin that is used to “relax” the bladder muscle much like it relaxes (paralyzes) facial muscles for wrinkles,” says board-certified urologist Karyn Eilber, MD. “When people have an overactive bladder, their bladder muscle is involuntarily contracting/spasming so they can get uncontrollable urges to urinate and even have incontinence,” she says. Botox comes in and assists the bladder by freezing muscles that typically contract too much.

Are there any risks?

“The main risk of bladder Botox is that it works too well and someone can temporarily have difficulty urinating or even inability to urinate, but fortunately, this occurs in a very small percentage of people, and it also doesn’t occur suddenly as Botox effects have a gradual onset,” says Dr. Eilber. Because of this risk, numerous tests to assess the function of the bladder are done before, during, and after treatment. The other consideration is that Botox is not permanent and usually requires treatment every five to six months—though this is often a good feature, as treatment allows patients relief for extended periods of time.

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