Botox and Its Use for Treating Bladder Problems

Botox is a prescription drug that’s used to treat certain bladder problems, such as overactive bladder in adults. For certain bladder problems, Botox may also be prescribed to children ages 5 years and older.

Botox comes as a powder that a healthcare professional mixes with liquid to make a solution for injection.

Botox belongs to a group of drugs called neurotoxins. The active ingredient in Botox is onabotulinumtoxinA, which is a biologic. (An active ingredient is what makes a drug work.) It does not come as a biosimilar drug. (Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs.)

To learn more about Botox, see this in-depth article.

Botox can be used for certain bladder problems in adults and in children. Specifically, it’s used to treat:

• overactive bladder (OAB) symptoms in adults
• urinary incontinence with detrusor overactivity* linked with a neurological condition, such as multiple sclerosis (MS) or a spinal cord injury, in adults and children ages 5 years and older

* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.

About OAB and detrusor overactivity

OAB and detrusor overactivity can both cause trouble with urination. With these conditions, you may have involuntary spasms in your bladder muscles, even when you don’t actually need to urinate.

The exact cause of OAB isn’t known. But some possible factors or causes may include:

• urinary tract infection (UTI)
• consuming caffeine, alcohol, or other bladder irritants
• taking medications that increase urine output
• other bladder problems, such as bladder stones
• not completely emptying the bladder

Detrusor overactivity can be linked with neurological conditions such as MS or a spinal cord injury. These neurological conditions affect how your brain communicates with the rest of your body. In some cases, they can cause bladder problems such as detrusor overactivity.

What are the symptoms of bladder problems?

Symptoms of bladder problems may include:

• a sudden urge to urinate
• frequent urination
• interrupted sleep because of nocturia (excessive urination at night)
• urinary incontinence, which causes urine to leak uncontrollably

The lists below include some of the main side effects that have been reported in people using Botox. For information about other possible side effects of the drug, talk with your doctor or pharmacist.

You can also learn more about side effects from this article or from the drug’s prescribing information.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Botox, visit MedWatch.

What are Botox’s mild side effects?

The mild side effects of Botox can vary depending on the condition it’s being used to treat. Some side effects also differ between adults and children using the drug.

Mild side effects reported in people using Botox for overactive bladder (OAB) symptoms include:

• urinary tract infection (UTI)
• trouble urinating, or pain or discomfort while urinating
• urinary retention (meaning the bladder doesn’t empty completely)

Mild side effects reported in people using Botox for detrusor overactivity* linked with a neurological condition include:

Mild side effects reported in children using Botox for detrusor overactivity linked with a neurological condition include:

• UTI
• bacteria in the urine
• leukocytes (a type of blood cell) in the urine

In many cases, mild side effects from the drug can be temporary. Some side effects may be easy to manage, too. But if side effects last for a longer time, or if they bother you or become severe, talk with your doctor or pharmacist.

* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.

What are Botox’s serious side effects?

In rare cases, serious side effects from Botox injections can occur.

Serious side effects of Botox injections that have been reported include:

• trouble breathing or swallowing
• autonomic dysreflexia (an injury to the spinal cord that can be fatal)
• risk of spread of toxin effects*
• allergic reaction†

Call your doctor right away if you have any serious side effects while using Botox. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.

* Botox has a boxed warning for this side effect. This is the most serious warning from the FDA. To learn more, see the “What should I know before using Botox?” section below.
† An allergic reaction is possible after using Botox. But it’s not clear whether this side effect occurred in studies.

Botox treats certain bladder problems in adults and in children. To learn more about the specific conditions it’s used for, see the “What are the bladder conditions Botox treats?” section above.

Botox isn’t a first-choice medication for treating bladder problems. It’s used when anticholinergic drugs didn’t work well enough for someone’s condition.

How does Botox work?

Botox helps relieve the symptoms of bladder problems by promoting bladder control.

The detrusor muscle that lines the bladder plays an important role in bladder control. When the muscle relaxes, the bladder can fill with urine. When you’re urinating, the muscle contracts to release urine.

If you have overactive bladder (OAB) symptoms or detrusor overactivity, your bladder muscles spasm involuntarily (without your control). Botox is injected into the detrusor muscle (your main bladder muscle) to block the nerve signals to the muscle. This helps control the muscle’s contractions.

Below are answers to some commonly asked questions about Botox’s use in treating bladder conditions.

Are there any long-term side effects from using Botox to treat bladder problems?

In general, you may have side effects within the first week of receiving Botox injections. Most of the time, these side effects are temporary, but sometimes, side effects can last for several months or longer.

Possible long-term side effects of Botox can include:

• ulcer in the cornea (the clear layer of tissue over the eye)
• urinary retention (meaning the bladder doesn’t empty completely)

If I want to use Botox to treat a bladder condition, will my insurance cover it?

It depends. Some insurance plans may offer coverage for Botox injections. Before using Botox, check with your insurance provider to see if you’re covered.

For more information, see the “How much does Botox cost?” section below.

What can I expect after receiving Botox injections for my bladder problem?

After receiving a Botox injection, you may have improved bladder control for about 12 weeks. Some people may still have bladder control after 24 weeks. After this period, the effect of Botox wears off, and you’ll need more injections.

Your experience with Botox injections may vary. If you have questions about the results you can expect with this drug, talk with your doctor. And for more information, see the “How effective is Botox?” section below.

Botox has been shown to be an effective treatment option for bladder problems. In studies, people who received Botox injections for overactive bladder (OAB) symptoms saw improvements in certain symptoms, such as frequent urination, in the 12 weeks after treatment. People also noticed an increase in the amount released during urination.

Another improvement that people using Botox for OAB symptoms noticed after receiving the injections was fewer episodes of urinary incontinence. In studies, these improvements lasted from 19 to 24 weeks.

Two studies looked at adults who had urinary incontinence with detrusor overactivity* linked with a neurological condition. These studies found that people who received Botox injections had fewer episodes of urinary incontinence. These improvements lasted 42 to 48 weeks for at least half the people in the study.

If you have questions about the results you can expect with this drug, talk with your doctor.

* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.

Botox is used to treat the following bladder problems:

• overactive bladder (OAB) symptoms in adults
• urinary incontinence with detrusor overactivity* linked with a neurological condition such as multiple sclerosis (MS) or a spinal cord injury, in adults and children ages 5 years and older

Botox is given as an injection into the detrusor muscle (the muscle lining the bladder). You’ll receive these injections at your doctor’s office.

Your doctor will explain the process for receiving Botox for your bladder condition. They’ll also explain how often you’ll need to receive the injections.

* This refers to overactivity of the detrusor muscle, which is the muscle that lines the bladder.

What is the typical dosage for Botox?

Below are commonly used dosages of Botox for bladder conditions. But your doctor will determine the right dosage to fit your needs.

For OAB symptoms in adults, the recommended dose is 100 units of Botox. This is also the maximum recommended dose for treating this condition.

For use in adults with detrusor overactivity caused by a neurological condition, the recommended dose is 200 units of Botox. This is also the recommended maximum dose for treating this condition.

Children’s dosage

Botox is used in children ages 5 years and older with detrusor overactivity caused by a neurological condition. For this purpose, the Botox dose is determined based on the child’s weight:

• For children who weigh at least 34 kilograms (kg), which is at least about 75 pounds (lb), the dose is 200 units of Botox.
• For children who weigh under 34 kg (under about 75 lb), the recommended dose is 6 units of Botox for every kilogram of body weight. Your child’s doctor will calculate the appropriate dose for them.

Note: Botox has other uses in addition to treating bladder problems. The dosage may be different for these other uses. To learn more, talk with your doctor.

How is Botox given?

To treat bladder conditions, Botox is given as an injection into the detrusor muscle (the muscle lining the bladder).

At each injection appointment, adults with OAB symptoms or children with detrusor overactivity will receive a Botox injection in 20 sites, located 1 centimeter (cm) apart in the detrusor muscle. (So, each dose is divided into 20 different injection sites.)

Adults with detrusor overactivity will receive a higher dose of Botox, which is injected in 30 sites, located 1 cm apart in the detrusor muscle.

In some cases, your doctor may inject a medication before your Botox injection to help with pain.

Your doctor will monitor you for at least 30 minutes after each Botox injection. If you’re using Botox to treat OAB symptoms, you’ll need to show that you can urinate before leaving your doctor’s office.

If you have questions about what to expect at your injection appointments, talk with your doctor.

How often will I get Botox injections?

How often you receive Botox injections may vary. You’ll need to track the symptoms of your bladder condition so that your doctor can determine how often you need the injections.

The minimum period between injections is 12 weeks, but in some cases, people feel the effects of Botox for longer periods. This means that they may need injections less often.

If you have questions about how often you’ll need to get Botox injections for your condition, talk with your doctor.

Before you use Botox, there’s some important information to keep in mind. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.

Boxed warning: Risk of spread of toxin effects

This drug has a boxed warning . This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

In rare cases, Botox may spread away from where it’s injected to other parts of your body. This can result in botulism, a potentially fatal condition that causes paralysis.

Symptoms of botulism may include:

• muscle weakness all over your body
• double vision or blurred vision
• drooping of your eyelids
• change in or loss of your voice
• loss of bladder control
• trouble breathing or swallowing

If you have any of these symptoms after receiving Botox injections, call 911 (or your local emergency number) right away or seek immediate emergency medical care.

If you have questions about your risk for botulism from Botox injections, talk with your doctor.

What other warnings should I know about?

In addition to the boxed warning described above, Botox has other warnings. If any of the following medical conditions or other health factors apply to you, talk with your doctor before using Botox:

• if you have a history of side effects from any botulinum toxin product
• if you have a condition that affects your muscles or nerves, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis
• if you currently have or have a history of breathing problems, such as asthma or emphysema
• if you currently have or have a history of problems with swallowing
• if you currently have or have a history of bleeding disorders
• if you have a urinary tract infection (UTI)
• if you have trouble emptying your bladder on your own
• if you have surgery planned
• if you’re pregnant or breastfeeding
• if you’ve had an allergic reaction to the drug or any of its ingredients

Botox injections may interact with other medications you’re taking. Tell your doctor about all drugs you’re using, including prescription and over-the-counter products.

Also, tell your doctor if you:

• have received other botulinum toxin products or injections in the past
• have recently received antibiotics by injection
• use muscle relaxers
• are taking an allergy or cold medication
• use sleep medication
• are taking blood thinners

The price of Botox depends on several factors. These can include your treatment plan, your insurance plan, and your location.

Currently, Botox is only available as a brand-name medication. It’s not available in a biosimilar form . Biosimilars are like generic drugs, but they’re made for biologic drugs such as Botox. Like generics, biosimilars tend to cost less than the brand-name drug they’re based on.

Talk with your doctor about using Botox for your bladder condition. They can help determine if Botox might be a good fit for you.

Here are some examples of questions you may want to ask your doctor:

• Can I receive Botox injections if I have a urinary tract infection (UTI)?
• After receiving my Botox injection, when will I see results?
• Does Botox interact with any other medications I’m taking?
• Can I receive Botox injections for bladder problems if I’m pregnant?

To learn more about Botox, see these articles:

• All About Botox
• Side Effects of Botox: What You Need to Know

To get information on different conditions and tips for improving your health, subscribe to any of Austra Health’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.