Botox to Treat Incontinence? Yes!

May 9, 2019

Did you know that Botox can do more for you than simply work as a wrinkle eraser? In fact, Botox is therapeutically used to treat patients suffering from all kinds of conditions that include everything from excessive sweating and neck spasms to premature ejaculation, migraines, cold hands and even the dangerous cardiac condition of atrial fibrillation after heart surgery, among others.

But, it’s also an FDA-approved treatment for an overactive bladder, a condition that affects about 33 million Americans every year. Botox can prevent involuntary muscle contractions that can cause people to feel like they have to pee even when they don't.

We caught up with Dr. Brent Parnell, an urogyencologist at Brookwood Baptist Medical Center, to chat about overactive bladder and why Botox might be the solution you’ve been searching for.

Q: Explain how Botox works and why it can help treat a leaky bladder.

Women develop incontinence for a variety of reasons. One common condition called overactive bladder (or OAB), causes a strong sense of urgency that may result in accidental loss of urine before making it to the bathroom. Bladders empty urine by contracting or squeezing. Many times women with OAB will have a bladder that squeezes when the timing is just not right. Botox relaxes muscle when injected directly into the muscle itself. So we take advantage of this to help relax the bladder, and it works really well for about 85% of women who try it.

Q: Is a Botox injection for a leaky bladder a last resort option? How do I know if it’s right for me?

When treating women with OAB, we think about it in terms of levels or steps.

Step 1: includes strategies such as avoiding caffeinated beverages, sodas or teas. Also learning to delay voiding using timed voiding can help decrease frequency. Finally, pelvic floor exercises can be used to help delay the urge to void. If these strategies fail to control the symptoms, we move to ....

Step 2: which includes medications such as Myrbetriq, Detrol, Vesicare and a variety of other medications. We generally try at least 2 medications, sometimes in combination prior to moving to ...

Step 3: which is Botox, but women should know, that prior to trying Botox, it is important to understand how the bladder works. So many times physicians will assess the bladders function using urodynamic testing prior to prescribing Botox, which allows the physician to determine if women will be good candidates for Botox. After working through these steps, women will then know if Botox could be right for them.

Q: What can I expect on the day of treatment?

At Alabama Center for Urogynecology and Pelvic Pain, we have streamlined the process to make it a short visit and a comfortable experience in the office that usually only takes a total of about 45-60 minutes (some physicians may perform bladder Botox injections in a surgery center or operating room). The procedure itself only takes about 2-3 minutes. At our office, we check a urine sample to make sure patients do not have a bladder infection. Then we fill the bladder with a numbing medicine and allow about 15 minutes for the numbing medicine to take effect. The staff has everything ready, so when I come into the procedure room we spend a few minutes reviewing the procedure and then get started. About 3 minutes later, the procedure is done, and the patient is allowed to empty her bladder. She will be ready to go home a few minutes later.

Q: How soon will Botox start to work?

Botox takes effect relatively quickly. Most patients will notice improvement within 5-7 days. 85% of women see a significant improvement in their OAB symptoms.

Q: How long will one treatment last?

In some of the larger trials with bladder Botox, it lasts up to 9 months. At the lowest dose, I generally tell patients to expect anywhere from 4-6 months. At higher doses, 6-9 months is more typical.

Q: How often will I need to treat with Botox?

With treatment of incontinence, our focus is always on improving quality of life. So as symptoms begin to return, we schedule the next Botox injection. This differs from person to person. At low doses, the typical patients will have injections performed about every 4-6 months which means about 2-3 times a year.

Q: Is this procedure covered under insurance?

All major insurers including Medicare cover intravesical or bladder Botox. To qualify for Botox, patients must have failed conservative strategies I mentioned earlier and at least two medications after an adequate trial. So working through the steps I mentioned helps us make sure we always treat women with the most conservative or safest effective treatment, and then when we arrive at the third step, insurers are happy to allow us to use this treatment.

Q: Are there any potential side effects?

As with all medical treatments or procedures, risks and benefits exist and should be well understood before moving forward with treatment. In most studies, the most common risk with bladder Botox is bladder infection. The risk women need to most familiar with prior to treatment is called urinary retention. This is a temporary condition where women have a difficult time adequately emptying their bladder that may require additional assistance until the bladder function returns. Usually this lasts a few weeks. This happens in about 5% of women who have bladder Botox.


As a board-certified urogynecologist, Dr. Parnell focuses his practice at Alabama Center for Urogynecology and Pelvic Pain solely on the treatment of pelvic floor disorders including pelvic organ prolapse, bladder and bowel incontinence using a wide array of conservative, medical and surgical treatments. Dr. Parnell has extensive experience with robotic surgery, sacral neuromodulation, Botox for overactive bladder and other minimally invasive techniques.

For more information about treatment for urinary incontinence, check out this video of Dr. Parnell in one of our recent Ask the Doctor segments with FOX6 News: