It’s happened to most of us at least once: You cough, laugh or run … and a little pee comes out. While a bit embarrassing, rare leaking episodes aren’t a big deal.
But what if it’s happening a lot? What if the leaking is impacting how you live your life?
Well. That’s a problem.
The same goes for urgency. Waking up at night to pee — or getting a sudden, barely controllable urge to go — isn’t concerning if it’s a rare occurrence.
But if you’re waking up every night, several times a night because you need to pee? If you’re having to stop on the side of the road because you can’t wait 10 more minutes until you get home? If you feel like your life revolves around your unpredictable bladder?
Yeah. That’s an issue.
Incontinence and overactive bladder (OAB) are common conditions. And luckily, they have multiple causes and available treatment options. If more traditional methods aren’t getting the job done, your doctor may suggest a surprising treatment: Botox® (onabotulinumtoxinA) injections.
This guide will cover what to expect after botox injection in bladder and cost of botox for urinary incontinence.
Botox injections are generally well-tolerated, though it may burn or sting the first few times a patient urinates. Patients may also experience blood in the urine right after treatment.
The most common side effect of using Botox to treat incontinence or OAB is a UTI. Other side effects may include fatigue, painful or difficult urination, and temporary inability to empty the bladder.
Botox injections are not just for wrinkles on your face. They also can be used to help if you have ongoing bladder continence issues. Botox is one option to treat urge incontinence or overactive bladder in people who have not had success with other treatment options.
The prevalent condition of urinary incontinence can harm your social, physical, or mental health. At some point in their lives, between 3% and 11% of men and 17% of women experience urge incontinence.
Urge incontinence is the unintentional loss of urine caused by your bladder contracting.
With an overactive bladder you may:
Feel a sudden urge to urinate that is difficult to control.
Experience incontinence, which is the involuntary loss of urine, as soon as you feel the need to urinate.
Urinate frequently — up to eight or more times per day.
Wake up two or more times in the night to urinate.
It’s important to understand that urge incontinence and overactive bladder are not caused by physical activity or movement, such as when you cough, exercise or sneeze. That type of incontinence would be classified as stress incontinence. It’s possible to have stress and urge incontinence at the same time.
A urologist can inject Botox into your bladder to treat urge incontinence or overactive bladder. This promotes muscle relaxation, giving you more time to reach the restroom when the urge to urinate arises. The injections are done in the clinic, and most patients tolerate the injections well. They do not “hurt” as you may expect, but you may have some short-term discomfort. Many patients have compared it to a period cramp.
The good news is that most people get symptom relief quickly, in as short as a few days. The treatment results last about six months, and you can have additional injections. One possible side effect is urine retention, and it is not recommended for males with a risk or history of enlarged prostate.
While incontinence increases with age, it is not a typical aspect of aging. Regrettably, a lot of people put off discussing their symptoms with their medical team for far too long. There are numerous therapy options available, all of which can enhance your quality of life. Do not be afraid to bring these up with your doctor.
Ask your primary care practitioner for a recommendation if you’re thinking about Botox injections, or look for a medical specialist with experience in these procedures online. Injections must be administered carefully to prevent negative effects.
Botox for overactive bladder
Most people think Botox is a tool for plastic surgeons and not urologists. But the drug is approved by the U.S. Food and Drug Administration (FDA) for people (including children) with overactive bladder symptoms with no apparent neurologic cause.
Research shows the drug is 70% to 80% effective for people who have sudden urgency-related leakage or incontinence, says Dr. Vasavada.
While effective, Botox isn’t a go-to treatment. Your doctor will probably recommend pelvic floor therapy, bladder retraining, medications, and behavioral and lifestyle changes before suggesting an invasive procedure.
Other bladder issues you can treat with Botox
While it’s primarily used for bladder issues without a neurologic cause, Botox is occasionally used to address incontinence connected to neurological conditions like multiple sclerosis (MS) or a spinal cord injury.
Who shouldn’t get Botox injections?
While it’s a safe procedure, bladder injections of this sort aren’t for everyone. Your doctor may recommend against Botox if:
You have a symptomatic urinary tract infection (UTI).
You have a risk or history of enlarged prostate.
You struggle to empty your bladder without the aid of a catheter.
You have a bleeding disorder or use blood thinners.
You have breathing problems like asthma or emphysema.
You’re unwilling or unable to self-catheterize.
You use muscle relaxers.
You’re pregnant or nursing.
You ‘e had recent surgery.
You’ve experienced side effects when using another botulinum toxin product.
You have a condition that affects your muscles or nerves, like amyotrophic lateral sclerosis (ALS) or myasthenia gravis.
How it works
Botox chemically affects muscle-nerve connections. That’s why it can also be used to treat other disorders, including chronic migraine and severe underarm sweating.
“The drug decreases the spasms that cause overactive bladder symptoms,” Dr. Vasavada explains. “It’s not so much for frequency of urination, as much as that sudden urge to go. It’s good to help people when urination is something they can’t postpone without leakage occurring.”
Treatment procedure
Botox injections into the bladder are usually outpatient or office-based procedures. It doesn’t require general anesthesia, and you don’t need anybody to drive you to or from your appointment.
Your urologist first injects a local anesthetic — similar to the numbing medication you get when having a cavity filled. After giving the anesthetic time to take effect, your doctor will spend 15 minutes making a series of small injections into the wall of your bladder through a lighted tube called a cystoscope.
After completing the injections, your doctor will keep you under observation for 30 minutes to make sure you’re alright. Before you leave, you’ll be asked to use the restroom, so your doctor can ensure that you’re able to completely empty your bladder unassisted. You may also get a prescription for a short-term antibiotic. Taking that medication should protect you against infection.
All told, you’ll spend approximately one hour at the doctor’s office.
What To Expect After Botox Injection In Bladder
It’s important to note that the injections won’t take immediate effect. While some people notice a difference within a few days, people with urinary incontinence can expect to wait one to two weeks before seeing the number of daily leakage episodes come down. According to the makers of Botox, you should expect to see “full results” by week 12.
It’s also important to remember that this treatment isn’t a cure. You may still experience occasional issues with urinary incontinence or overactive bladder, and the effects of the injections will wear off over time and need to be repeated. More on that later.
Cost Of Botox For Urinary Incontinence
We generally don’t mind spending money on things we enjoy, like food, new clothes, and vacations to beautiful places. It’s much less fun to spend money on practical things like car insurance or treatment for a medical condition. Even a mild incidence of urine incontinence likely costs you a sizable portion of your hard-earned money to treat.
You should evaluate the efficacy of the treatment, its durability, the type of incontinence it is intended to treat, and any potential side effects when deciding on the most economical urinary incontinence treatment option.
Average Cost of Common Treatments for Incontinence
Given that many sufferers of urine incontinence employ a combination of treatments, the cost of treating urinary incontinence mounts. According to one study, women with urine incontinence of various degrees cost $750 USD on average. The average annual cost of treatment for women with severe urine incontinence was $900 USD, according to a study. The cost of absorption products and associated expenses like dry cleaning and washing must be covered out of pocket, although insurance frequently pays for drugs and surgeries.
Absorbent Products: $388/year
Absorbent products like pads and diapers are often the first choice for treatment of incontinence as they are easy to use and obtain. While the cost of treating incontinence using absorbent products varies greatly depending on the severity of the urinary incontinence, at least one study puts the amount at more than $300 USD per year, on average.
Medications: $120-$5000/year
Urinary incontinence is treated with a range of drugs. Medications prescribed may be designed to relax muscles or stimulate the urethral sphincter, and vary greatly in price according to the type of medication and dosage. One study estimates retail prices per year to fall between $120 and $5000 USD.
Photo by Towfiqu barbhuiya on Unsplash
Injections such as Botox: $1200-$2000/year
Botox is a frequently used treatment for urinary urge incontinence caused by an overactive bladder. One Botox treatment lasts about 6 months, at which time another injection is usually needed. Botox works by relaxing the muscles that cause the spasms involved in causing a sense of urgency. As you might expect, Botox tends to be more expensive than many less invasive treatments, averaging around $1200 USD a year. Another common injectable treatment is a urethral bulking agent, which is injected around the neck of your bladder to improve your ability to retain urine. This type of injection requires anaesthesia or sedation and usually lasts about a year.
Laser Therapy: $900-$3000/year
Even though there aren’t many studies on employing laser therapy to treat female incontinence, noninvasive pulsed laser therapy is widely regarded as a promising treatment and is growing in popularity. Laser treatment seems to stimulate collagen production and the regeneration of tissues around the urethra, reducing symptoms of incontinence. No anaesthesia is required and side effects are minimal; however, this is an expensive therapy and sometimes multiple treatments are needed.
Pelvic Floor Therapy: $500-$1500/year
One of the most popular therapies for incontinence, particularly urge and stress incontinence, is pelvic floor physical therapy. A pelvic floor therapist guides patients through exercises that are designed to help strengthen the muscles involved in urination. These might include Kegels, abdominal exercises, and posture work. Some pelvic floor physical therapists use devices with sensors that provide biofeedback to help patients understand when they’re doing an exercise correctly. While you can do some basic pelvic floor exercises on your own at home, pelvic floor therapy is most effective when it’s guided by a trained therapist. Like other therapies mentioned here, the cost of pelvic floor therapy will depend on whether sessions are group or individual and the frequency of sessions.
Surgery: $10,000-$20,000
The most common type of surgical treatment for incontinence is sling surgery, in which doctors will place a “sling” under your urethra to support it. Sling surgery is usually performed to improve symptoms of stress urinary incontinence, but can als reduce symptoms of urge incontinence for those with mixed incontinence. The cost of controlling urine incontinence after surgery was shown to be lowered from $750 to $190 per year in one study, despite the fact that surgery is by far the most expensive treatment option for incontinence. Surgery is typically reimbursed by insurance. Yet, because it is intrusive and has a number of potential side effects and consequences, including urinary tract infections and trouble peeing, it is typically only used as a last resort for people with incontinence.
Urinary Incontinence Devices: $90-$150/year
There are a few different mechanical products for women that can be put into the vagina to support the bladder (or the neck of the bladder) and apply pressure to the urethra to lessen incontinence symptoms. Not all of these gadgets are made equal; some of them are uncomfortable and increase your chances of getting a UTI. Reusable mechanical devices, however, are frequently simple to use, have fewer side effects, and cost less than many other incontinence treatment options.
Choosing a Type of Incontinence Treatment That Doesn’t Break the Bank
Selecting the best treatment for your incontinence is a very personal choice that will vary from case to case because there are numerous types and degrees of incontinence as well as a wide range of causes and triggers. Most patients with urine incontinence must first identify the type of incontinence they are experiencing before choosing a course of treatment.
For instance, while there are several medications used to treat urge incontinence by relaxing the bladder and reducing bladder spasms, no medications are currently approved to treat stress incontinence. Instead, stress incontinence is more frequently treated with pelvic floor therapy, injected bulking agents, and mechanical devices.
Because pelvic floor therapy is simple, noninvasive, less expensive than many other treatments, and can reduce symptoms of both stress and urge incontinence, it is often a first recommendation by doctors. Pelvic floor therapy can also reduce the cost of treating incontinence by making it possible to purchase fewer absorbent products. Mechanical intravaginal devices can also be helpful in reducing treatment costs by making it possible to buy fewer pads and similar products. Relatively low-cost treatments like reusable intravaginal support devices and pelvic floor exercises can also help patients avoid more invasive and expensive treatments like injections and sling surgery.