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Is Botox effective for treating urinary incontinence?

Robin Wulffson MD's picture
urgency urinary incontinence, urine leakage, Botox, anticholinergics

Most people associate Botox injections with cosmetic procedures such as the removal of facial wrinkles. However, it is also being employed for a number of medical problems such as migraine headaches, multiple sclerosis, and severe sweating. Researchers at Loyola University Chicago Stritch School of Medicine have used Botox injections for the treatment of urinary urgency incontinence in women and compared it to oral medication. They published their findings on October 4 in the New England Journal of Medicine.

The researchers note that urinary incontinence is characterized by the unpredictable loss of urine.

Urinary urgency incontinence condition is much more common in women than men; approximately 19% of women in the United States suffer from the disorder. Anticholinergic medications are commonly used to treat the condition. Anticholinergics inhibit parasympathetic (involuntary) nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells. The nerve fibers of the parasympathetic system are responsible for the involuntary movements of smooth muscles present in the bladder. The researchers note that a recent systematic review of trials comparing treatments for urgency urinary incontinence showed that none of the six drugs evaluated was superior to another in treating the condition and that current evidence was insufficient to guide the choice among other therapies, including injections of Botox. The injections have been reported to be effective in treating urgency urinary incontinence that is resistant to anticholinergic therapy; however, this treatment can result in incomplete bladder emptying, necessitating temporary bladder catheterization. They note that studies comparing Botox to anticholinergic agents are lacking in the medical literature. Therefore, they conducted a randomized trial comparing an oral anticholinergic medication regimen with a single Botox injection into the bladder detrusor muscle of women with urgency urinary incontinence. They assessed whether the reduction in episodes of urgency urinary incontinence over the course of six months, improvement in quality of life, and side effects.

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The researchers performed a double-blind, double-placebo–controlled, randomized trial involving women with idiopathic (cause unknown) urgency urinary incontinence who had five or more episodes of urgency urinary incontinence per three-day period, as recorded in a diary. For a period of six months, the women were randomly assigned to daily oral anticholinergic medication (solifenacin, 5 mg initially, with possible escalation to 10 mg and, if necessary, subsequent switch to trospium XR, 60 mg) plus one intradetrusor injection of saline or one intra-detrusor injection of 100 U of Botox plus daily oral placebo. The primary outcome measurement was the reduction from baseline in mean episodes of urgency urinary incontinence per day over the six-month period, as recorded in three-day diaries submitted monthly. Secondary outcome measurements included complete resolution of urgency urinary incontinence, quality of life, use of catheters, and adverse events.

The investigators found that among 249 study participants, 247 were treated, and 241 had data available for the primary outcome analyses. The average reduction in episodes of urgency urinary incontinence per day over the course of six months, from a baseline average of 5.0 per day, was 3.4 in the anticholinergic group and 3.3 in the Botox group. Complete resolution of urgency urinary incontinence was reported by 13% of the women in the anticholinergic group and 27% of the women in the Botox group. Quality of life improved in both groups, without significant between-group differences. The anticholinergic group had a higher rate of dry mouth (a common side effect of anticholinergics; 46% vs. 31%); however, they had lower rates of catheter use at two months (0% vs. 5%) and urinary tract infections (13% vs. 33%).

The authors concluded that oral anticholinergic therapy and Botox by injection were associated with similar reductions in the frequency of daily episodes of urgency urinary incontinence. The group receiving Botox was less likely to have dry mouth and more likely to have complete resolution of urgency urinary incontinence but had higher rates of transient urinary retention and urinary tract infections.

New England Journal of Medicine
Loyola University Chicago Stritch School of Medicine