Multiple Sclerosis, Bladder Problems and Botox
At least 80 percent of people with multiple sclerosis experience bladder problems, and treatment can be a challenge. One of the treatment options is onabotulinumtoxin A, also known as Botox.
Bladder problems occur in individuals with multiple sclerosis when lesions interfere with the transmission of nerve signals that control the bladder and urinary sphincters. This interference can result in various issues, including urinary urgency, urinary frequency, incontinence, inability to empty the bladder completely, delay in starting urination, and the need to urinate often during the night (nocturia).
If urinary dysfunction is not addressed, it can eventually lead to worsening of weakness, spasticity and other MS symptoms, frequent urinary tract infections, kidney stones, skin infections, and worries about urinary incontinence that results in a loss of independence and restricted activities.
Botox for urinary dysfunction in MS
A new study looked at the use of Botox in 31 females with multiple sclerosis and overactive bladder and detrusor overactivity. Detrusor overactivity means an individual experience uncontrolled contraction of the detrusor muscle (bladder wall), resulting in urinary urgency, urinary frequency, leakage, and nocturia.
All the participants were evaluated for urinary problems and completed a variety of questionnaires concerning incontinence, sexual function, anxiety, and depression before and three months after receiving an injection of onabotulinum toxin A. Here’s what the authors found:
- The injection of Botox significantly improved urinary symptoms
- Sexual functioning and psychological status also improved significantly
The authors concluded that the sexual benefits seen in this study were “likely due to an indirect effect exerted by the overall urological clinical improvement on sexual function at both the psychological and emotional levels.” In addition, the positive impact on depression and anxiety suggests that urinary problems have a negative effect on psychological well-being.
In a review study, participants included individuals with detrusor overactivity as a result of multiple sclerosis or subcervical spinal cord injury. The authors found that 200 units of Botox resulted in significant benefits in phase III trials when compared with placebo and that the treatment was well tolerated.
In addition, similar positive results were seen in an extension study of the phase III trials, showing that repeat injections of Botox were effective and well tolerated.
In a third recent study, the authors evaluated the cost effectiveness of Botox (200 Units) in individuals with detrusor overactivity associated with multiple sclerosis or subcervical spinal cord injury that had not responded to anticholinergic medication.
The study compared Botox plus best supportive care (BSC) over five years with BSC alone. BSC included behavioral therapy and use of pads, alone or along with catheterization and possibly with anticholinergic drugs.
Data were collected from 468 individuals taking Botox in two phase III clinical trials. The bottom line was that the combination of Botox plus BSC was more cost effective than use of BSC alone.
Other treatment options
Botox by no means is the only treatment option for bladder dysfunction in multiple sclerosis. Other possibilities, especially lifestyle changes, should be tried before resorting to more invasive means.
- Lifestyle changes can include changing fluid intake before bedtime, bladder training, and dietary changes, such as avoiding spicy foods, caffeine, soda, alcohol, MSG, artificial sweeteners, and tomatoes.
- Pelvic floor exercises along with biofeedback and neuromuscular stimulation can be practiced regularly to help reduce overactive bladder symptoms. Once you learn these techniques from a qualified therapist, you can practice them at home to strengthen pelvic floor muscles and enhance muscle control.
- Medications to manage an overactive bladder are available. These drugs help relax the bladder muscles and aid in reducing bladder spasms. The drugs include darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, and trospium.
- A minimally invasive procedure called percutaneous tibial nerve stimulation can reduce urinary urgency and frequency, incontinence, and nocturia. It involves placing a needle electrode in the ankle. This electrode sends a nerve impulse to the nerves that control the bladder and pelvic floor muscles. Research shows that more than 60 percent of female patients responded to this treatment approach.
- Individuals who have trouble emptying their bladder may be referred for intermittent self-catheterization. This involves placing a catheter into the urethra to empty the bladder one or more times daily, after which time it is removed.
Bladder dysfunction is a physically and emotionally challenging experience for people with multiple sclerosis. Botox injections can be a treatment option for some patients and should be discussed with one’s healthcare provider.
Also read about alternative treatments for multiple sclerosis
Giannantoni A et al. Onabotulinumtoxin A intradetrusorial injections improve sexual function in female patients affected by multiple sclerosis: preliminary results. World Journal of Urology 2015 May 13
Hamid R et al. Cost-effectiveness analysis of onabotulinumtoxin A (Botox) for the management of urinary incontinence in adults with neurogenic detrusor overactivity: a UK perspective. Pharmacoeconomics 2015 Apr; 33(4): 381-93
National Multiple Sclerosis Society
Sanford M. OnabotulinumtoxinA (Botox): a review of its use in the treatment of urinary incontinence in patients with multiple sclerosis or subcervical spinal cord injury. Drugs 2014 Sep; 74(14): 1659-72
Zecca C et al. Motor and sensory responses after percutaneous tibial nerve stimulation in multiple sclerosis patients with lower urinary tract symptoms treated in daily practice. European Journal of Neurology 2014 Mar; 21(3): 506-11