New Study Reveals Successful Overactive Bladder Treatment

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Diagnosis of an overactive bladder is based on episodes of sudden urges to urinate that become so difficult to suppress that it often leads to moments of embarrassing involuntary voiding of urine referred to as incontinence. Treatment for an overactive bladder is typically limited to not-always-successful methods such as fluid restriction, bladder training, pelvic floor exercises and medication. However, a new study recently reveals that a more successful treatment for an overactive bladder results from the same Botox injections used in cosmetic procedures.

An overactive bladder is a serious medical issue because it often leads to a significant disruption in quality of life aspects for a person on a daily basis. A person who suffers from an overactive bladder may experience some or all of the following symptoms:

• Feeling a strong, sudden urge to urinate

• Urinating frequently, usually eight or more times in 24 hours

• Awakening two or more times in the night to urinate (nocturia)

• Experiencing “urge incontinence”—the involuntary loss of urine immediately following an urgent need to urinate

One of the biggest myths of an overactive bladder condition is that it is a normal part of the aging process and that eventually the majority of people will experience incontinence and will have to begin wearing absorbent undergarments or bulky pads. However, what is true is that as a person ages they are at an increased risk of developing conditions that can mimic an overactive bladder and that up to 20 percent of the population over age 40 suffers from an overactive bladder to some degree.

Normal bladder function is dependent upon kidney function, sensory nerves and muscle action.

When the kidneys filter the blood, excess fluid, metabolites and impurities leave the kidneys and travel to the bladder for temporary storage. The bladder stretches as urine accumulates. As the level of urine reaches about 1/3 of the capacity of the bladder, nerves surrounding the bladder signal the brain telling it that it is time to void. When a person concentrates on voiding, the brain signals the nerves to cause the pelvic floor muscles and the muscles surrounding the neck of the bladder and upper portion of the urethra to relax, while the muscles of the bladder contract and force the urine out.

When there is a disruption of normal bladder function such as with an overactive bladder, the majority of cases are the result of involuntary contractions of the bladder muscles. However, medical conditions can mimic the symptoms of an overactive bladder and may include:

• Neurological disorders, such as Parkinson's disease, strokes and multiple sclerosis

• Poor kidney function or diabetes

• An acute urinary tract

• Bladder tumors or bladder stones

• Diuretics and other medications that cause a rapid increase in urine production

• An enlarged prostate, constipation or previous operations to treat other forms of incontinence can impede normal urine flow

Therefore, because of the risk of having a condition more serious to overall health than that of an overactive bladder, health authorities state that an accurate diagnosis needs to be made by a physician whenever someone begins to experience overactive bladder symptoms.

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If an overactive bladder is not secondary to an underlying medical condition or disease, treatment typically addresses multiple methods such as:

• Restricting the amount and timing of your fluid intake

• Double voiding where after voiding once, wait a few minutes and attempt a 2nd void

• Training your bladder to “hold it in” until your bladder is relatively full

• Kegel exercises to strengthen your pelvic floor muscles

• Strict scheduling of times throughout the day to initiate voiding

• Using a catheter to drain your bladder

• Wearing absorbent pads or underwear

• Taking a variety of medications

• Surgery to increase the size of the bladder, or to remove the bladder and install a stoma

However, a recent study demonstrates that the aforementioned treatments may be a thing of the past for some sufferers of an overactive bladder.

In an overactive female bladder study involving 240 women severely affected by an overactive bladder who had failed to respond favorably to two different drug treatments, researchers have shown that Botox injections used in cosmetic procedures for removing wrinkles on the face can also be used on bladders to suppress excessive urges to void.

Dr. Douglas Tincello—the lead author of the study—states that, “We found that a single treatment with botulinum toxin was a very effective treatment for the symptoms of DO [detrusor over-activity, i.e. overactive bladder muscle contraction]; patients were able to pass water one or two times less often during the day, and also noticed far fewer times when they had had feelings of urgency and had to rush to the bathroom. In patients treated with botulinum toxin the times of urgency dropped from six a day to less than one a day. Most excitingly, about 4 in 10 women become completely continent again after six weeks and a third were still continent again six months after treatment.”

However, the effect is not permanent nor is it without some complications. According to the authors of the paper, treatment wears off after approximately 6 months necessitating repeat injections. Furthermore, due to paralysis of the bladder muscle, approximately 1 in 8 women had some difficulty emptying their bladder during the six months following the Botox injection, thereby necessitating the use of a catheter to empty their bladders. Some of the women who had to have the catheterization also subsequently developed urinary tract infections.

“These findings are important because many doctors have been offering this treatment to patients based on the information from previous studies in people with spinal injuries, and now we have accurate information on exactly what benefit is likely to be noticed after treatment and how common the side effects will be,” says Dr. Tincello. “This will allow patients to decide whether they wish to have this treatment, which at the moment is not licensed for treating DO and OAB.”

While the treatment of some cases of overactive bladder syndrome with Botox appears to be promising and has met the approval of the FDA, patients and their doctors will have to decide whether the benefits and risks of such a procedure are warranted and desirable. Further large-scale studies are needed to determine the exact risks statistics as well as whether there might be any long-term complications from repeated Botox treatment to the bladder muscles.

Image Source: Courtesy of MorgueFile

Reference: “Botulinum Toxin A Versus Placebo for Refractory Detrusor Overactivity in Women: A Randomised Blinded Placebo-Controlled Trial of 240 Women (the RELAX Study)” European Urology Jan. 2012; Douglas G. Tincello, Sara Kenyon, Keith R. Abrams, Christopher Mayned, PhilipToozs-Hobsone, David Taylor and Mark Slack.

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