This week’s question is inspired by the forum topic “Study Shows Low-dose Botox Therapy Improves Urinary Symptoms in People with MS,” from Aug. 13, 2018.
What are the common urinary symptoms in MS?
People with MS may experience problems with their urinary tract as a result of demyelinating activity in the brain. Some of these problems include:
- The urgent need to void the bladder
- Frequent urination
- Urinary incontinence (an inability to control the muscles that operate the bladder)
- Urinary tract infections
How does low-dose Botox therapy help with urinary symptoms?
First of all … what is Botox?
According to its manufacturers (per the National Multiple Sclerosis Society webpage), Botox (onabotulinumtoxinA) is a medication known as an acetylcholine release inhibitor and neuromuscular blocking agent. It is a neurotoxin used in multiple ways, including treatments for two concerns specific to people with MS:
- Overactive bladder, including symptoms such as urge incontinence, urgency, and frequency
- Urinary incontinence caused by overactivity of the detrusor muscles, a problem commonly associated with MS
These uses are intended for adults who have previously tried, but did not respond to or tolerate, other anticholinergic medications prescribed for this purpose.
Low-dose applications (100 units) are recommended for the treatment of urinary symptoms; at units of greater than 200, complications can include urinary retention problems that require the use of a catheter to correct.
How is low-dose Botox therapy applied?
Low-dose onabotulinumtoxinA is delivered in 0.5 mL injections across 20 sites in the detrusor muscle region to inhibit their activity. The procedure, which can take as little as an hour to perform and may require repeat visits over time, also might include general anesthetic and sedation.
Prior to injection, the bladder should be drained and irrigated with sterile saline. Injections are applied through a small lighted instrument known as a cystoscope.
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