The botulinum toxin, also known as the prescription medicine Botox, is approved by the FDA to treat muscle spasticity and spasms, as well as bladder dysfunction. It is produced by the bacteria Clostridium botulinum.
The toxin blocks neuromuscular conduction between the nerves and the muscles for short-term localized relaxation of the targeted muscle.
Manufactured by Allergan, Botox is injected into the bladder muscle to treat overactive bladder symptoms that include strong urges to urinate with leakage or wetting accidents, and frequent urination when other types of medication don’t work or can’t be taken. It is also used to treat incontinence in adults with a neurologic condition who have small leakages or don’t tolerate the side effects of other medication.
Before Botox can be recommended, patients undergo a set of tests to diagnose and understand the underlying problem. The tests, called urodynamics, provide a computerized assessment of the overall bladder function. It measures if the bladder muscles contract involuntarily while the bladder is being filled, how much urine is left in the bladder after urinating, how much pressure exists inside the bladder, and the bladder’s capacity.
How Botox is Administered for Bladder Dysfunction in MS Patients
Here’s what happens after the decision to use Botox treatment for bladder dysfunction is made:
- Before treatment: The urologist will instruct the patient about medicines that should be stopped, recommend antibiotics that should be taken to prevent urinary tract infections, and explain that a catheter may be needed after treatment to drain the bladder completely.
- On the day of treatment: The patient will be assessed for urinary tract infection and the specialist will explain which type of anesthesia will be used. Then, Botox will be administered through small injections in the bladder wall. The procedure usually takes less than an hour.
- After treatment: The patient’s blood pressure, pulse rate, and bladder emptying capability will be measured for about 30 minutes. The urologist will recommend antibiotics and check if urine is left in the bladder after urinating within 2 weeks after treatment and up to 12 weeks.
Things to be Aware of with Botox
The effects of the botulinum toxin may spread from the area of injection and produce symptoms that may last as long as some weeks after injection. Swallowing, speaking, and breathing difficulties can be life threatening.
Other serious adverse reactions that may affect areas not connected to the injection site could include loss of strength and all-over muscle weakness; double vision, blurred vision and drooping eyelids; speaking problems, loss of bladder control, swallowing difficulties, and breathing problems.
Common side effects reported within the first 12 weeks following treatment include urinary tract infection, urinary retention, presence of blood in the urine, fatigue, and insomnia.
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