Botox approved for overactive bladder
12th September 2013 -- Botox injections, also known as botulinum toxin A, can now be offered as a treatment for women with overactive bladder by the NHS in England and Wales.
The decision has been announced by the National Institute for Health and Care Excellence (NICE). The Scottish Medicines Consortium makes its decision on Botox for OAB in October.
How does Botox help overactive bladder?
Botox is better known as a way to help smooth wrinkles on the forehead. For overactive bladder, or OAB, it helps to relax the muscular bladder wall. It is thought to do this by paralysing the detrusor muscle, but exactly how it helps isn’t known.
OAB is a type of urinary problem whose other symptoms include having to go often (frequency), the need to get up in the night to pass urine (nocturia), and wetting accidents before reaching the toilet (incontinence).
A University of Leicester study in 2012 found that injecting Botox into the wall of the bladder is an effective way of treating OAB.
Until now, treatments have included pelvic floor muscle exercises, advice on fluid intake and tablets. While these measures work for some people, many women gain little or no relief or have uncomfortable side-effects from medicines.
Botox risks and benefits for OAB
The inclusion of Botox as an OAB treatment option is part of updated guidance from the National Institute for Health and Care Excellence (NICE).
It can be offered after lifestyle and other measures haven’t worked, and after discussing the risks and benefits.
The Botox is injected into the bladder using a device called a cystoscope inserted into the urethra.
There is evidence to suggest the treatment can be effective for up to 6 months.
However, side-effects include having difficulty urinating with the possibility of having to use a catheter for a period of time, as well as the risk of recurrent urine infections.
After the injection, patients should be followed up face-to-face or over the phone 4 weeks later.
Botox in 100 unit doses is licenced for OAB in the UK. If a higher 200 unit dose is required, the patient will have to give what's called informed consent, as this dose isn’t yet licenced.
'Don't suffer in silence'
Urinary incontinence, or UI, affects around 5 million women in England and Wales over the age of 20.
As well as OAB, types of urinary incontinence include:
- Stress UI - involuntary urine leakage, sometimes after exertion, including sneezing or coughing
- Urge UI - involuntary urine leakage and urgency.
- Mixed UI - involuntary urine leakage with exertion and urgency.
In a statement, Professor Mark Baker, director of the centre for clinical practice at NICE, says: "Urinary incontinence is a distressing condition affecting the lives of millions of women of all ages. While rarely life-threatening, it may seriously influence a woman’s physical, psychological and social wellbeing.
"Over the years we have seen an increase in women seeking treatment, yet many others are still suffering in silence and not receiving the appropriate care for their condition."