DEAR DR. ROACH: In two weeks, I am supposed to get Botox injections for my overactive bladder (OAB) and my frequent need to urinate at nighttime. Are these injections safe? Are there any bad side effects? How long do they work? — D.J.
ANSWER: The initial treatment for OAB symptoms usually consists of lifestyle changes (i.e., quitting smoking and avoiding medications that worsen symptoms at night), pelvic floor muscle exercises, and bladder training. If these are ineffective, medication is often used. If medications don’t work or cannot be tolerated, additional treatments are considered, such as Botox.
The underlying problem with an OAB are uncontrolled bladder spasms. Botox is a powerful suppressor of muscle activity. If just the right amount is used, the excess muscle spasms are reduced, and the person gets good results.
However, if too much is used, the person may not be able to urinate spontaneously at all, so your urologist will be giving you instructions on how to self-catheterize, in case you are unable to void your bladder after the injection.
If you note that the leakage has worsened a week or so after the procedure, this is a big clue that the bladder is not functioning after the injection. This can last for months, but typically no more than three months. Fortunately, this complication happens uncommonly, in about 2%-7% of people.
Other complications include infections and bleeding, but these are not common. Antibiotics are given to reduce the risk of infection. Very rarely, muscles outside of the bladder are affected, including generalized weakness and eye muscle weakness.
When it works well, most people start noticing benefit in a week or so, and relief typically lasts 9-12 months before another injection is given.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med. cornell.edu.