What is onabotulinum toxin A?

Botox, or onabotulinum toxin Type A, is an effective treatment option for urgency urinary incontinence or overactive bladder symptoms in women with and without underlying neurologic disorders. In both of these conditions, the muscle in the wall of the bladder, called the detrusor muscle, may contract too often or at inappropriate times. This can cause sudden urgency to urinate, sometimes with urinary leakage.

Many people may recognize the name Botox. This is a brand name for onabotulinum toxin Type A, a protein obtained from bacteria in a controlled laboratory setting, similar to the way that penicillin is obtained from mold. When injected into the bladder wall, onabotulinum toxin Type A works by relaxing the bladder muscle, inhibiting the excessive contractions of this muscle. This can significantly improve the symptoms of urinary urgency and urgency incontinence.

How are onabotulinum toxin Type A injections performed?

At Northwestern Medicine, your urogynecologist will determine if you are a good candidate for onabotulinum toxin Type A injection into your bladder. Women with urgency incontinence are good candidates for onabotulinum toxin A if they do not want to take daily medications or cannot tolerate them secondary to side effects such as dry eyes, dry mouth and constipation. The procedure is done by your urogynecologist in the office. A numbing gel will be placed in your urethra, and a cystoscope will be placed into your bladder. A cystoscope is a narrow camera with a light source that allows your urogynecologist to look inside your bladder. The onabotulinum toxin Type A is then injected into the bladder muscle through the cystoscope.

How successful is onabotulinum toxin Type A?

Onabotulinum toxin Type A is a very effective treatment for urgency incontinence or overactive bladder symptoms. Clinical trials demonstrated the effectiveness of onabotulinum toxin Type A in the treatment of urgency incontinence and refractory urgency incontinence in healthy women and those with neurologic disorders, such as multiple sclerosis and Parkinson’s disease. The effects of onabotulinum toxin Type A are not permanent, typically lasting for six to nine months, and the procedure can be repeated after it wears off.

Are there risks or side-effects associated with onabotulinum toxin Type A?

Recurrent urinary tract infection and difficulty emptying your bladder are known, albeit temporary, risks of onabotulinum toxin Type A. You will receive an antibiotic at the time of your injection to reduce your risk of urinary tract infection. Depending on the dosage of onabotulinum toxin Type A injected into your bladder, you have a 5 to 8 percent chance of temporarily needing to empty your bladder with a catheter. Therefore, we often recommend that you learn to perform self-catheterization prior to the procedure—our nurses will teach you how to do this quite easily.

What is the recovery?

Onabotulinum toxin Type A does not work instantly; it takes up to two weeks to work maximally. It is not uncommon to have some burning or even a small amount of bleeding with urination immediately after your procedure. It is also normal to feel a sense of urgency immediately after the procedure, but this will subside over the course of the day.