Botox in the Bladder

A major British study funded by the leading women’s health charity, Wellbeing of Women, means Botox (Botulinum toxin) could soon be widely prescribed for patients with overactive bladder syndrome (OAB).

The condition affects one in five women aged 40 and over and can cause urinary incontinence.

Dr Douglas Tincello, Senior Lecturer at the University of Leicester, found that just a single treatment of Botox - typically used as a cosmetic treatment to smooth out facial wrinkles – can reduce the symptoms of urinary incontinence by half in the majority of patients.

The Wellbeing of Women study marks the biggest and most significant research into this area and means Botox could soon be licensed by doctors for treating overactive bladders.

‘It’s a very positive result,’ says Dr Tincello, an Honorary Consultant Gynaecologist at University Hospitals of Leicester NHS Trust.  ‘Overactive bladder syndrome is a relatively common health issue which affects up to a fifth of women aged 40 and over.

‘The study hopefully means much better treatment for this condition which can severely impact on quality of life and cause women considerable embarrassment.’

THE STUDY

Over four years, Dr Tincello and his team worked with 240 female patients suffering from moderate to severe urinary incontinence.  122 patients had the Botox treatment whilst 118 got a placebo (salt water).

Their symptoms included having to rush to the toilet at short notice, having to pass water often, and nocturia (interrupted sleep patterns caused by a need to go to the toilet at night).

After Botox treatments, Dr Tincello’s patients reported a 25% reduction in the frequency of emptying their bladders. They also noticed far fewer instances of having to rush to the toilet at a moment’s notice.

Those tested also reported a 50% reduction in ‘urgency’ episodes and urinary incontinence episodes.

Most significantly, around four in ten women became completely continent again after six weeks and a third were still continent six months after the treatment.

WHAT IS OVERACTIVE BLADDER SYNDROME (OAB)?

Overactive bladder syndrome is usually caused by the bladder muscle being too reactive, known as ‘detrusor overactivity’. In other words, the bladder muscles contract too much even when the bladder is only marginally or half full. This is what causes the feeling of needing to rush to the toilet.

Failure to do so can be painful and in some cases people end up having incidents of urinary incontinence.

‘Some of those affected find it hard to cope,’ says Dr Tincello. ‘One patient told me of a harrowing situation whereby she ended up passing water over a supermarket floor.’

HOW DOES THE BOTOX TREATMENT WORK?

Patients are given a local anaesthetic. Botox is then injected in several areas of the bladder muscle via a cystoscope (a small camera inserted through the urethra). The Botox partially paralyses the bladder muscle, and so relieves the symptoms.

‘The treatment is not without some complications,’ says Dr Tincello. ‘About one in eight women we treated had difficulty emptying their bladder at some time in the six months after treatment (due to paralysis of the bladder muscle).

‘However, this was treated by teaching the women to use disposable catheters - an option they said they’d choose rather than battling urinary incontinence.  The effects of the Botulinum toxin begin to wear off after about six months or so.’

PREVIOUS TREATMENTS FOR OVERACTIVE BLADDER SYNDROME

Up until now, one of a range of tablets called anticholinergics has been prescribed for overactive bladders. These work by blocking the nerve signals to the bladder muscle, and reducing sensation of bladder filling, but they can cause side-effects such as dry mouth and constipation.

Patients are often advised to try ‘bladder training’ which involves daily pelvic floor exercises and trying to stretch the bladder by putting off going to the toilet for longer than usual.

‘I’m delighted to say that a Botulinum toxin has much better results than a six-month course of tablets or bladder training,’ says Dr Tincello.

‘Our work may lead to Botox being licensed to treat overactive bladder syndrome in the UK.  It may also turn out be cheaper than using a customary six-month course of anticholinergics.’

Liz Campbell, Director of Wellbeing of Women says of the study: ‘This is a horrible condition and often means otherwise healthy active women curtail their lives, becoming prisoners in their homes. 

‘It is rarely discussed but affects many women.  I am delighted that Wellbeing of Women has been able to support such an important study that will improve the quality of life of many women.’

Ends

To set up interview opportunities with Liz Campbell, Director of Wellbeing of Women and/ or Dr Douglas Tincello please contact: Rachael Lloyd at Brown Lloyd James, rachaell@blj.co.uk

Tel 020 7 932 1599/ 07969 990183

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