Botulinum (Botox) Toxin Injections for Overactive Bladder

Botulinum toxin (also known as Botox® and Xeomin®) is a purified form of a toxin produced from bacteria. It works by blocking signals between nerves and muscles, causing temporary relaxation of the muscle.

It has been used for over 20 years to treat a range of medical conditions, including muscle spasms of the neck, eyelids and shoulders, headaches and excessive sweating. More recently, it has also become well known for cosmetic treatments.

Botulinum toxin has been used successfully to treat bladder problems for around 10 years and is licensed and approved for this use in Scotland.

Why might botulinum toxin injections be useful?

Botulinum toxin can be used to treat an overactive bladder. This is a common condition that affects the bladder’s ability to store urine and can cause symptoms such as:

A sudden urge to pass urine (urgency)
Leakage before reaching the toilet (urge incontinence)
Passing urine frequently, more than eight times a day
Needing to pass urine during the night (nocturia)
Bedwetting at night (nocturnal enuresis)

Overactive bladder symptoms often improve with bladder training exercises, medication and changes to fluid intake. If these treatments have not helped, botulinum toxin injections may be offered.

Note: Stress incontinence (leakage when coughing, laughing or exerting yourself) is treated differently and will not improve with botulinum toxin injections.

Who should not have botulinum toxin injections?

Botulinum toxin injections are not suitable if you:

Are pregnant
Are allergic to albumin (for example, an egg allergy)

They may also not be suitable if you have:

Myasthenia gravis
Eaton Lambert syndrome
Amyotrophic lateral sclerosis (ALS)

What happens before the procedure?

You do not need to fast before the procedure and can eat and drink as normal. You should take your usual medication, except anticoagulants.

If you take anticoagulant medication such as warfarin or clopidogrel, you will usually need to stop this seven days before the procedure, if it is safe to do so. If stopping is not safe, an alternative may be needed. This should be discussed with a healthcare professional beforehand.

When you arrive at the Urology Department:

Your details will be checked
You will be asked to change into a gown
You will provide a urine sample to check for infection

The procedure cannot go ahead if you have a urine infection.

You will usually be given antibiotics to reduce the risk of infection afterwards and asked to sign a consent form.

What happens during the procedure?

The procedure is carried out by a urology doctor, supported by urology nurses.

You will lie on a couch and be covered with sterile drapes
The genital area will be cleaned
A numbing and lubricating jelly will be applied

A small flexible camera (called a cystoscope) is passed into the bladder through the urethra. The bladder is filled with water so it can be checked.

A special needle is then passed through the cystoscope to inject the botulinum toxin into the bladder wall. The injections are usually not painful, although some people may experience discomfort.

The procedure usually takes around 10 minutes.

What happens after the procedure?

Afterwards, you will be able to get dressed and will usually stay in the department for about 30 minutes to make sure you feel well.

If this is your first treatment, you will be given an advice sheet and a contact number
You will usually have an outpatient appointment about eight weeks after the procedure
If you have had this treatment before, a routine follow‑up appointment is not normally needed, but you will be given a number to contact if you need further injections

You can usually return to normal activities the day after the procedure.

What are the benefits of this treatment?

Around 80% of patients experience an improvement in bladder symptoms
Many people have at least a 50% reduction in urgency or leakage
Around 30–50% of people with urge incontinence may become completely dry

Improvements can take up to two weeks to appear and typically last between six and nine months. The procedure can be repeated if needed.

What are the risks and side effects?

Most people do not experience significant side effects, but possible risks include:

Urine infection (around one in four people experience this in the months after treatment)
Difficulty emptying the bladder (around one in ten people). This can last weeks or months but always returns to normal. You may need to use a catheter temporarily
Very rarely, general muscle weakness. If this happens you should seek medical advice immediately
Mild bleeding in the urine and discomfort for a day or two after the procedure, which is normal and usually settles with extra fluids