Botox isn’t just for tightening wrinkles.
Duke researchers recently discovered that Botox injections into the bladder can be used to treat urinary incontinence—the involuntary loss of urine. The study, funded by the National Institutes of Health, is the first ever to conduct a side-by-side comparison of Botox and anticholinergic drugs, oral medication typically used to treat urinary incontinence. Botox was found to be twice as effective as oral medication at completely eliminating symptoms of urinary incontinence after six months.
“You have the treatment option of medication, but [oral drugs] don’t work in everyone, and they have side effects associated with them, so we were looking for an alternative,” said Dr. Anthony Visco, lead author of the study and chief of the urogynecology division at Duke Medicine.
Visco noted that Botox was first used about 10 years ago as treatment for incontinence. Botox hinders the release of chemicals to prevent contractions where the nerves interact with the muscles in the bladder, thereby reducing incontinence.
The study conducted trials on approximately 250 women diagnosed with urinary incontinence who were 58 years old, on average. The women were divided into two groups—the first group received Botox injections into the bladder, and the second received oral anticholinergic medications. After six months, 27 percent of the women who received Botox as treatment reported that their symptoms had gone away completely. Of those who took the oral medication, only 13 percent reported that their symptoms were gone.
Dr. Nikki Le, assistant professor of surgery in the urology division, said the effects of bladder incontinence can be debilitating for patients, especially in women where the condition is more common.
An estimated 15.7 percent of women experience urinary incontinence at some point in their life, according to a 2008 study done at the University of Utah School of Medicine. Females are twice as likely as men to struggle with this condition, and it is particularly prevalent among older women.
“The problem with incontinence is there’s no warning, and so there is a lot of anxiety,” she said.
Le said she hopes that the findings of this study will increase treatment options for patients. Oral medications are common but are not always the best line of treatment, she said, adding that patients may not want to take a pill everyday, and daily medications can become costly. At times, it may be in the patient’s best interest to get a Botox injection to treat urinary incontinence.
Botox was at one time only prescribed to women once they had first tried oral medications, Le said. The success of the study, however, indicates that Botox could be considered as a first line of treatment.
“In the future, [Botox] may become a first line of treatment for patients, meaning you don’t have to fail the oral medications first,” Le said. “You can go straight to Botox if your doctor thinks you are a good candidate for it.”
Currently, the Food and Drug Administration has only approved Botox for patients who have a neurologic cause for their incontinence. Visco said that he hopes the study will encourage the FDA help expand the approval, eventually leading to insurance coverage for the injections.
Dr. Cindy Amundsen, professor of urogynecology and Visco’s partner, is currently leading another study that compares Botox injections in the bladder to InterStim therapy, which uses mild electrical pulses to treat urinary incontinence.
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