Botox: Injecting into the Bladder

Some children have trouble controlling their urine. This is called incontinence. There are several types of incontinence. Some may cause symptoms like an urgent need to urinate. Injecting Botox into the bladder, however, can treat children with various bladder disorders. These include:

  • Neurogenic bladder
  • Idiopathic detrusor overactivity
  • Detrusor sphincter dyssynergia

Your child’s doctor may suggest Botox injections if medicines or other forms of therapy do not work.

What is Botox?

Botox is the commercial name for the protein molecule called Botulism toxin type A. Botox is a neurotoxin, but can be used safely in a variety of medical and cosmetic procedures.

How can Botox help your child control their urine?

Our muscles move by releasing certain chemicals. These chemicals tell our muscles to either:

  • squeeze together (contract) or;
  • expand (relax)

We are able to control when we urinate by contracting and relaxing muscles in our bladder. In a child with incontinence, the muscles contract uncontrollably – signaling the bladder to release urine too often. Botox binds to the muscle endings, blocking the release of these chemicals. This stops the muscles from contracting together. By relaxing the muscles, the bladder does not contract as frequently. This gives your child more control over when they urinate.

The effect is temporary. It lasts for about six months. Botox only relaxes the specific muscles it’s injected into. The surrounding muscles work normally.

Are bladder Botox injections safe?

Doctors are increasingly using Botox bladder injections to treat muscular spasms. The results have been positive, with minor or no complications. Based on reported studies, Botox bladder injections are safe to use in children with bladder problems and bladder disorders. 

Who should not be treated with Botox?

Doctors will not inject Botox if your child:

  • is pregnant
  • is allergic to the medicine
  • has a disorder that causes weakness in the muscles and nerves (Myasthenia gravis).
  • has a disorder that causes muscle weakness in the limbs (Eaton Lambert syndrome)
  • has a disease of the nerve cells in the brain and spine that control voluntary muscle moment (amyotrophic lateral sclerosis or ALS)

What happens during the procedure?

Botox bladder injections are a minor procedure. It takes about 30 minutes.

  • Before the procedure, the doctor will give your child a general anesthetic.
  • When your child is asleep, the doctor places a small tube containing a camera (cystoscope) into your child’s bladder. A thin tube, called the urethra, connects the bladder to the genitals. The surgeon passes the cystoscope through the urethra. The urethra is checked before the injection. 
  • The surgeon then injects a thin needle containing Botox through the cystoscope. Botox is injected into different areas of the bladder wall.

This is a day surgery, so your child does not need to stay overnight in the hospital.

After your child wakes up and is able to drink fluids, she can go home.

After the procedure

How to take care of your child at home

It takes a few days for the Botox to work. At first, your child may feel discomfort and soreness in the bladder. This is normal. To relieve pain, give your child Acetaminophen (Tylenol) or ibuprofen​. Your child can get back into their normal routine as soon as she feels ready.

Your child is able to bathe as they normally would before the procedure. She can also continue eating normally, but encourage her to drink more fluids. This flushes the organs responsible for producing, storing, and excreting urine (urinary system or urinary tract). It will also help prevent any infection in the area (urinary tract infection).

Follow up

The effects of the Botox injection last for six months. When it wears off, your child’s doctor will conduct a follow-up appointment. If your child responds well, the doctor will continue to give injections every six months.

Your child will have follow-up checkups with the doctor. The doctor will regularly monitor your child using different methods. The doctor may run:

  • an ultrasound to examining the kidneys and bladder (renal ultrasound)

  • tests that check the bladder while it is filling up. Before starting the tests, a catheter is inserted into the bladder. The nurse injects a sterile mixture of salt and water (normal saline solution) through the catheter. As the bladder fills up, the nurse checks its pressure, and how much it can hold and stretch while filling up. This is called a full urodynamic study

Your child’s doctor may perform other tests. These vary depending on the reason and dose of your child’s Botox injection, as well as medical history.

Botox bladder injections: Side effects

Doctors are still testing Botox injections for bladder problems in children. So far, all side effects are uncommon and fairly minor. These include:

  • An infection in the organs responsible for storing, producing, and excreting urine (urinary system). This is called a urinary tract infection. It can be treated within a week with antibiotics.
  • Discomfort when passing urine. This happens 48 hours after the procedure. The discomfort passes within a few days.
  • Traces of blood in the urine. This should disappear after a few days.

Other rare side effects can include:

  • headaches
  • light-headedness
  • abdominal pain
  • problems emptying the bladder

As the procedure is still relatively new, there is little information available concerning long-term side effects. However, Botox has been used in other medical procedures for over 20 years and no serious long-term side effects have been reported.

Call your doctor if:

  • your child has pain that is not controlled by pain medicines
  • your child has a fever higher than 38.5 °C
  • your child bleeds when passing urine
  • your child has not urinated within eight to 12 hours

For an interactive guide on how the bladder works, click through the animation Bladder Filling and Emptying in the How the Body Works section of AboutKidsHealth.

For more information about bladder and urine tests, see:

 

Key Points

  • Botox bladder injections can treat children who have trouble controlling their urine (incontinence).
  • Botox injections relax the bladder muscles so it does not contract too frequently, and gives the child more control over when they urinate.
  • Studies show Botox bladder injections are safe, with minor or no complications
  • It takes a few days for the Botox to work. It lasts for six months.
  • The doctor will run follow-up tests to check the bladder and see if the injections are helping

 

Dalia Bozic, RN, MN, NP-PHC

Victor Figueroa, MD

12/8/2011




Notes: