It’s safe to assume that most people don’t associate Botox with overactive bladders, but doctors who use it to treat just a sliver of the 33 million people in the U.S. struggling with uncontrollable urges to pee and leaks say the injections could be life changing. 

Steph Aiello, 33, has felt the benefits firsthand. She used to receive Botox injections into her bladder twice annually for six years after a car accident in 2010 left her paralyzed from the neck down. 

Aiello lost all bladder control and function, so she had her bladder rerouted to her belly button where she inserts a catheter to drain her urine every four to five hours. The process is complicated and frequently causes urinary tract infections, as well as frustrating leaks. Botox helped her significantly, and doctors say it has been a godsend for many of their patients with overactive bladders.

Dr. Sara Wood, chief of the division of urogynecology and reconstructive pelvic surgery at the Washington University School of Medicine in St. Louis, who frequently performs bladder Botox, said the conditions that warrant the treatment can be isolating and debilitating. She has had many patients overcome with frustration and shame about having to carry extra underwear and clothes. 

“The sense of not knowing when you might leak and the social embarrassment that comes along with that causes people to marginalize themselves and withdraw from doing activities they used to do. Movement is medicine, so this problem affects both physical and mental health,” Wood told USA TODAY. “It’s a very effective treatment, and I’ve seen many people feel improvements that allow them to live the life they want and deserve.” 

“Overactive bladder affects people that range from young and active to those in their golden years,” Wood continued. “I want people to seek help and feel empowered and educated to bring this up to their doctor.”

What is bladder Botox?

Botox, made from a toxin produced by the bacterium Clostridium botulinum, was FDA-approved to treat overactive bladder in 2013, but it has been used in urology for over 20 years. In fact, Botox is approved for several other conditions, such as chronic migraine, severe armpit sweating, uncontrollable blinking and spasticity (stiff muscles) in children and adults. 

Bladder Botox is an office-based procedure that involves inserting a tiny camera with a needle the size of a hair follicle through the numbed urethra, a tube that connects to the bladder. It works by relaxing the detrusor muscle located within the bladder walls, allowing the bladder to store more urine, thereby decreasing strong urges, spasms that cause leaks and the number of times people have to rush to the bathroom, Wood said. 

The procedure takes about five minutes and patients can often drive themselves home. People typically need one to three injections per year.

What are the risks of bladder Botox?

Doctors say that the benefits of bladder Botox generally outweigh the risks, which range from discomfort and a possible UTI to issues with retention — when your bladder cannot empty completely — which affects less than 6% of patients, according to Dr. Melissa Kaufman, chief of the division of reconstructive urology and pelvic health at Vanderbilt Medical Center.

If retention occurs, people sometimes have to temporarily catheterize themselves. Kaufman said patients generally don't mind tolerating this side effect because it means they'll regain some control of their bladder.

This is why it’s important to get bladder Botox only if you need it. “It’s a very high burden and a lot of responsibility, so if you don't really need it to start with, then I don't think it's a reasonable trade-off,” Kaufman said. 

How effective is bladder Botox?

Studies have found that the majority of people with overactive bladder who receive bladder Botox experience fewer leaks and trips to the bathroom, reduced urgency and improved quality in life. That said, research shows that Botox functions better as a short-term treatment given it cannot cure overactive bladder; the goal, rather, is to help control or lessen symptoms, Wood said.

Botox is considered a more advanced and invasive treatment for overactive bladder, and should only be used after other options, such as weight loss, diet changes, pelvic floor therapy and medications, are found to be unhelpful. 

Medications initially helped reduce Aiellos’ bladder leaks, but over time they became less effective and left her with unpleasant side effects such as dry mouth and lethargy. Her urologist then recommended bladder Botox.

The procedure was successful enough to give Aiello the option to stop taking her medications for several months until the Botox wore off. A clinical trial conducted in 2011 found that women taking Botox were less likely to leak compared to those taking oral medications.

“Incontinence is a huge problem in my community, as well as not feeling confident and lacking the ability to be spontaneous without worrying about bringing a change of clothes or diapers,” Aiello said. “I've been very blessed with being able to get Botox because there are people who don't even have the ability to get as far as I do.”

If you feel like you’ll benefit from bladder Botox, Kaufman says it’s worth putting any shame aside and being honest with your healthcare provider about your symptoms.

“These are very treatable symptoms and many people are quite reticent to approach a healthcare provider because it's an intimate problem,” Kaufman said. “It's going to require a very delicate conversation, but I want people to recognize that we have outstanding therapies that can really improve their quality of life.”