Botox: New Treatment Option for Urinary Urgency Incontinence

By Ivanhoe Health Correspondent, Kelly Billon

Almost 16 percent of women living in the U.S. experience urinary incontinence—multiple episodes of involuntary urination a day. The distressing condition has been traditionally treated with oral medications, however a new study suggests onabotulinum toxin-A (Botox) is an effective, and in some cases a superior first-line treatment option on the path to complete resolution.

Prior to the study, women experiencing urinary urgency incontinence were most likely prescribed anticholinergics. The oral drugs enlist the body’s nervous system to target the bladder muscle. Botox was considered as a treatment option only if anticholinergics were ineffective. Linda Brubaker, MD, MS, co-authored a study that investigated the promise of Botox as a first-line alternative to oral medication.

Researchers analyzed urinary urgency incontinence episodes experienced by 241 participants over a six-month period and concluded that both anticholinergics and Botox were viable first-line treatment options. Each placebo controlled group experienced a significant drop in daily urinary urgency incontinence episodes, while the Botox group was twice as likely to reach complete resolution—they no longer suffered from urinary incontinence.

Though both effective, the treatment mechanisms differ.

"Botox blocks the messaging between the nerve and the muscle. The medication affects the receptors that are on the muscle in the bladder," Dr. Brubaker told Ivanhoe. "The oral medication affects those receptors wherever they are in the body. It’s not a smart pill; it can’t go straight to the bladder." Brubaker is the dean of Loyola University Chicago Stritch School of Medicine (SSOM).

Doctors and patients need to discuss the benefits of each medication as well as the risks to identify an individual’s best first-line treatment option.

"It really speaks to options for patients. It’s not that one is clearly right and one is clearly wrong. It’s more options for patients which is the best kind of result we could possibly hope for," Dr. Brubaker said.

Oral medication requires a daily commitment, while the Botox injection provides a treatment solution typically on the magnitude of months.

"Just like Botox for wrinkles on the face which most people are familiar with, this Botox will wear off over time. You would have to have retreatment if and when your symptoms came back. We know from other studies how long that takes differs: different people have different times," Dr. Brubaker explained.

The study allows more treatment options emphasizing a new field of interest: patient healthcare decision-making trends.

"I think looking at how patients make their selection when faced with this high-quality evidence, that’s going to be a really important area of research," Dr. Brubaker said.

The study also promotes future urinary incontinence investigations to better treat women struggling with the condition.

"Further research needs to be done to understanding who is a good candidate for which treatment, a more personalized approach to their medical care. "

Source: The New England Journal of Medicine, Interview with Dr. Linda Brubaker.