A long-term side effect refers to an effect (beneficial, harmful, or negligible) that appears months or years after starting or stopping the medicine. The medicine might have been taken for a short period of time yet several years later an unanticipated outcome might emerge. A medication might be taken for a long time and the cumulative effect of long-term exposure might have consequences.
What is Botox injection?
Botox is a drug made from a toxin produced by the bacterium Clostridium botulinum. It’s the same toxin that causes a life-threatening type of food poisoning called botulism. Doctors use it in small doses to treat health problems, including:
• Temporary smoothing of facial wrinkles and improving your appearance
• Severe underarm sweating
• Cervical dystonia – a neurological disorder that causes severe neck and shoulder muscle contractions
• Blepharospasm – uncontrollable blinking
• Strabismus – misaligned eyes
• Chronic migraine
• Overactive bladder
Botox injections work by weakening or paralyzing certain muscles or by blocking certain nerves. The effects last about three to twelve months, depending on what you are treating. The most common side effects are pain, swelling, or bruising at the injection site. You could also have flu-like symptoms, headaches, and stomach upset. Injections in the face may also cause temporary drooping eyelids. You should not use Botox if you are pregnant or breastfeeding.
Botulinum toxin has been FDA approved for the indication of overactive bladder since January 2013. However, botulinum toxin has been used to treat symptoms of overactive bladder for over 20 years.
Botox injection into the bladder is a well-established treatment for overactive bladder and urgency incontinence, including urgency incontinence associated with neurological disease. It is usually used when behavioral and exercise therapies and medications have not been effective in treating symptoms. Botox has been shown to produce dramatic improvements in symptoms and quality of life in women who have not responded to or could not tolerate other treatments.
What the treatment involves
Botox injection treatment is administered in the office under local anesthesia. Local anesthetic (lidocaine) is placed via a catheter and allowed to remain in the bladder for 20-30 minutes to provide numbing of the lining of the bladder. After 20-30 minutes, a small scope (about the size of a catheter used to drain the bladder) which is connected to a camera is placed into your bladder through the urethra, and a series of injections of Botox solution is done into the muscle of the bladder using a small needle that is passed through the scope. The actual injection procedure takes about 5 minutes or less.
Dose of Botox
The dose of Botox is determined by your doctor based on your condition and response to prior Botox treatments. The usual dosing is 100-200 units.
Benefits of the treatment
The expected benefits of successful Botox treatment include reduction or elimination of episodes of urinary incontinence, reduction or elimination of severe urgency, reduced number of times you urinate during the day and night, reduction in or elimination of pad use for urinary incontinence, and improved quality of life. Approximately 70-75% of patients experience a significant reduction in symptoms and improvement in quality of life.
How safe is Botox for overactive bladder?
Injecting Botox into the bladder muscle can reduce episodes of urge incontinence, although urinary retention and urinary tract infection (UTI) are possible side effects. Studies have reported a high level of safety and effectiveness of Botox injections, but none specifically in patients age 80 and older, until now.
How long does Botox for overactive bladder last?
The effect of Botox on the bladder is not permanent. In most patients the effects last 6-12 months (about 7.5 months on average). When the effects wear off, repeat injection is necessary to maintain the clinical effect.
There are two side effects associated with Botox injection in the bladder. The first is an increase in post-void residual or the amount of urine left in the bladder after voiding. In most cases, this does not cause any symptoms and does not need to be treated.
However, in some patients (about 6% in clinical trials) it can be a problem and may require the temporary use of a catheter to help empty the bladder. When this happens, patients are taught to catheterize themselves from once to several times a day because of problems associated with an increase in post-void residual such as a complete inability to urinate (urinary retention). In the small number of people that this occurs in, the need for catheterization usually lasts for 2-6 weeks. The other side effects include bleeding in the urine or a urinary tract infection which can occur with or without an elevated post-void residual.
What are the long-term effects of Botox on the bladder?
When used for a long period, Botox can cause several side effects which can include:
- Muscle atrophy
- Muscle weakness at the injection site
- Vision problems
- Trouble speaking or swallowing
- Breathing problems
- Loss of bladder control
Doctors generally recommend against using Botox when you’re pregnant or breastfeeding. And Botox should not be used in people who are allergic to cow’s milk protein.
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