Treatment review library

Botox injections

What are Botox injections?
You’ve probably heard of Botox, or botulinum toxin, being used to treat wrinkles. Well, now wrinkles aren’t the only thing that Botox is being used to treat – it can be used to help people with overactive bladder.

Many common problems are caused by an overactive bladder:

1. A sudden urge to go to the toilet (called urgency)
2. Needing to go to the toilet very often - more than 7 times a day (called frequency)
3. Getting up several times to go to the toilet during the night (called nocturia)
4. Wetting the bed (called nocturnal enuresis)

Botox can be injected into the bladder wall to lessen the contractions of the bladder - Botox works by blocking the release of a chemical which makes the bladder contract.

The injections are administered in hospital, using a local anaesthetic. Most patients can go home the same day, or the next. Treatments do have to be repeated as the effects wear off over time, but many people are turning to Botox instead of undergoing major surgery.

Botox is a relatively new treatment and, as with all treatments, Botox might work well for some people and not for others. It is important to discuss all the options available with a healthcare professional, before deciding on the right course of action for you. Incontact can give you the number of your nearest Continence Advisor.

My Botox Diary
Maria John has had an overactive bladder for 40 years most likely, she thinks, caused by childbirth. Maria had undergone surgical repairs to strengthen the bladder muscles, but the problem remained. She was advised to have Botox injections by her urologist and gynaecologist. They told her that it might not work, but she decided to give it a try (the only other option left for her was radical surgery, which she didn’t want).

The injections were a success and for around 5 weeks she was living in ‘paradise’. Maria slept through the night a few times – something she had not done for 40 years. Gone also was the need to plan her activities around the nearest toilet, which considerably lessened her anxiety.

Although the effects wear off over time, Maria said she would definitely have the injections again. She is planning a trip to Australia soon, so is hoping to have the procedure repeated before then.

Maria kept a diary for a couple of months after she had her Botox injections. Here are a few extracts that she wants to share with other Incontact readers:

“Had a good night. Will not take Detrusitol today and see if it makes any difference. I am feeling better every day. I went to the loo a lot today – I found it was sore if I tried to hold it for any length of time.”

“I feel good and I find I can hold my urine until I am ready to go. Mind you, I don’t push it too far. I haven’t been wet at all and I am not sore. All I have to do is get my mind to accept that I am not running to the toilet all the time, and after all these years it is quite hard.”

“Today has been good. I have gone when I have wanted to and have not been wet. Wow! It looks like it is working and I am over the moon.”

“I had a check up yesterday and everyone was pleased with me. I feel quite happy with myself. On the whole I have been very good.”

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Percutaneous Endoscopic Colostomy

A Percutaneous Endoscopic Colostomy (PEC) is carried out to help relieve severe bowel problems. An incision is made into the colon and a tube is inserted, through which patients can irrigate their colon once or twice a day. It offers an alternative to a colostomy, where faeces are collected in a bag. With a PEC, patients can empty their bowels into the toilet. Then the tube is taped out of the way. It is still a relatively new and innovative procedure.

Two readers tell us about their experience of the operation…

“I have battled with bowel incontinence for some 28 years after suffering a third degree tear at the birth of my first child which my GP had repaired on the assumption that I would be fine. It took 5 years of feeling alone, frightened, worried and ashamed before I managed to tell my GP what was really causing the anxiety I was being treated for.

I was referred to St. Marks Hospital, where several tests were done and I had a Post Anal Repair. Unfortunately the repair made the incontinence worse, but in those days there was nothing more that could be done. I had suffered with constipation from childhood and these were the times when the passive leakage was worst, so it became a regular thing to juggle food, fibre and laxatives in order to keep the constipation away and keep the incontinence to a minimum.

At the age of 50 the constipation became chronic and the incontinence was happening 10 or more times a day and was controlled by unpleasant manual evacuation.

The local hospital consultant referred me back to hospital where I had similar tests carried out again and was given bio-feedback treatment. Sadly this didn’t work for me, and other medicinal remedies were tried but the only thing that worked was rectal enemas. These were time consuming, messy and extremely painful. The alternative was a full colostomy which is something I could not personally accept.

My Consultant Nurse Specialist and Colorectal Surgeon proposed a new technique called Percutaneous Endoscopic Colostomy – PEC procedure. This uses a small standard PEG (Gastrostomy) tube inserted into the sigmoid colon through which I would irrigate enema and water to wash-out the lower bowel whilst sitting on the toilet as normal. I knew immediately this would be much more acceptable to me and decided to go ahead.

The PEC procedure is minimally invasive and can be done under local anaesthetic via colonoscopy and is highly successful. I now irrigate my bowel once a day using one enema followed by 500ml of boiled water. It is quick and easy to use, pain and strain free. It takes 20 minutes from start to finish. The tube is taped neatly to one side when not in use and I hardly know it’s there.

The PEC has proved to be a highly successful, minimally invasive surgical procedure which I think is a very attractive alternative to a colostomy for continence.”
G.S.

“My problems were caused by childbirth. In 1973 I suffered a third degree tear followed by further damage in 1976 caused by an episiotomy.

Everything was all right until the late 80’s-early 90’s. I was diagnosed in 1997 as having a hole in the sphincter muscle. If the consultant hadn’t had a bowel questionnaire the day of the consultation, I daresay I would still be incontinent. The consultant said the only cure was major surgery.

I was referred back to my local hospital and had an operation called an analplasty, which actually made me worse. I became bowel incontinent 24 hours a day once I had opened my bowels. I plucked up the courage to complain and was told the operation was a success, but they felt I should have 3 months of codeine to constipate me and enemas to make me go. I have a fear of enemas and came home and phoned the Royal London Hospital.

I had physiology tests there and this confirmed I still had the damage. I had a dynamicgraciloplasty in 1999 – major surgery where you have to have a temporary colostomy until the wounds heal. This enabled me to switch myself ‘on’ and ‘off’. When I was ‘off’, I was continent. But, this wasn’t the end of my problems.

Thanks to Incontact, GS rang me. We had similar conditions and we both used enemas. We had both even tried the biofeedback, which we both hated. GS was offered the PEC. I saw her surgeon too, but both he and my consultant were not happy with me having the procedure. But, being a person who does not give up, I contacted the surgeon who pioneered the procedure. He said I was a suitable patient and he referred me to have the operation. My chances were supposedly nil, but my surgeon and I were positive it would work. And it did. I now irrigate twice a day through my PEC and I have my dignity back.”
C.H.

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Drug treatment for overactive bladder

- What is it? Does it work? What can you expect from treatment?

The drugs used to treat OAB belong to a ‘class’ or ‘type’ of drugs called antimuscarinics. These medications suppress the bladder’s detrusor muscle, which in people with OAB becomes overactive, causing increased and spontaneous bladder emptying. By suppressing this muscle antimuscarinic drugs help reduce symptoms such as urgency and frequency of urination.

There are several different antimuscarinic drugs that may be prescribed to people with OAB [Table 1]. Although these treatments belong to the same class and work in a similar way, a drug review published in the medical journal European Urology has found there are differences between them.

Results of clinical trials reviewed in European Urology found all the antimuscarinic drugs to be safe and effective in reducing urgency and incontinent episodes in OAB, with evidence suggesting that they can return patients to continence. However, there were significant differences in the side effects experienced by those taking the different treatments.

The most commonly prescribed medications for OAB are tolterodine (Detrusitol) and oxybutynin. Both drugs are available as immediate or extended release (which releases the drug into the blood stream over 24 hours) pills. Oxybutynin is also available as a skin patch and liquid formulation.

Common side effects associated with antimuscarinic drugs include dry mouth, constipation, nausea and blurred vision. In the review, oxybutynin immediate release was associated with more reports and increased dry mouth than tolterodine extended or immediate release. The less widely used treatments, trospium, propiverine hydrochloride and oxybutynin patches, were also less likely to cause dry mouth than the immediate release oxybutynin. Newer treatment, solifenacin was associated with increased constipation compared to tolterodine, oxybutynin immediate release and oxybutynin skin patches.

Overall, the review found that patients taking tolterodine extended release were less likely to report side effects or stop treatment. In comparison patients taking oxybutynin were six times more likely to stop their treatment.

Antimuscarinic drugs are a safe and effective way of treating overactive bladder and greatly improve patients’ quality of life. However, there are differences in the way the different drugs work and the side effects they can cause. People react differently to medication; one treatment may be more suitable for one person than for another. It is important to remember that because one treatment hasn’t been successful it doesn’t mean that another won’t be. Discussing the options with a doctor, ensuring treatment is maintained and attending regular follow up appointments so progress can be monitored, is therefore essential.

What treatment meant for me
Caroline Spencer first experienced symptoms of OAB over 16 years ago.

“I went to my doctor and had several bladder stretches but it didn’t seem to help. I was becoming desperate. It felt like the constant sensation of my bladder being squeezed was taking over my life. I avoided going shopping or socialising and work became difficult.

Caroline was referred to a urologist where her OAB was diagnosed. “Firstly I was prescribed oxybutynin which didn’t agree with me. It gave me terrible dry mouth, and didn’t really stop my bladder contractions.”

“In August I began treatment with tolterodine and noticed a difference quickly. The bladder contractions that made my life a misery are under control and I don’t need to spend all day in the toilet. I still get a bit of dry mouth but this is usually in the late afternoon and is fine after I have a drink. Having overactive bladder was eating away at my confidence but now I feel like I am back in control. I can walk the dogs, visit friends and go out for a drink the evening. I feel like I’ve been liberated.”

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