Women send me questions every day. I'm often asked:
• Is there a way to stop LBL?
• Does weight have an effect on bladder control?
• What kind of exercises can I do to prevent leaks?
Recently I received this question: "Is it true that doctors are using Botox injections for LBL?" Botox? I had to read the question twice. When in doubt, I check things out with a reliable medical expert. I reached out to Kenneth M. Peters, M.D., professor and chairman of the Urology department at Oakland University William Beaumont School of Medicine. Dr. Peters explained that Botox is indeed used successfully under certain circumstances to reduce leakage. And it's not for everyone. It was just approved last month by the FDA for the neurogenic bladder. It's typically used for certain people who experience urge incontinence, characterized by a strong and sudden urge to go. "In general, our initial treatments for those who experience urge incontinence are behavioral," Dr. Peters explained. He encourages women to eliminate food and drinks that are irritating to the bladder, use Kegel exercises properly to calm bladder muscle spasms, and sometimes he suggests overactive bladder (OAB) medications.
Another treatment Dr. Peters often tries before Botox is something called InterStim Neuromodulation. "When the nerves are hyperactive, the bladder contracts, resulting in leakage. In simple terms the brain is sending the wrong signals," Dr. Peters said, "What Interstim does is send a signal with an electrical impulse to the bladder so it becomes less overactive. A benefit of Interstim over Botox is that it not only helps the bladder, but also often improves bowel function." "I thought Botox was only used for smoothing out wrinkles," I said to Dr. Peters. "What's interesting about a wrinkle is it's actually a muscle spasm," Dr. Peters said, "When you inject Botox into a wrinkle it relaxes. The bladder is a muscle and will leak suddenly due to a spasm. Botox will relax the bladder." He explained that Botox is delivered to the bladder through little cameras. "We look into the bladder and with a tiny needle inject 20- 30 spots," said Dr. Peters, "The procedure can be done in the office in about 15 minutes, and most tolerate it very well. There is a low risk of complications from it, and patients go home right afterwards." He cautions that it doesn't work on the first day. It takes 5 to 14 days to take effect. "The studies on Botox has shown anywhere from 65 to 80 percent will have a significant reduction of leakage, " Dr. Peters said. "Do your patients ask you to save a few injections for their face too?" I asked. Dr. Peters laughed. He hears that a lot.
How long does a Botox treatment last? According to Dr. Peters the treatment typically has to be repeated every 6 months or so. "Most patients are very happy with the results," Dr. Peters said. They prefer it to the typical side effects of OAB medications like dry mouth. "Most patients stop taking medication within a year because they find it doesn't work well enough to counter the cost and side effects," Dr. Peters said. A potential risk of Botox (which happens to 3 to 5 percent of patients) is that the treatment works too well and you can't urinate, in which case you need to use a catheter. "It's a conversation we always have with patients," said Dr. Peters, "We have some patients that leak so bad that they feel it's okay if they have to use a catheter for a while." So there you go! Botox is another option available to some women who experience unwanted leaks. And that's not the only newer treatment out. "As of January of this year, we've also got Tibial Nerve Stimulation," Dr. Peters said. The tibia is a bone in your leg. Apparently they can now use a device near your ankle (much like an acupuncture needle with an electrical current) that somehow affects the bladder, offering a 60 – 70 percent bladder leakage reduction after 12 weeks!
What about you? Are you using behavioral treatments, like pelvic floor exercises or other ways to manage your LBL? Have you talked with your medical professional recently?