Botox for your Overactive Bladder: AUA 2016


Botox for Your Overactive Bladder. I’m serious.




Three weeks ago I went to the annual American Urological Association (AUA) meeting and gathered some important notes.

Today, I will share with you what I learned on treating overactive bladder.


What is Overactive Bladder (OAB)?

OAB is sudden, frequent and excessive contraction of the bladder, which causes a person to feel the urge to urinate more often and more strongly. While people normally feel an urge to urinate roughly every two hours, people with OAB often go less than two hours before feeling the urge to urinate again.

What is Botulinum?

Botulinum (pronounced “BAW-choo-LINE-um”) is known by its commercial name, Botox. That’s right: it’s the same stuff that takes away your wrinkles.

Did you know that Botulinum is produced from bacteria (Clostridium botulinum) that is toxic to your nerves? Botox works by paralyzing nerves, which stops muscle contractions. If you paralyze your nerves, your muscles won’t contract much, and you won’t wrinkle. Apparently, you don’t pee excessively either.

What is neuromodulation?

Neuromodulation (NYURR-oh-MAWD-you-LAY-shun) is the process of inserting electrodes just above your tail bone (the sacrum) and shutting down the nerve stimulation that causes the bladder to contract. Without that nerve stimulation, you won’t feel the urge to pee.

What they said at the AUA

Dr. Cindy Amundsen, MD, and colleagues from the Duke University Medical Center looked at 386 women who were about 63 years old. All of these women had at least six urgent episodes of urinary incontinence per day (meaning, they really had to go, at least six times a day). They were put into two groups: one that got treated with Botulinum (200 units, to be specific), and one that received neuromodulation.

After six months, the Botulinum injection group had to pee a lot less than the neuromodulation group.

There was a downside to this study. According to Dr. Victor Nitti, a fellow NYU urology physician (and a renowned expert in female urology and urinary dysfunction), noted that it was too bad that the study used such a high dose of Botox. Normally, Botox is given in half the dose it was given in this study.

Remember that Botox paralyzes your muscles. If you give too high a dose, it could paralyze the bladder muscles completely, which would mean you’d have to manually extract the urine with a tube. Too much Botox could actually prevent people from urinating at all. (And that’s no fun.)

Note, however, that of all the women in this study, only 8 percent actually needed to have their pee extracted through a tube after 1 month. At 3 months, that number was down to 4 percent. After 6 months, it was 2 percent. Seems like the longer you have been getting Botulized, the less likely it is that you’ll have a total pee failure. The risk is still there, though.

My Take on Using Botulinum to Treat OAB

Giving someone Botox is an invasive procedure. Not only that, but it doesn’t address the cause of the problem. Maybe it might be a good option if nothing else works. (Hey, maybe someone can give you a two-for-one deal and get rid of some wrinkles while they’re at it.)

What should you do if the bathroom is becoming your best friend

Desperate times call for desperate measures. If you’re feeling like you have to pee every 15 to 30 minutes, you might consider getting some Botox.

However, there are a lot of therapies that you should try first:

In my experience, I have been able to treat OAB successfully with acupuncture and naturopathic and functional medicine. (Actually, early this year, I worked with a team headed by Dr. Bilal Chungtai at Cornell Urology and published this review on acupuncture’s benefits for OAB.)

From a naturopathic perspective, you treat the bladder by treating stomach and digestive problems like constipation and irritable bowel syndrome (IBS). There is some compelling research suggesting a bowel-bladder connection.

Bottom Line

Unless you’re peeing every 15 – 30 minutes or less, you probably don’t need Botulinum injections to your bladder. But how mentally, emotionally and sometimes physically painful the urgency symptoms depends on your subjective experience. Try physical therapy, acupuncture, or naturopathic and functional medicine first.

Lastly, the pharmaceutical drugs used for OAB include these anticholinergics : Oxybutinin (Ditropan, Gelnique), Tolterodine (Detrol), Darifenacin (Enablex) and Solifenacin (Vesicare) come with numerous side effects that include constipation. Yes, constipation has been associated with OAB symptoms as explained above.



Starting Thursday, June 9, I will be also seeing patients at Stamford, CT at 1011 High Street. I’ll be working to bring health back to men and women who are struggling with urological problems. (I give Red Sox fans the same love I give Yankees fans. Promise.)

Note: I will see patients in Stamford only on Thursday’s. The rest of the week I will be at my normal New York office.

(For an appointment call Erica at 646.490.0536, or email her at

Be well.


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