What is bladder Botox?
Small amounts of onabotulinumtoxin A are injected into the bladder wall through a cystoscope. The medication relaxes the overactive bladder muscle so it stops contracting without warning.
Procedure Library
Bladder Function
Bladder Botox (Onabotulinumtoxin A Injection)
Botox is injected into the bladder muscle to calm involuntary contractions, reducing urgency, frequency, and urgency leakage for roughly six to nine months at a time.
Who may benefit?
- Adults with overactive bladder not controlled by behavioral therapy and medication.
- Patients who cannot tolerate the side effects of OAB medications.
- Patients with neurogenic bladder from multiple sclerosis, spinal cord injury, or Parkinson disease.
How is the procedure performed?
Most treatments are done in the office in about ten minutes using numbing gel instilled into the bladder. A thin flexible cystoscope is passed through the urethra and the medication is delivered in roughly 20 small injections. Some patients prefer sedation.
What are the benefits?
- Meaningful reduction in urgency episodes and leakage for most patients.
- No daily pill and no systemic anticholinergic side effects.
- Reversible, since the effect wears off.
What are the alternatives?
Bladder training and fluid management, pelvic floor physical therapy, oral medications including beta-3 agonists and antimuscarinics, tibial nerve stimulation, and sacral neuromodulation.
What are the risks?
- Urinary tract infection.
- Temporary difficulty emptying the bladder; a small percentage of patients need to catheterize for a period of time.
- Blood in the urine for a day or two.
- Loss of effect over months, requiring repeat treatment.
What should I expect before the procedure?
- A urine test to confirm there is no infection.
- An antibiotic before the injection.
- Willingness and ability to perform self-catheterization if retention occurs.
What should I expect during recovery?
- Mild burning and pink urine for one to two days.
- Improvement begins within one to two weeks and peaks by about six weeks.
- A follow-up check of bladder emptying is arranged after treatment.
When should I call the office?
- Fever above 101.5°F or shaking chills.
- Inability to urinate, or a catheter that stops draining.
- Heavy bleeding, or clots that do not clear with increased fluids.
- Pain that is not controlled by your prescribed medication.
- Redness, swelling, or drainage at an incision site.
Bladder Botox: Frequently Asked Questions
How often do I need it repeated?+
Most patients repeat treatment every six to nine months, guided by symptoms rather than the calendar.
Will I need a catheter?+
Most patients do not. A minority develop incomplete emptying and catheterize temporarily until the effect softens.