Injections can be used to treat patients with either urge and stress incontinence.
The bladder makes urination possible through a series of muscle contractions that control when urine is delivered to the tube that leads out of the body (urethra). If bladder muscles aren’t working effectively, the resulting leaks or persistent urge to go is referred to as urinary incontinence (UI).
For most people, a loss of bladder control is a minor inconvenience that’s often manageable with lifestyle changes and medication.
It’s when UI affects daily life and doesn’t respond well to initial treatments that a urologist may suggest injections.
Botox injections are usually recommended for patients with severe urge incontinence or those experiencing control issues due to nerve damage. Produced by Clostridium botulinum bacteria, Botox (botulinum toxin) works by blocking nerve signals that tell muscles in and around the bladder to contract. Doing so prevents muscles from contracting.
Injections are often administered during an outpatient procedure in a urologist’s office. You’ll be asked to empty your bladder prior to treatment. A local anesthetic gel is applied around the urethra to reduce sensitivity and maintain comfort.
A special lighted tube called a cystoscope is inserted into the urethra. An attached camera allows the urologic surgeon to view the urine tube and the adjacent bladder. Sterile water is usually pumped into the bladder to provide a better view for the doctor. A series of Botox injections are administered during a procedure that normally takes about 20 minutes to complete.
You may notice slight burning sensations while urinating during the first few days after receiving Botox injections. This is a normal reaction that can sometimes be minimized by drinking more water. While considered a rare side effect, urinary tract infections (UTIs) sometimes develop post-procedure. Let your doctor know if you experience frequent urination and other signs of a UTI.
Urethral Bulking Agents
If urine leaks are primarily caused by a hole in the urethra, bulking agents may be used to add extra bulk to naturally block the opening. Injections of bulking agents may also be given to tighten the area around urethral sphincters to prevent urine leakages.
Different types of bulking agents can be used, with one of the most common ones used being collagen. Performed under general or local anesthesia, treatments involving injections of bulking agents are sometimes placed through the vagina. Injections can also be done through the skin. A cystoscope placed into the urethra helps with needle placement.
Following the injections, you may be asked to stand up to see if urine is still leaking. If there is still leakage, additional bulking agent injections may be done. The procedure takes about 30 minutes to complete.
Types of UI Treated with Injections
Urge incontinence is characterized by a strong urge to urinate that often results in accidents. Stress incontinence is a form of UI that usually occurs following actions that place pressure on the abdomen and bladder, such as a forceful sneeze, a fit of coughing, or robust laughter. Both can be helped with injections.
If urinary incontinence is caused by an underlying problem, such as an enlarged prostate or an obstruction that’s blocking the flow of urine, injections won’t be effective. This is why it’s important to get a thorough urologic examination to rule out other possible sources of UI to determine if injections may be right for you. Some patients also benefit from complementary management efforts like pelvic floor exercises, scheduled bathroom usage, and bladder training.