Harvard Women's Health Watch

Botox as effective as oral medication for overactive bladder

For women who have trouble controlling the urge to go, injections of botulinum toxin (Botox) work just as well as oral medicines at reducing bladder muscle contractions, although differing side effects might make women consider one treatment over the other, according to a study published online in October by The New England Journal of Medicine. The study compared the anticholinergic drug solifenacin (VESIcare) with injections of Botox in 247 women (average age 58). The women were randomly assigned to receive 5 milligrams of the oral drug daily plus an inactive saline injection into the detrusor muscle (the bladder muscle that contracts to release urine), or a detrusor injection of Botox plus an inactive sugar pill. At the start of the study, the women had about five incontinence episodes a day. Six months later, they were down to one to two episodes daily with either treatment. Nearly 30% of the women on Botox were completely free from symptoms, compared with 13% on VESIcare. Side effects also differed. Women who took the pills were less likely to have urinary tract infections but more likely to report dry mouth than those on Botox. This was the first time these medications were tested head-to-head, and the trial included women who hadn't previously been treated with anticholinergics—which are typically the first-line treatment for urge incontinence. "This is the first study to compare the effectiveness of Botox treatments to oral medication," lead study author Dr. Susan Meikle of the Pelvic Floor Disorders Network said in a release. "Previously, Botox was reserved for women who had tried oral medications but found them ineffective. Because we included some women who had not been treated with oral medication before, these results suggest that Botox could be discussed as an option for first-line treatment."

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