An injection of Botox in the bladder could work better than the surgically implanted device, InterStim, to help women with severe incontinence, a U.S. study reports. The research collected data from 381 women and found that Botox reduced incontinence episodes to zero in 20 percent of its group against 4 percent of women using InterStim.
Researchers used onabotulinumtoxinA (Botox) and InterStim in patients with overactive bladder. Those patients could not tolerate other drugs or did not respond to them. Also, the patients in the study did not improve with other treatments including pelvic floor muscle training or fluid restriction.
Dr. Cindy Amundsen of Duke University, North Carolina, led the study and the findings were published Tuesday in the Journal of the American Medical Association, JAMA.
The study involved women with severe incontinence. The participants were around 63 years old on average and typically overweight or obese because urinary incontinence is linked to obesity and multiple pregnancies. To be selected for the experiment, the women had to have at least six episodes of incontinence over three days.
The research was performed at nine medical centers, and participants had to keep a diary for six months to record their experiences.
All 381 women were separated into two groups: one received a shot of Botox, and the other to get the nerve stimulator InterStim. Botox is popular for smooth wrinkles, but for the study, the drug was used to relax muscle spasms that do not let people control their bladder.
Another thing to consider about the study is that women from the Botox group received a single Botox injection of 200 units when the usual recommended maximum dose in the United States for overactive bladder is 100 units.
InterStim is not a drug, it is a device and sends mild electrical impulses to the sacral nerves that control movement and sensation in parts of the pelvis. The electric stimulus prevents bladder contractions and avoids it to empty its content spontaneously. InterStim is placed under the skin just above the tailbone and patients have a control to adjust its features. The device can be turned on and off, and its intensity can be control.
People that used the device for a considerable period have shown better communication between the brain and the bladder, reducing incontinence.
Botox is significantly better than InterStim, although both treatments have their pros and cons
The Botox injections showed that 20 percent of the participants did not suffer accidents, compared to 4 percent who had the nerve stimulator implant. The study reported that 46 percent in the Botox group experienced a reduction in the number of incontinence episodes and 26 percent of the InterStim group also experienced fewer episodes. For both groups, their treatment reduced at least 75 percent of accidents.
Both treatments can relax the nerves responsible for signaling the bladder to empty, and both of them cut the number of accidents during the study: On average, Botox reduced accidents to four times a day and InterStim to three times a day.
Regarding satisfaction, both groups reported the same gratification, although the Botox group showed to have less bothersome symptoms. Over six months, all women reported improvements in their quality life, but both treatments also had side effects.
The Botox group had more urinary tract infections compared to the InterStim group, being 35 percent versus 11 percent in the surgery group. Dr. Amundsen stated it was not clear why the Botox treatment had more risks to contract a UTI. Her team is working to discover the reason.
Among the women with infections, 39 percent of the Botox group and 30 percent of the InterStim group had at least two UTI during the six months of research.
Because participants of the Botox group only received one shot with all 200 units, it is impossible for the study to say how a series of shots or other doses will affect women with incontinence. Researchers cannot tell if a series of Botox doses will be better than InterStim.
Also, six women, which represents 3 percent of the InterStim group, had to come back the operating room to revise or remove the stimulation device.
Between 25 percent and 45 percent of all women have some degree of urinary incontinence
According to the National Institutes of Health, millions of women in the U.S. suffer some degree of incontinence, and even when women are more vulnerable to the condition that men, they are not safe from it.
Female have more risk to suffer from incontinence because of pregnancy, childbirth, menopause and the structure of the female urinary tract. The National Institute of Diabetes and Digestive and Kidney Diseases said on its website that women experienced urinary incontinence twice as often as men.
“The prevalence of this disruptive condition is common and increases with age, from 17 percent of women older than 45 years to 27 percent older than 75 years in the United States,” the authors of the study wrote.
Incontinence is embarrassing and a serious problem for both women and men. People that cannot control their bladder starts changing their lifestyle to avoid going out and make sure they stay close to home. People dealing with incontinence are even ashamed to go to the doctor.
Botox and InterStim are not the first options to treat incontinence, for the contrary they are used as a last resource.
Doctors usually try to start with lifestyle treatment, recommending their patients to lose weight, avoid caffeine and alcohol, and avoid lifting heavy objects. There are also exercises designed to strengthen the pelvic floor muscles and even “bladder training” to get the body used to urinating at regular times.
There is also medication to treat incontinence, but it is unpleasant for most patients due to its side effects, including extremely dry mouth, NBC News reports.
Source: NBC News