Written by Mr Jai Seth, BSc(Hons) MBBS MRCS MSc(Urol) MD(Res) FRCS(Urol)
Consultant Urological Surgeon · Last updated: · Publications
If you struggle with an overactive bladder, urgency, or urge incontinence that has not responded to other treatments, bladder Botox injections is the usual next step. This minimally invasive procedure is a well-established treatment, and most patients who have it notice a real improvement in control and quality of life.
How Does Bladder Botox Work?
Botulinum toxin (Botox) works by temporarily relaxing the bladder muscle. When injected into the bladder wall, it blocks the nerve signals that cause the bladder to contract involuntarily. This reduces the sudden, urgent need to urinate and decreases episodes of incontinence.
Who Is a Good Candidate?
Bladder Botox is typically recommended for patients who have:
- Overactive bladder symptoms that have not improved with lifestyle changes or medications
- Urge incontinence that significantly impacts daily life
- Side effects from oral medications that are intolerable
What Happens During the Procedure?
The procedure is performed as a day case, usually under local anaesthetic. Using a cystoscope (a thin camera inserted through the urethra), the surgeon injects small amounts of Botox into multiple sites in the bladder wall. The entire procedure takes approximately 15-20 minutes.
What Results Can You Expect?
Most patients begin to notice improvement within one to two weeks. The effect usually lasts four to nine months, after which the procedure can be repeated (BAUS leaflet). Around seven in ten patients report a significant improvement (BAUS; Nitti et al., 2013).
Potential Side Effects
Like all medical procedures, bladder Botox carries some risks:
- Urinary tract infection needing antibiotics, the commonest after-effect, in about 1 in 6 to 1 in 7 patients (BAUS)
- Temporary difficulty emptying the bladder, needing self-catheterisation for a time, in between 1 in 15 and 1 in 5 (6 to 20%), more likely at higher doses; the trials at the standard dose put it nearer 1 in 16 (Nitti et al., 2013)
- Mild burning and a little blood in the urine for a day or so, in almost everyone
- No improvement in around 3 in 10, and symptoms returning after four to nine months in almost all, which is why injections are repeated
Most of these are temporary; the retention can last weeks or months and is rarely permanent (BAUS). A specialist will discuss all risks and benefits with you before the procedure, along with the alternatives, such as PTNS and sacral neuromodulation.
Is this the right step for you?
Bladder Botox is not usually a first-line treatment. In most cases it follows a trial of bladder training, pelvic floor exercises, and oral medications. If those have not controlled your symptoms, the next reasonable step is to talk to a GP about referral to a urologist or a functional-urology clinic, on the NHS or privately, for formal assessment. Whether Botox is the right step is decided at that appointment.
References
- Nitti VW, et al. OnabotulinumtoxinA for the treatment of patients with overactive bladder and urinary incontinence: results of a phase 3, randomized, placebo controlled trial. J Urol. 2013 Jun;189(6):2186-93.
- Chapple C, et al. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms and quality of life in patients with overactive bladder and urinary incontinence: a randomised, double-blind, placebo-controlled trial. Eur Urol. 2013 Aug;64(2):249-56.
- Seth J, Khan MS, Dasgupta P, Sahai A. Botulinum toxin—what urologic uses does the data support? Curr Urol Rep. 2013 Jun;14(3):227-234.
- British Association of Urological Surgeons. Botulinum toxin-A injections into the bladder wall: patient information leaflet F25/003. January 2025.