Dear Dr. Roach: In two weeks, I am supposed to get Botox injections in my bladder for an overactive bladder (OAB) and my frequent need to urinate at nighttime. Are these injections safe? Are there any bad side effects? How long do they work?
D.J.
The initial treatment for OAB symptoms usually consists of lifestyle changes (i.e., quitting smoking, avoiding medications that worsen symptoms and excess fluid intake at night), pelvic floor muscle exercises, and bladder training. If these are ineffective, medication is often used. If these don’t work or cannot be tolerated, additional treatments are considered, such as Botox.
The underlying problem with an OAB is uncontrolled bladder spasms. Botox is a powerful suppressor of muscle activity. If just the right amount is used, the excess muscle spasms are reduced, and the person gets good results. However, if too much is used, the person may not be able to urinate spontaneously at all, so your urologist will be giving you instructions on how to self-catheterize, in case you are unable to void after the injection.
If you note that leakage has worsened a week or so after the procedure, this is a big clue that the bladder is not functioning after the injection. This can last for months, but typically no more than three months. Fortunately, this complication happens uncommonly, in about 2%-7% of people. Other complications include infections and bleeding, but these are not common. Antibiotics are given to reduce the risk of infection. Very rarely, muscles outside the bladder are affected, including generalized weakness and eye muscle weakness.
When it works well, most start noticing benefit in a week or so, and relief typically lasts 9-12 months before another injection is given.
Dear Dr. Roach: I have been a registered nurse in a hospital for many years. I worked with a urologist who mentioned something that kept him very busy: improperly inserted Foley catheters. When the balloon is inflated, these catheters can damage the urethra. Of course, a catheter is supposed to be inserted into the correct spot, then the balloon will inflate. I found out that nursing schools are teaching their students to inflate the balloon when urine is seen, but sometimes there is urine in the urethra. The catheter might also get stuck in the prostate, where there can be urine as well. Can you help me get the word out about this?
I also like to let male patients know about transurethral lidocaine use to anesthetize the urethra for a catheter insertion. It is cruelty to catheterize a man without it!
S.H.
I appreciate your writing. I am seeing a downward trend in hospitals using Foley catheters, which are plastic tubes to drain the bladder. In men, these are inserted in the penis and have a balloon to prevent the catheter from falling out. The balloon is supposed to be inflated when the tip of the catheter is safely inserted into the bladder. Inflating the balloon in the urethra is very dangerous.
I read during my fellowship that Foley catheters are the most likely of all lines (IVs and central lines, among others) to cause harm to patients. Not only can they cause damage to the urethra (estimates range from 0.3%-25% of inpatient hospital visits for men), prolonged placement of these catheters may cause infection and scarring.
There are new low-friction catheters that do not require lubrication, but they still have the potential for complication and discomfort.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected] or send mail to 628 Virginia Dr., Orlando, FL 32803.
