Key takeaways

  • Botox is used to treat overactive bladder (OAB) in adults. It’s also approved to treat urinary incontinence caused by certain neurological conditions in adults and children ages 5 years and older.
  • The treatment works by blocking nerve signals to the detrusor muscle (bladder muscle) to help manage involuntary muscle contractions and promote better bladder control.
  • There are pros and cons of bladder Botox treatment. It can help relieve symptoms of urinary incontinence and OAB, but it also carries the risk of side effects, some of which may be long term. In addition, injections may be necessary every 3 to 6 months to maintain effectiveness.

Botox comes as a powder that a healthcare professional mixes with liquid to make a solution for injection.

Botox belongs to a group of drugs called neurotoxins. The active ingredient in Botox is onabotulinumtoxinA, which is a biologic. It does not come as a biosimilar drug. (Biosimilars are like generic drugs. But unlike generics, which are made for nonbiologic drugs, biosimilars are made for biologic drugs.)

Botox has a boxed warning. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For details, see the “What should I know before using Botox?” section.

Botox can be used for certain bladder problems in adults and in children. Specifically, it’s used to treat:

For these conditions, Botox is used when anticholinergic medications haven’t been effective or have caused intolerable side effects.

The lists below include some of the main side effects that have been reported in people using Botox. For information about other possible side effects of Botox, talk with your doctor.

What are Botox’s mild side effects?

Mild side effects reported in adults using Botox include:

  • UTI
  • trouble urinating, or pain or discomfort while urinating
  • urinary retention (meaning the bladder doesn’t empty completely)

Mild side effects reported in children using Botox include:

In many cases, mild side effects from the drug can be temporary. Some side effects may be easy to manage, too. But if side effects last for a longer time, or if they bother you or become severe, talk with your doctor.

What are Botox’s serious side effects?

In rare cases, serious side effects from Botox injections can occur.

Serious side effects of Botox injections that have been reported include:

  • trouble breathing or swallowing
  • autonomic dysreflexia (an injury to the spinal cord that can be fatal)
  • boxed warning: risk of spreading toxin effects (see the “What should I know before using Botox?” section)

An allergic reaction is also possible with Botox, but it’s not clear whether this side effect occurred in clinical studies.

Call your doctor right away if you have any serious side effects while using Botox. If the side effects seem life threatening or you think you’re having a medical emergency, call 911 or your local emergency number immediately.

Experiencing side effects? After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you develop a side effect while taking this drug and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

Long-term effects of Botox in the bladder

In general, you may have side effects within the first week of receiving Botox injections. Most of the time, these side effects are temporary, but sometimes, side effects can last for several months or longer.

Possible long-term side effects of Botox injections for bladder problems can include urinary retention and an increased risk of recurring UTIs.

These side effects may go away if you stop treatment with Botox. However, it’s also possible for these effects to continue even after you stop using Botox.

Botox helps relieve the symptoms of bladder problems by promoting bladder control.

The detrusor muscle that lines the bladder plays an important role in bladder control. When the muscle relaxes, the bladder can fill with urine. When you’re urinating, the muscle contracts to release urine.

If you have OAB symptoms or detrusor overactivity, your bladder muscles spasm involuntarily (without your control). Botox is injected into the detrusor muscle (your main bladder muscle) to block the nerve signals to the muscle. This helps control the muscle’s contractions.

Below are answers to some commonly asked questions about Botox’s use in treating bladder conditions.

Botox injections into the bladder can cause pain, pressure, or tenderness. According to patients’ pain scores in a 2022 review, Botox injections in the bladder done with local anesthetic are generally well tolerated. Pain can vary greatly from person to person, however. It could feel like slight pressure or sharp jabs.

Your doctor will work with you on pain management before the procedure. Your options might include:

• local anesthetic injected into your bladder through a catheter in your urethra
• a sedative, to help you relax
• general anesthesia

After the injections, you shouldn’t expect to feel much pain, but you might feel some tenderness or swelling. Your doctor will make sure that you’re able to urinate after the injections.

It depends. Some insurance plans may offer coverage for Botox injections. Before using Botox, check with your insurance provider to see if you’re covered.

If you have commercial insurance, there is a Botox savings program that you might qualify for.

After receiving a Botox injection, you may have improved bladder control for about 12 weeks. Some people may still have bladder control after 24 weeks. After this period, the effect of Botox wears off, and you’ll need more injections.

Your experience with Botox injections may vary. If you have questions about the results you can expect with this drug, talk with your doctor.

Botox has been shown to be an effective treatment option for bladder problems. In studies, people who received Botox injections for OAB saw improvements in certain symptoms, such as frequent urination, in the 12 weeks after treatment. People also noticed an increase in the amount released during urination.

Another improvement that people using Botox for OAB symptoms noticed after receiving the injections was fewer episodes of urinary incontinence. In studies, these improvements lasted from 19 to 24 weeks.

Two studies looked at adults who had urinary incontinence with detrusor overactivity linked with a neurological condition. These studies found that people who received Botox injections had fewer episodes of urinary incontinence. These improvements lasted 42 to 48 weeks for at least half the people in the study.

If you have questions about the results you can expect with this drug, talk with your doctor.

Botox is given as an injection into the detrusor muscle (the muscle lining the bladder). You’ll receive these injections at your doctor’s office.

Your doctor will explain the process for receiving Botox for your bladder condition. They’ll also explain how often you’ll need to receive the injections.

If you have questions about what to expect at your injection appointments, talk with your doctor.

Dosages

For OAB symptoms in adults, the recommended dose is 100 units of Botox. This is also the maximum recommended dose for treating this condition.

For use in adults with detrusor overactivity caused by a neurological condition, the recommended dose is 200 units of Botox. This is also the recommended maximum dose for treating this condition.

For treating detrusor overactivity in children, the recommended Botox dosage is based on the child’s weight. Your child’s doctor will discuss the specific Botox dosage recommended for your child’s condition.

If you have questions about what to expect at your injection appointments, talk with your doctor.

Q:

Will I need to pick up Botox from my pharmacy?

Anonymous

A:

No. If your doctor prescribes Botox for you, the drug will be sent directly to your doctor’s office. Botox is provided by specialty pharmacies, which are pharmacies authorized to carry specialty medications. These are drugs that may be expensive or may require help from healthcare professionals to be used safely and effectively.

To learn more about getting Botox from a specialty pharmacy, talk with your doctor.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Before you use Botox, there’s some important information to keep in mind. The drug may not be a safe option for you if you have certain medical conditions or other factors that affect your health. Some of these are mentioned below.

Boxed warning: Risk of spread of toxin effects

This drug has a boxed warning. A boxed warning is the most serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

In rare cases, Botox may spread away from where it’s injected to other parts of your body. This can result in botulism, a potentially fatal condition that causes paralysis.

Symptoms of botulism may include:

  • muscle weakness all over your body
  • double vision or blurred vision
  • drooping of your eyelids
  • change in or loss of your voice
  • loss of bladder control
  • trouble breathing or swallowing

If you have any of these symptoms after receiving Botox injections, call 911 (or your local emergency number) right away or seek immediate emergency medical care.

If you have questions about your risk for botulism from Botox injections, talk with your doctor.

What other warnings should I know about?

Before receiving Botox injections, be sure to tell your doctor about all prescription and over-the-counter medications you may be taking. Also be sure to tell them if you:

  • have a history of side effects from any botulinum toxin product
  • have a condition that affects your muscles or nerves, such as amyotrophic lateral sclerosis (ALS) or myasthenia gravis
  • currently have or have a history of breathing problems, such as asthma or emphysema
  • currently have or have a history of problems with swallowing
  • currently have or have a history of bleeding disorders
  • have a UTI
  • have trouble emptying your bladder on your own
  • have surgery planned
  • are pregnant or breastfeeding
  • have had an allergic reaction to the drug or any of its ingredients

The price of Botox depends on several factors, including your treatment plan, your insurance plan, and your location. If you have commercial insurance, you might qualify for a Botox savings program.

Currently, Botox is only available as a brand-name medication. It’s not available in a biosimilar form. Biosimilars are like generic drugs, but they’re made for biologic drugs such as Botox. Like generics, biosimilars tend to cost less than the brand-name drug they’re based on.

Botox can be used to treat OAB in adults and urinary incontinence in certain children. It is given as an injection at your doctor’s office.

If you have questions about whether Botox is right for you, talk with your doctor.

Disclaimer: While Healthline strives for factual, comprehensive, and current information, this article is not a substitute for a licensed healthcare professional’s expertise. Always consult a doctor before taking or discontinuing any medication. Drug information is subject to change and may not cover all uses, directions, precautions, warnings, interactions, reactions, or adverse effects. The lack of a warning does not guarantee a drug’s safety, effectiveness, or appropriateness for all patients or specific uses. Learn more about our approach to content integrity.