Before I dive into my experience with bladder Botox, let me explain how I got here. For as long as I can remember I have always, always, had to pee. Ducking out multiple times during meals and movies is my norm and on road trips I’m the one who pipes up, about every 45 minutes or so, “Do you mind pulling into the next rest stop, please?”

I’m a petite person, so I’d cheerily make size-related jokes about what I assumed was a very small bladder. Over the past year, however, the frequency was getting out of hand, even for me. Not only was I going several times an hour, I never quite felt, for lack of a better word, finished. It wasn’t a cute little annoyance anymore. It was becoming embarrassing and extremely inconvenient.

I finally sought advice from Elizabeth Kavaler, MD, a double-board certified New York City-based urogynecologist and urological surgeon, who immediately set me straight on my small bladder theory. “There’s no such thing as a bladder that’s just small,” she explains. Most bladders, she says, are more or less the same size. “It’s about what is a functional capacity and how much you can tolerate.” The average person can hold about 300-500 cubic centimeters (ccs) of liquid. Mine, she determined after a urodynamics assessment (in which the bladder is filled with liquid while an ultrasound monitors how much it can hold), barely held 150 before I was in severe discomfort. The diagnosis: overactive bladder (OAB).

Meet the experts

• Elizabeth Kavaler, MD, a double-board certified New York City-based urogynecologist and urological surgeon.
• Nissrine Nakib, MD, associate professor and director of pelvic floor medicine at the University of Minnesota and member of the scientific advisory board for medical device company Flyte.

How can Botox help treat an overactive bladder?

Dr. Kavaler laid out my options. There are several medications that specifically address OAB. If none were effective, we could try Botox. I perked up with curiosity at that. I’ve had cosmetic Botox on my face before, but had no idea how it might help south of the border.

Botox, in case you’re unfamiliar, is the brand name for the botulinum toxin type A product by the pharmaceutical company Allergan. When injected into areas of the face, like forehead lines or the outer corner around the eyes, it temporarily smoothes wrinkles by relaxing the facial muscles and preventing them from contracting by slowing the nerves down. When used on the bladder, Botox provides a similar effect.

“An overactive bladder is over-responsive and oversensitive, so it spasms,” says Dr. Kavaler. “When Botox is injected into the muscle of the bladder, it relaxes it so it’s less overactive, less spastic. You can hold more, the urgency becomes less urgent, but you’re still able to empty your bladder.” The results, she says, can last up to six months.

I tried three of the OAB medications first. None made a noticeable difference and one gave me such sudden dry mouth, I broke into coughing fits in the middle of the street. It was time, we decided, to move on to Botox.

To get an idea how successful it might be, I spoke with Kerry Durkin, a patient of Nissrine Nakib, MD, associate professor and director of pelvic floor medicine at the University of Minnesota. Durkin lives in St. Paul and has been getting bladder Botox for over ten years, right around the time it was approved by the FDA to treat overactive bladder in 2013. Prior to that, doctors had been using it in an off-label capacity. Durkin receives it to treat frequency issues related to her multiple sclerosis (MS). According to the National MS Society, bladder dysfunction affects up to 80 percent of patients because of blockage or delays to the nerve signals that control the bladder.

“It’s changed my life,” says Durkin. “I used to get up several times during the night, maybe eight times over seven or eight hours. What kind of sleep do you end up getting? None at all. The night after I had Botox for the first time, I slept through the night.”

How does bladder Botox differ from cosmetic Botox?

Both bladder Botox and cosmetic Botox employ the same medication by Allergan. When injected into the face, results typically last about three to four months. Bladder Botox, however, can last up to six months because — even in cases of OAB — the bladder muscle doesn’t move as rapidly. “The muscles in our face are always in action and used more frequently [as we] express and move around,” says Dr. Nakib, who is a member of the scientific advisory board for medical device company Flyte. “That’s why Botox tends to fade faster there. In the case of overactive bladder treatment, the muscles aren’t moving as constantly so the effects of the Botox can last longer.”

The amounts needed differ as well. Bladder Botox typically uses 100-200 units, according to UCLA Health. The standard dose for the face is about 20-40 units per area. Facial muscles are small and thin, requiring less Botox to achieve the desired effect, while the bladder muscle is comparatively much larger.

And since facial Botox is an elective, cosmetic procedure, it’s normally paid out of pocket, often to the pricey tune of several hundred dollars and up per visit depending on the practitioner and geographic location. Because bladder Botox treats a medical condition, it’s eligible for insurance coverage. In my case, my doctor’s office helped me obtain precertification from my insurance to cover the cost. Without coverage, it would have cost me $1,400 for a single treatment.

Getty Images / Bella Geraci

What is it like to get bladder Botox?

Although bladder Botox can be performed at an outpatient surgical center under sedation, I opted for my doctor’s office using a local anesthetic. After arriving for my appointment and undressing from the waist down, a nurse administered lidocaine jelly by running a catheter through my urethra. It sounds super un-fun, I know, but in reality the insertion only felt like a brief pinch.

After a 30-minute wait for the numbing to kick in, I was ready to go. Dr. Kavaler explained she would be administering 100 units of Botox — or about 10 ccs — using 21 injections into different parts of the bladder muscle through my urethra, each injection containing .5 ccs. I made a jokey request for laughing gas, laid back, and gave her the OK to proceed. The injections went quickly over the course of a few minutes. Most felt like small pushes of pressure, though a few jabs were sharp enough that I tensed and inhaled deeply.

When it was done I sat up and asked to see the needle. I’m usually needle-averse and try to avoid looking, but in this case I wanted to take a peek. It was smaller and shorter than I expected. Because the bladder is only five millimeters thick, the needle only needs to be three millimeters to perform injections precisely, Dr. Kavaler says. It’s also thin enough to fit through the narrow scope hooked up to a video monitor so the doctor can see where they’re going.

After getting dressed, I was given three days’ worth of antibiotics to prevent a possible infection and warned I might experience some light bleeding. I would probably start seeing the effects, I was told, anywhere from five days to two weeks.

What if bladder Botox doesn’t work?

There are about five percent of people for whom neither medication nor bladder Botox works, according to Dr. Kavaler. A third option is sacral neuromodulation, in which a small device is surgically implanted to essentially act as a pacemaker for the bladder. “It’s placed in the lower back region at the level of the third sacral nerve, which is what controls the entire pelvic region. A little wire is placed to run alongside that nerve, then attached to a very small battery that sits in the buttocks area,” explains Dr. Nakib. “It interferes with the abnormal signals coming from the bladder and therefore interrupts that sensation and the way that your brain responds to it.”

There are two types of modulator batteries, Dr. Nakib continues, chargeable and rechargeable. The non-rechargeable batteries can last up to 10 years; the rechargeable can last 15 to 20, the caveat being it requires recharging every six to ten months with a belt that transmits the charge through the skin. Very Terminator meets Devil Wears Prada.

Patients can test-drive sacral neuromodulation using a temporary external battery before committing to the surgical implant, which is why Dr. Nakib often believes it’s worth trying before Botox: “My philosophy is, if the Botox doesn’t work, you have to wait six months for any effects of the Botox to completely wear off to try the device. If you try the device and it doesn’t work, you can try Botox right away.”

Everyone has individual comfort levels when it comes to choosing treatments. If the Botox isn’t effective, I’m not sure I’d be down with a surgical implant. Others, of course, may feel differently.

How bladder Botox worked for me

First, the drawbacks. During her initial explanation of bladder Botox, Dr. Kavaler said that if effective, patients need to return every few months for a new round, which some might find inconvenient. Also, as mentioned, even with local anesthesia, the experience wasn’t totally pain-free. My quip about laughing gas had been in humor, but Dr. Kavaler says in-office nitrous oxide can be used to help with discomfort, which I’ll definitely keep in mind if I decide to repeat the procedure. And while I didn’t experience any light bleeding, I was a little sore for about a day.

Now for the good news. I’m three weeks out from the procedure and while I’m told maximum efficacy takes about a month, I’m already seeing day-to-day improvements. I recently spent two and half hours at the beach with no problem and made it through a four-hour (!) train ride without having to pee once, which blew my mind. And when I do go, it feels noticeably more complete. This might sound silly, but those are wins to me.

Was bladder Botox ultimately worth it? I’ll keep you posted. Fingers crossed I won’t be doing it from the bathroom.

Read more about Botox:

• What’s the Difference Between Botox, Dysport, and Other Injectable Neuromodulators?
• Everything You’ve Always Wanted to Know About Botox (But Were Afraid to Ask)
• Does Daxxify Work Better Than Botox? I Tried The New Neurotoxin.

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