Now, Botox for controlling incontinence

By Azera Parveen Rahman
New Delhi, Jan 21 (IANS):
Better known as the miracle aid to fight wrinkles that come with age, Botox is now used to treat incontinence - a condition in which one loses bladder control, leading to involuntary urination - that affects both women and men.

Approved by the Drug Controller General of India (DGCI) last year, doctors in different hospitals recommending botox to treat their patients say that the success rate till now has been 100 percent.

Although doctors find it difficult to put a number, a large number of people in India silently suffer from incontinence. In women, it often happens after childbirth, when apart from going through mental and physical stress, there is a loss of support of the urethra, leading to small amount of urine leakage while coughing, sneezing and lifting. At times it's also age related and can affect any individual.

"Increased urinary frequency, urgency and urge incontinence are a part of an overactive bladder that can happen to any normal individual. A person suffering from a neurological disease like spinal cord injury, spinal cord deformity, Multiple Sclerosis, Parkinsons disease, cerebral atrophy and ageing may also suffer from these conditions," Sanjay Pandey of the Urology-Andrology department of Mumbai's Kokilaben Dhirubhai Ambani Hospital told IANS on the phone.

How Botulinum Toxin Type A, or Botox, works in such cases is as a purified protein, which, once injected into the detrusor muscle, blocks the overactive nerve impulses that trigger excessive muscle contractions in the bladder.

It is pertinent to mention here that the effect of Botox in such cases lasts upto 10 months. And while one may question the temporary relief, doctors list its advantages over other line of treatments.

"Take a condition where a person has to take medicine every day. There is the cost you bear with long intake of the medicine, plus if you forget to take the medicine, it will impact the effect. In this case, with one injection of Botulinum Toxin Type A, the effect lasts up to 10 months, depending on the individual's condition, providing ample relief from the debilitating ailment," N. K. Mohanty, head of the Urology department at Delhi's Saket City Hospital told IANS.

"The injection is at the place of the problem, hence it doesn't affect any other part of the body, and is a non-invasive procedure that doesn't take more than 15 minutes," he added.

Pandey further explained: "Lasting up to nine-ten months, the bladder's over-activity is vastly decreased (by Botox) and thus returns to the reorganized activity of the concerted bladder contractions in response to stimuli of bladder filling at more appropriate times of complete bladder fullness. It is very helpful in cases where oral and conventional therapy have failed as first line of medical management".

"The gross urgency and possible urge incontinence that was the agony of the past is therefore gone and the patient is dry and free from wetness and urinary leakages, which ultimately improves the quality of life," Pandey added.

Usually when a patient comes with such a complaint, doctors first suggest lifestyle changes, weight reduction (in obese patients), quitting alcohol and coffee, reduction of fluid consumption, bladder training and pelvic floor exercises, before delving into other forms of medical therapies, or Botox.

Mohanty recalls the case of his florist who shared his dilemma of an unsatisfied marriage because of his wife's habit of frequent urination and a "constant foul smell". "I suggested him to get his wife checked, and after a few round of tests, we found that she was suffering from Neurogenic Detrusor Overactivity and put her on medication. After two months, there was about 40 percent improvement in her condition, but the problem persisted. Then I suggested the other route and gave her Botolinum Toxin Type A injection, after which there was a dramatic improvement in her condition, and as he says, in their lives," he noted.

With continued complaints of incontinence, some hospitals in India, like the Kokilaben Dhirubhai Ambani Hospital, now also have a dedicated clinic for such patients in the Urology department in which Botox is used as a line of treatment in case conventional therapies fail. The US Food and Drug Administration (FDA) also approved the use of Botox to treat overactive bladders in adults last year.


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