Botulinum toxin preparations, such as Botox, have rapidly become a viable treatment option for urinary urge incontinence disorders, say experts from the Royal College of Obstetricians and Gynaecologists (RCOG) in a new Scientific Impact Paper launched today.
Urinary incontinence disorders such as detrusor overactivity (DO) and an overactive bladder (OAB) affect an estimated five million women in England and Wales over the age of 20. While not life-threatening, the symptoms can be debilitating and disruptive to a good quality of life.
The paper analyses recent data on the use of botulinum toxin (BoNT-A) to treat urge incontinence in patients with neurogenic failures, such as spinal cord injuries or multiple sclerosis, and in patients with no underlying causes.
Routine treatment for patients with OAB usually consists of lifestyle changes, including reducing caffeine intake and pelvic floor exercises, sometimes accompanied by oral medications. However, if these methods fail, clinicians may recommend second line treatments including implantable nerve stimulators or BoNT-A injections.
The authors of the paper suggest that while data on the success of BoNT-A as a treatment option have previously been limited, more evidence is emerging in support of a range of significant short-term benefits for patients.
Recent studies of patients with neurogenic destrusor overactivity (NDO), after spinal injury or multiple sclerosis, show that BoNT-A successfully increases bladder capacity for an overall reduction in episodes of incontinence.
Though it has been noted that improvements in NDO patients have also been offset by a degree of impaired bladder emptying, the use of BoNT-A to treat these patients is currently licensed in the UK and most European countries.
There is less evidence to suggest the same benefit for patients with no underlying causes of detrusor overactivity (idiopathic or IDO). Though, the evidence that does exist shows similar results with the use of BoNT-A improving symptoms considerably, with most studies finding an improvement in symptoms for the majority of women with IDO and a reduction in overall incontinence episodes.
Moreover, the authors note that BoNT-A may provide significant relief from symptoms with a median duration of around six months. They state that patients should be warned regarding any adverse effects including urinary tract infections in up to one in six patients, and voiding dysfunction (either total or partial) in up to 10% of women which is usually managed with self-catheterisation.
Douglas Tincello, Professor of Urogynaecology at the University of Leicester and lead author of the paper, said:
“The data we looked at suggest BoNT-A is effective for the symptomatic treatment of urge incontinence disorders with many studies finding significant short-term improvements to quality of life.
“However, due to a lack of evidence and unknown outcomes for prolonged treatment there is currently no agreed consensus from all international guidance. While internationally an increasing number of clinicians are now using BoNT-A to treat this symptom syndrome, the majority of UK clinicians do not routinely use it as an option in women without prior diagnosis of detrusor overactivity.”
Dr Sadaf Ghaem-Maghami, Chair of the RCOG’s Scientific Advisory Committee, said:
“The research supporting the use of BoNT-A for various urinary incontinence disorders has increased significantly over the past decade, with many trials reporting significant improvements in patients’ voiding frequency, urgency and leakage episodes as well as continence.
“While research into the longer-term effects of BoNT-A is limited, emerging data show promise for future treatment of overactive bladder, detrusor overactivity and painful bladder.
“Any women with concerns about the medical management of their incontinence or who are not responding to conservative methods of treatment should consult their gynaecologist or GP to discuss further treatment options.”
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View the opinion paper in full here.
About RCOG Scientific Impact Papers
RCOG Scientific Impact Papers (formerly SAC Opinion papers) are produced by the Scientific Advisory Committee. They are up to date reviews of emerging or controversial scientific issues of relevance to obstetrics and gynaecology, together with the implications for future practice. These documents have been rebranded to raise awareness of the issues in obstetrics and gynaecology discussed in the documents and to more accurately reflect their content and remit of the Committee.
The NICE guideline on urinary incontinence can be found here.