Information for patients
This leaflet can be made available in other formats including large print, CD and Braille and in languages other than English, upon request.
You have been provided with a link to this leaflet as you are considering to proceed with cystoscopic Botulinum Toxin A injections into the bladder. This is because you have been diagnosed with overactive bladder. Botulinum Toxin A is not to treat urinary stress incontinence.
What is overactive bladder?
Overactive Bladder (OAB) is when there is an urgent need to pass urine, also known as urgency. This can also cause leakage known as urge incontinence. OAB can also cause the need for frequency of urination throughout the day or night.
What is Botulinum Toxin A?
Botulinum Toxin A is injected into the bladder via a cystoscope (a small telescope that passes through the urethra). It helps OAB symptoms by relaxing muscles, reducing urgency and allowing the bladder to hold more urine.
What happens at the hospital?
Once your consent has been obtained to proceed with the Botulinum Toxin A treatment, you will be placed on a waiting list. Waiting list times can vary depending if you have chosen to have a general anaesthetic, spinal anaesthetic or local anaesthetic.
For general or spinal anaesthetic, you will have your procedure in the theatre setting. This will require you to attend the access lounge on the day of your procedure. This is where you are admitted, see the nurses and doctors and will wait until you are called for your procedure.
Once the procedure is completed in theatres, you will return here to recover and pass urine successfully before going home. In some cases, you may have to stay overnight but this is generally not the case with Botulinum Toxin A injections.
You may have to attend access lounge at a required time and have a wait before being called for your procedure.
If you have chosen to have the procedure done with local anaesthetic, you may also have your procedure completed in theatres or in the outpatient setting depending on availability.
In the outpatient setting, you will attend at your required appointment time. There you will have your procedure done under the care of the doctors and nurses. You will need to pass urine before leaving clinic. This appointment can usually take 1 to 3 hours.
You will have a telephone follow up review with the Urogynaecology specialist nurse. At this appointment you can discuss your recovery, symptoms and any questions that you may have.
What are the advantages of having Botox injections?
Cystoscopic Botulinum Toxin A injections can be a treatment option for you if all other consecutive measurements have been tried and unsuccessful.
You may also proceed with Botulinum Toxin A injections without trying these alternative options but you must be aware there are associated risks with having these injections and alternative options are likely to present with less risks.
What are the associated risks?
There are risks associated with Botulinum Toxin A injections into the bladder. Most of these risks will disappear after time but this can vary from patient to patient.
A common risk includes symptoms returning, requiring repeat injections. This usually occurs after 6 to 12 months. Some patients may also see no improvement in their symptoms (3 in 10 patients).
There is a risk of mild burning on passing urine, blood in the urine, or infection requiring antibiotic treatment. You will receive antibiotics to take before and after your treatment to prevent this from occuring.
Some patients (around 1 in 10) may have difficulty passing urine and require self-catheterisation. If you are interested in learning this before your procedure please let you specialist nurse know.
Other risks such as allergic reaction and generalised weakness are uncommon (1 in 250 patients). The long term effects of Botulinum Toxin A treatment is also unknown.
Are there any alternative treatments?
Before proceeding with Botulinum Toxin A injections to treat your OAB symptoms, it is recommended to try conservative measurements first. These are bladder training, fluid management and pelvic floor exercises.
It is also recommended that you have tried 2 different types of medications to treat OAB, unless there are reasons why you cannot.
Before proceeding with Botulinum Toxin A injections, you will have a test called Urodynamics, this is completed in the outpatient setting and gives your doctor or nurse more information regarding your bladder.
Your case and urodynamic assessment will be discussed at an MDT (multidisciplinary team meeting) to ensure Botulinum Toxin A is the best treatment option for you.
Botulinum Toxin A can be a great option for you if other conservative measurements have not worked, or if you have declined trailing these. Other treatment options include sacral nerve stimulation and Percutaneous Tibial nerve stimulation.
British Society of Urogynaecology (Botox Injections to treat overactive Bladder)
International Urogynaecology Association (Overactive Bladder)
International Urogynaecology Association (Pelvic Floor Exercises)
International Urogynaecology Association (Intermittent Self Catheterisation)
International Urogynaecology Association (Cystoscopy)
International Urogynaecology Association (Urodynamics)
Tuesday to Thursday 8am to 4pm
Friday 8am to 1pm
Monday to Friday 8am to 4pm
Urogynaecology Specialist Nurse
Monday to Friday 8am to 4pm
Please be aware these are not emergency lines and any urgent medical attention or query should be addressed with 111 or 999.
International Urogynaecology Association: Botulinum Toxin A (BOTA) for Overactive Bladder and Nuerogenic Detrusor Overactivity.
International Urogynaecology Association: Overactive Bladder; A Guide for Women.
British Society of Urogynaecology; Botox injections to treat overactive bladder.
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This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:
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Leaflet reference: PIL1476
Date for Review: December 2026