Posts Tagged ‘botulism’

Botox: For A “Gladder” Bladder

December 19, 2015

Andrew Siegel MD   12/19/15

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You are probably aware of Botox used for improving the cosmetic appearance of facial wrinkles. When injected into frown lines Botox paralyzes facial muscles resulting in creases, furrows and grooves disappearing and presto, you look a decade younger! Botox has numerous medical uses that go beyond improving one’s appearance. It is commonly used to improve internal body functions, e.g., injecting it into the bladder muscle to improve symptoms of overactive bladder (OAB).

Making Lemonade From Lemons

Botox is derived from the most poisonous substance known to man—botulinum toxin. This neurotoxin is produced by the Clostridium bacterium, responsible for botulism. Botulism is a rare but serious illness that can result in paralysis. Botulinum toxin, when used in minute quantities in a derivative known as Botox, is a magically effective and powerful potion.

How It Works

Botox is a neuromuscular blocking agent that weakens or paralyzes muscles. Beyond cosmetics, it can be beneficial for a variety of medical conditions that have in common some form of localized muscle over-activity. Its uses generally involve conditions with muscle spasticity, involuntary muscle contractions, excessive sweating and eyelid or eye muscle spasm.

Botox For The Bladder

Overactive bladder (OAB) syndrome consists of the symptoms of urinary urgency (the sudden desire to urinate), with or without urgency incontinence (urinary leakage associated with urgency), usually accompanied by frequent urination during both awake and sleep hours. OAB has been described as the “bladder squeezing without your permission to do so.”

When injected into the muscle of the bladder,  Botox treats the “wrinkles,” the thick muscle bands known in medical jargon as trabeculation, which are typically present in conditions that cause obstruction to the outflow of urine or bladder overactivity.  By temporarily paralyzing a portion of the bladder muscle, OAB symptoms can improve dramatically. 

Botox can be used in both genders.  It is usually a second line treatment for those who have not responded well or have been intolerant to oral bladder relaxant medications.  The goal of Botox is to  effectively treat persistent and disabling urinary urgency, frequency and urgency incontinence.  Botox is FDA approved in the USA in a 100 unit dose for overactive bladder and  200 unit dose for overactive bladder associated with neurological conditions.

Bladder Botox injection is a brief office procedure usually done under light sedation. It involves placing a cystoscope into the bladder and injecting  Botox into numerous sites in the bladder via a needle that fits through the cystoscope. The entire procedure takes 10 minutes or so.

Preparing for Bladder Botox/ Expectations 

  1. Stop blood thinner medications one week before Botox.
  2. Antibiotics are started 2 days before and continued for 2 days after.
  3. You may experience blood-tinged urine, burning with urination and pelvic pain for a day or so after the procedure.
  4. You may experience difficulty urinating and feel that you are not emptying completely; if so, this may require a catheter or temporarily learning how to do self-catheterization.
  5. It may take a week or two to notice improvement. Although Botox is highly effective, it is not so in everyone.
  6. Follow up urinalysis and check of the post-void residual volume (how much urine is left in the bladder after voiding) in two weeks.
  7. Botox should last 6-9 months or so. After the improvement wears off, the injection can be repeated. If ineffective or only partially effective, the Botox dosage can be increased.

Bottom line: Botox, a  neurotoxin produced by Clostridium that causes paralysis, can be beneficial when injected into virtually any muscle in the body that is in a state of hyper-contraction and spasticity.  It has found utility for a variety of medical conditions, particularly for the treatment of overactive bladder symptoms.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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Botox: Not Just for a Pretty Face

January 11, 2014

Blog #136

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Botox is derived from a poison produced by the Clostridium bacterium, the microorganism responsible for botulism in humans and animals.  Botulism—caused by eating foods contaminated with the Clostridium bacterium—is a rare but serious illness that can result in paralysis and is considered a potentially fatal medical emergency. The highly toxic and lethal botulinum toxin was initially identified by Kerner in rancid sausages and was refined and purified by van Ermengen in the Netherlands.

It is shocking that the most poisonous substance known to humanity—Botulinum toxinwhen used in minute quantities in a derivative known as Botox, becomes a magically effective and powerful potion to treat a variety of conditions. Talk about making lemonade from lemons!

Most people are aware of the use of Botox to prevent or improve the cosmetic appearance of facial wrinkles. When injected into the frown lines it paralyzes the facial muscles involved and makes creases, furrows and grooves disappear. Facial Botox injections are among the most common cosmetic procedures performed in the United State and have fostered a billion dollar industry. It is important to know that getting beyond cosmetics, Botox can be beneficial for a variety of medical conditions that have in common some form of localized muscle over-activity.

Technically speaking, Botox is a neuromuscular blocking agent that weakens, if not paralyzes muscles. It has numerous potential uses involving the following: overactive bladder (condition causing urinary urgency, frequency and incontinence); urinary incontinence due to neurological conditions including spinal cord injury and multiple sclerosis; chronic migraine headache; upper limb spasticity; cervical dystonia (involuntary contraction of the neck muscles causing abnormal movements and an awkward posture of the head and neck); axillary hyperhidrosis (excessive underarm sweating); blepharospasm (eyelid spasm with uncontrollable blinking); strabismus (cross-eye or wall-eye); and of course, the cosmetic usage to improve the look of frown lines and wrinkles. For all of the aforementioned conditions, the effect of Botox is temporary and needs to be repeated on an indefinite basis in order to maintain the therapeutic effect.

Overactive bladder and incontinence due to neurological conditions: Botox can be useful in those who have not responded to conservative methods including behavioral methods, pelvic floor exercises and medications. Such persistent and disabling urgency, frequency and urgency incontinence can be effectively managed by injecting Botox into the urinary bladder. It works by paralyzing or weakening the bladder muscle. It is done via cystoscopy (a visual inspection of the bladder with a lighted narrow telescope) and requires injecting the Botox into about 20 sites within the bladder muscle.

Chronic migraine headache: Botox is useful for preventing migraines in adults affected more than 15 days per month with headaches lasting for more than 4 hours daily. It is accomplished by injecting the Botox into different areas of the head and neck including muscles of the following areas: forehead; temples; back of head; and the neck and upper back.

Upper limb spasticity: Botox is helpful to decrease the severity of the excessive muscle tone in the elbow, wrist and finger flexors and works by paralyzing these spastic muscles. It is injected directly into the flexor muscles as well as the biceps.

Cervical dystonia: Botox can be effective to reduce the severity of the abnormal head position and neck pain. It works by paralyzing the dystonic muscles and is injected into the sternocleidomastoid muscle.

Axillary hyperhidrosis: Botox is useful in those with severe underarm sweating that has not been managed successfully with topical agents. The Botox functions to paralyze the sweat glands and is injected in numerous sites to cover the area of hyperhidrosis.

Blepharospasm and strabismus: Botox is indicated when these conditions are associated with dystonia as well as benign essential blepharospasm and facial nerve disorders. It works by paralyzing the eyelid and eye muscles and is injected into the eyelid muscles and extraocular muscles, respectively.

Bottom line: Botox, a toxin produced by Clostridium that causes paralysis, can be beneficial when injected into virtually any muscle in the body that is in a state of hyper-contraction and spasticity and has found utility for a variety of medical conditions.

Andrew Siegel, M.D.

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