Botulinum toxin, already popular as a cosmetic procedure, is now being used to treat women suffering from detrusor over-activity, otherwise known as an over-active bladder; a highly restrictive and embarrassing condition for those unfortunate enough to experience it.
One in three post-menopausal women is affected by the condition whose symptoms include an urgent and frequent need to urinate, urge incontinence, interrupted sleep and bed-wetting. It often has a dramatic impact on these people’s quality of life restricting their sex-life, ability to socialise and travel freely.
Until now the standard treatment has been bladder retraining and pelvic floor exercises or, if this fails, anti-cholinergic medicines. There are several medications available but a high number of women find these of not help or stop taking their medication within six months because of intolerable side effects such as dry mouth, heart burn and constipation. For these patients the only alternative is major surgery; being highly invasive and costly many prefer to struggle on as best they can, leaving this embarrassing problem untreated.
“Botulinum toxin has been shown in multiple clinical trials to be an effective solution for the vast majority of these women,” said Mr Ash Monga, Consultant Gynaecologist at Spire Southampton Hospital.
“It works by reducing the detrusor muscle spasms which trigger urinary incontinence, is effective in up to 70% of cases and a single injection controls for the problem for up to nine months, on average, before needing to be repeated.
“The day-case procedure is performed under general anaesthetic but we are now planning to provide it using local anaesthesia which has obvious benefits in terms of both the recovery time and cost of this treatment,” he said.
For Gillian Babb, of Southampton, the trigger for detrusor over-activity was a hysterectomy performed 12 years ago. At the time the only possible treatment was colpo-suspension; a major surgical operation which she describes as being akin to another hysterectomy and from which she took several months to recover.
Although the surgery was effective, its benefits wore off. In July 2007 she consulted Mr Monga. After a variety of tests she was found to be suitable for treatment with botulinum toxin. The relief this delivered was apparent within 48 hours of treatment.
“The benefits are tremendous. This treatment literally gave me my life back. It meant not having to worry if I laughed or coughed. That I have the freedom to go anywhere and enjoy activities I have not been able to do for ages such as taking a walk.
“Detrusor over-activity is an incredibly restrictive condition. Before treatment the first thing I did – wherever I went – was locate the nearest loo.
“The issue I now have is convincing my medical insurer to pay for the repeated treatments I require. The only other option for me is major surgery which costs thousands of pounds and takes months to recover from. While my insurer is happy to cover the cost of this operation, they are unwilling to pay for additional treatments of botulinum toxin despite the fact that it gives immediate relief - at a fraction of the cost - and has no recovery period,” she said.
People wishing to make an appointment or find out more about this treatment should call 023 8076 4347. A GPs referral is required.
Spire Southampton Hospital has an outstanding record in terms of patient care and hygiene. Ninety-seven per cent of patients surveyed in 2007 said they would recommend its’ services to friends and family. The hospital also has an extremely low infection rate – below the national standard at 0.9% - and no reported incidence of hospital-acquired MRSA.
