How Does Botox Compare to Medications such as Oxybutynin, Vesicare, and Detrol?
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC who specializes in treating men and women with urinary problems including frequent urination, difficulty emptying the bladder, urinary urgency and incontinence.
Botox vs Medications: What’s More Effective?
Treatment with oral anticholinergic medications requires taking the medications daily – they work only as long as the patient uses them. Due to the side effects many people giving up the treatment. About 50% of patients stop the medications either because of side effects or inadequate benefit within 6 months.
Common side effects of oxybutynin and other anticholinergic medications include dry mouth (50%) and constipation.
Botox works differently. It works directly on the nerve, preventing the release of acetylcholine from the nerve. Because the effects of Botox are local – it works where it is injected and does not affect the entire body, side effects are fewer and Botox is very effective, having a 63-85% success rate, in reducing the frequency of peeing, the sense of urgency and also reducing urinary incontinence.
In one study, 20 weeks after Botox treatment, 80% of women became dry and daytime frequency decreased from 11.7 to 6.2; night-time frequency decreased from 2.6 times to 1.2 times.
The Bottom Line:
- Overall, Botox is more effective than oral medications
- Patient satisfaction and quality of life is higher with Botox
- Side effects of Botox tend to be more tolerable
What is the Cause of OAB?
OAB is caused by the detrusor muscle in the bladder contracting too readily and oversensitivity of bladder wall to distension by urine. The result of abnormal bladder sensitivity and muscle function is that you want to void, often urgently, even when your bladder is nowhere near full.
In order for the muscle to contract, it needs to receive a message from nerves that it’s time to pee. When the nerve is activated, it releases a chemical at the nerve ending called acetylcholine.
How Do Oral Medications Work?
Anticholinergic drugs, such as oxybutynin, Vesicare, Ditropan and Detrol block transmission of nerve signals from the nerve endings that tell the muscle to “push” from the nerve to muscle. This prevents the acetylcholine from initiating bladder contraction and sensation of ‘urgency”.
Anticholinergic medications block the action of acetylcholine, they are called acetylcholine receptor inhibitors. Medications such as oxybutynin, Vesicare and Detrol have been the main treatment for OAB for years, together with behavioural therapy, and pelvic floor exercises.