Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 15, 2026
Does Botox help overactive bladder?
Yes. Botox is one of the most effective treatments for OAB when behavioral therapy and medications haven’t been enough. Botulinum toxin (Botox) is injected directly into the bladder muscle. It calms the muscle contractions that cause urgency, frequency, and urge incontinence. It’s FDA-approved for OAB and has been used for this purpose for over a decade.
How it works
OnabotulinumtoxinA (Botox) temporarily blocks the nerve signals that tell your bladder muscle to squeeze when it shouldn’t. By relaxing the overactive muscle, it:
- Reduces urgency episodes
- Decreases how often you need the bathroom
- Reduces or stops urge incontinence
- Lets your bladder hold more comfortably
For patients who haven’t gotten enough relief from medications, Botox works directly where the problem is, in the bladder muscle itself. I’ve seen patients go from 15 urgency episodes a day to 2-3.
The procedure
It’s understandable to feel nervous about a bladder procedure. You’re in control the whole time, and most patients say it was easier than they expected.
The injection is done in the office and takes about 10-15 minutes:
- We numb your bladder with a local anesthetic placed through a small catheter
- A cystoscope (a small camera) lets us see inside the bladder
- Botox is injected into about 20 spots in the bladder wall using a tiny needle
- The cystoscope is removed and you can go home
Most women describe the discomfort as mild. You can get back to normal activities right away.
Results and duration
- Onset: Most women notice improvement within 1-2 weeks
- Peak effect: Usually reached by 4-6 weeks
- Duration: Effects typically last 6-9 months
- Repeat treatments: When symptoms return, Botox can be re-injected
- In the ABC trial, 27% of women had complete resolution of urge incontinence with Botox (compared to 13% with oral medication). Overall, about two-thirds of patients see meaningful improvement.
Things to know before choosing Botox
The main side effect is temporary trouble emptying your bladder. This happens in about 5-10% of patients and usually resolves on its own as the Botox wears off. We check your bladder emptying after the procedure.
Botox also carries a higher risk of urinary tract infections (UTIs) compared to other OAB treatments, around 33% in clinical trials. If you’re someone who already gets frequent UTIs, that’s something we’d talk about when weighing your options.
I walk through the pros and cons with every patient before we decide together whether Botox is the right fit. Other options at this stage include sacral neuromodulation (a small device that calms bladder nerve signals) and tibial nerve stimulation. The best choice depends on what matters most to you.
References
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Visco AG, Brubaker L, Richter HE, et al. Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence. N Engl J Med. 2012;367(19):1803-1813. doi:10.1056/NEJMoa1208872
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Amundsen CL, Richter HE, Menefee SA, et al. OnabotulinumtoxinA vs sacral neuromodulation on refractory urgency urinary incontinence in women: a randomized clinical trial. JAMA. 2016;316(13):1366-1374. doi:10.1001/jama.2016.14617
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Amundsen CL, Komesu YM, Chermansky C, et al. Two-year outcomes of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: a randomized trial. Eur Urol. 2018;74(1):66-73. doi:10.1016/j.eururo.2018.02.011
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Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol. 2019;202(3):558-563. doi:10.1097/JU.0000000000000309
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