Botox injections can now be offered as a treatment for urinary incontinence, the NHS drugs watchdog has said.
Yesterday, the National Institute of Clinical Excellence (NICE) said free Botox treatment should be offered to women with ‘overactive bladder syndrome’, also known as urinary incontinence.
This is not the first time Botox has been recommended by NICE for treatments that don’t involve freezing wrinkles. For example, late last year the treatment was also approved as effective for chronic migraine.
Healthista asked leading plastic surgeon Baljit Dheansa to explain the many ways doctors are now using Botox injections to treat problems other than wrinkles.
There is more to botulinum toxin than simply smooth foreheads. The toxin comes from a particular type of bacteria and was sometimes called the sausage poison because of its association with poorly handled meat products. Although we have known about it since the late 1800s, as early as the 1950s scientists were able to show potential uses of this lethal toxin to actually help patients – and they weren’t even looking for cosmetic treatments!
They experimented by using tiny amounts of the toxin so that the effects were limited and therefore not dangerous. Once this discovery was made scientists were able to show that precise and small doses into muscle could cause paralysis for several weeks and this meant exciting treatments, not only wrinkle reduction. Today, doctors use Botox to treat many different conditions including the following.
1.TWITCHING EYES One of the first conditions shown to improve with botulinum toxin was blepharospasm, a condition which causes twitching of the muscles around the eyes. Patients often have excessive, uncontrollable blinking and sometimes their eyes clamp shut. Not only is this distressing but also results in dry eyes or uncontrollable movements in the face too. Injections into the muscles have transformed many patients’ lives and provided they have injections every 3-4 months lead normal lives.
2. SQUINTING Eye specialists also saw the benefit of balancing eye muscles in people who had squints using botulinum toxin and this has proved to be particularly useful in adults who may have not had an operation to balance the eyes as a child but are distressed by the appearance. This approach often means that they do not need an operation. However it is not an alternative for more formal treatment in children who need a combination of eye patches, glasses and surgery.
3. POST-STROKE SPASMS AND CEREBRAL PALSY Once doctors were comfortable with its use they began to see the benefits in patients with spasms in their arms and legs after strokes or if they had cerebral palsy. Often such patients had excessive muscle activity which meant that they could not use their limb easily or sometimes caused muscle contractions. In some cases patients closed up their fingers so much that they could cause skin damage to the palm from their nails. Previously in such cases surgeons would have to consider operations to release the muscles or even cut the tendons. Botulinum toxin allowed these patients to avoid operations and be able to get physiotherapy to help their movement and function.
4. FACIAL WEAKNESS Plastic surgeons were also beginning to realise that the patients who they were treating for facial palsy (weakness of the face after nerve injury or treatment for tumours) still had differences in their facial appearance despite good treatment for the affected side. They noted that the normal side muscles were over active and that patients needed to have botulinum toxin injections on the normal side to balance their faces to get the best from surgical treatment on the affected side.
5. OVERACTIVE BLADDERS Since then doctors have looked at other conditions that have excessive muscle action within the body. The bladder muscle can be overactive and can cause stress incontinence. Patients find they have to go the toilet frequently but sometimes don’t make it in time. This is not only distressing but can sometimes be very difficult to treat. Until recently drugs and bladder training were the mainstay of treatment but recently doctors have found that injections of the toxin directly into the bladder wall can have a dramatic effect on patients who can then lead a more normal life.
6. INABILITY TO SWALLOW This has also been the case for a condition called achalasia which is a condition where the oesophagus (food pipe) has excessive muscle activity affecting the ability of patients to swallow. Not only is this distressing and uncomfortable but patients also lose weight and sometimes food that isn’t swallowed comes back up and goes into the lungs casing pneumonia. Many patients need lifelong drugs or surgery and may also need stretching of the oesophagus. Botulinum treatments may help avoid these and allow patients to eat normally.
7. EXTREME SWEATING When patients having the treatment for other reasons noted that areas treated in them sweated less, doctors tried botulinum toxin in the skin of people who had excessive sweating and noted a dramatic improvement. Up until then such people had to use creams or even resort to surgery. These treatments proved to be safe and effective meaning that patients rarely need to consider surgery now.
8. MIGRAINES Patients with migraines who were having cosmetic treatments also noted that their migraines got better and that they needed their medication less often. Nobody is really sure how it works in this case but it has meant that some patients who were disabled by the frequency and intensity of their migraines can now lead more active lives without the need for drugs and this treatment – for the right patient – can be treated on the NHS Mr
Baljit Dheansa is a consultant plastic surgeon at the McIndoe Surgical Centre mcindoesurgical.co.uk, my-plastic-surgeon.co.uk
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