Incontinence/Botox

[PTPiper]

I am a 50-year-old PT who is having urgency incontinence and two episodes of night incontinence.  I have done all I can exercise wise to address the problem. Now that I am experiencing night incontinence I have consulted a Urogynecologist and have been recommended to have either botox or a pacemaker.  Do you have any information or references for these techniques?
Thank you

[PTPiper]

Thank you for the input. I had read several of the botox studies and did not see that complication noted.  I see my Urogynecologist tomorrow, thanks for the timely insight before I head to that appointment.  
Barbara Piper, PT, DPT

[Lennox Hoyte, M.D.]

Don't do the Botox. The preliminary studies have shown an increased risk of retention and infection, and those studies have been stopped. Get evaluated by a pelvic floor PT who may be able to help with myofascial release on the puborectalis, iliococcygeus and obturators. Alternatively, vesicare or Enablex, may be helpful, but put you at risk for retention, constipation, and dry mouth as well. Being noninvasive, it may be worth a try. Other alternatives inlude liberty ESTIM, which is a removable vaginal insert pacemaker which can cure up to 50% of women with urge incontinence who use it twice daily for 8 weeks. Then at the other end of the spectrum is the INTERSTIM implantable pacemaker, which can cure the vast majority of women with refractory (i.e., can't be cured with anything else) urge incontinence. Downside is that INTERSTIM is a metal implant, and you can't have MRI scans if you have it in.

PLease let eht Forym know if this information was helpful,

Dr. Hoyte