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Not just for the face: Using Botox on the bladder

Wednesday - 12/4/2013, 2:18pm  ET

Botox.jpg
Botox isn't just being used for cosmetic reasons. It's found its way into the medial field to help treat a variety of medical conditions. (Thinkstock)

This Botox procedure is not for your face

WTOP's Rachel Nania reports.

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A new treatment for overactive bladder

WTOP's Rachel Nania reports.

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WASHINGTON - Similar to an increasing number of Americans, Bekki Welter receives Botox injections. Only she'll tell you, the Botox doesn't go where you might think.

What is commonly used among men and women to smooth wrinkles and diminish crow's feet is becoming a more common sight in physicians' offices and outpatient rooms across the country.

That's because Botox is being used to soothe everything from migraines to muscle spasms. And Welter says Botox dramatically changed her life.

A Rare Disorder Leaves Unimaginable Damage

In 2009, Welter, a Northwest D.C. resident, went to a local emergency room with a terrible pain in her abdomen.

"It was so severe, I had never felt anything like it before," says Welter, 43.

She was ultimately sent home with an incorrect diagnosis, but returned the next morning with the same complaint. When Welter eventually left the hospital, she was practically paralyzed.

"Within a 48-hour period, I went from being a completely active, healthy person, to being what they did categorize as being a quadriplegic, even though I had use of my right hand and my sort of head and neck," she says.

The doctors were stumped. They knew something neurological was going on, but they weren't sure what it was that was attacking Welter's body.

"Basically there were five different sets of specialists ruling out everything you could imagine. It was almost like an episode of ‘House,'" says Welter, who was eventually transferred to MedStar Washington Hospital Center.

Bekki Welter receives Botox on the bladder to help with overactive bladder. (WTOP/Rachel Nania)

Her diagnosis was transverse myelitis, which, according to the National Institute of Neurological Disorders and Stroke, is a neurological disorder caused by inflammation across both sides of one level, or segment, of the spinal cord.

Despite its quick onset, Welter's recovery from transverse myelitis was not so swift -- she was left in spinal shock for six weeks, meaning she lost all of her reflexes.

The promising flicking movement of her big toe after the spinal shock timeframe was just one thing that kept Welter going throughout her four-year-long recovery.

Her 14-month-old daughter was another.

Re-learning Life's Daily Routine

Welter spent three months slowly recovering at the MedStar National Rehabilitation Hospital. During her time there, she still could not walk and could not dress herself. Those were just two functions Welter had to re-learn during her long recovery. Also, She had to learn how to go to the bathroom.

During her time in the hospital, Welter relied on a Foley catheter -- a tube that drains the body's waste automatically. But as her body's sensations and reflexes gradually came back, so did her urge to go to the bathroom.

The Foley catheter was removed and the medical staff taught Welter to "self-cath" whenever she needed to urinate. But unlike most other reflexes in her body, the normal function of her bladder never returned.

As time went on, the urgency to go to the bathroom increased severely and the time Welter had to get to the restroom got shorter and shorter.

"So I had accidents left-and-right. If I was in Costco at one end, I couldn't make it to the bathroom at the other end. If I was in my car, you know, I might have to pull over … I've been at black tie events where urine was dripping down my leg because I just couldn't get to where I needed to be on time," Welter says.

"It kind of affects you in pretty much every area."

Similar to the 17 percent of women and 16 percent of men in the U.S. who have overactive bladder, Welter was prescribed a common drug by a urologist to control the frequency of her urges.

But for her, the drug did not work well, and the side effects -- especially dry mouth -- made this form of treatment intolerable.

Per chance, Welter met a gynecological urologist, Dr. Andrew Sokol, through a mutual friend.

"I pulled him aside and said there has got to be something you can do for me," Welter says.

It turns out, there was.

Botox on the Bladder

Shortly after meeting Sokol, Welter began receiving Botox injections on her bladder from Dr. Cheryl Iglesia, a board-certified gynecologist and obstetrician and section director of female pelvic medicine and reconstructive surgery at MedStar Washington Hospital Center.

Dr. Cheryl Iglesia is the section director of female pelvic medicine and reconstructive surgery at MedStar Washington Hospital Center. (Courtesy Dr. Cheryl Iglesia)

Welter says the changes from the procedure, which was approved by the Food and Drug Administration in early 2013, have been dramatic and have completely altered her daily life.

"You have to go back and do your maintenance and all of that to maintain the desired effect, but it works. It absolutely works," she says.

The Botox is administered via a lighted telescope, a needle and some local anesthetic to approximately 30 spots along the bladder's muscles. Essentially, it does the same thing to the bladder that it does to the face -- it takes the wrinkles out, making the bladder firm.

"You feel it, but it's completely tolerable," says Welter, who compares the sensation to a bee sting.

The Botox gradually begins to work three to seven days after the injection, and most people require two injections a year.

"It just starts to kick in slowly so it's not like you wait seven days and it's kicked in. It just keeps getting better and better and better," says Welter, has received two injections since February.

"This thing was taking over her life," says Iglesia, who adds that Welter's condition caused stress on her sleeping habits, her work life and her personal life.

Now, Welter has more control over when and where she uses the restroom. And this past March, she was even able to run in the Nike Women's Half Marathon.

"I finished 10 miles and I am very proud of that -- and I never had to take a pit stop," Welter says.

The Ideal Bladder Botox Patient

Welter's experience with overactive bladder is not necessarily the same urinary incontinence that is experienced by one-third of men and women ages 30 to 70, since it can range in severity and origin on a case-by-case basis.

Iglesia explains Botox treatments are best for those experiencing incontinence due to neurological issues and severe overactive bladder, which is more common in older adults.

She says the prime candidates for Botox treatment are "people who have tried all the original stuff and it's not helping. You've got overactive bladder, whether you're MS, Parkinson's, spinal cord injury or these meds aren't working for you."

Iglesia says Botox is also ideal for those who strongly dislike the side effects of medications prescribed for overactive bladder.

"The beautiful thing about this is that there are no systemic side effects. It's just local," she says.

However, the procedure does not come without risks. Iglesia says there is a small chance the procedure can "work too well" and cause temporary paralysis on the bladder muscle. Because of this, Iglesia says it's imperative that her patients learn to self-catheterize in case the bladder is paralyzed and does not contract to empty for a few days.

The cost of Botox is higher than traditional prescription, but for Welter, the treatment is covered by insurance.

Iglesia says 100 units of Botox (her patients usually receive 100 to 200 units each visit) is typically around $500. The medications for overactive bladder are closer to $90 or $100 each month. But the indirect costs are what make the procedure more desirable.

"Think about that, a daily pill versus a once-or-twice-a-year shot. It is kind of revolutionary for people," Iglesia says. "I think, in general, most people feel the benefits outweigh the risks of the procedure."

Bekki's Recovery

Welter's four-year path to recovery has been a long one, but with her recent discovery in the Botox treatment for her overactive bladder, she remains incredibly positive. She also relies on her daughter to help her get through each day.

Through her experience, she offers advice to women dealing with similar overactive bladder issues.

"When women are having incontinence problems or anything along those lines, they have got to seek out a gynecological urologist, not just a regular urologist," Welter says.

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