Wait, Botox Where? How The Injectable Is Helping Parents With Pelvic Pain

When most people hear the word “Botox”, they think about reducing wrinkles. But the popular cosmetic injectable has many medical uses, including treating hyperhidrosis (excessive sweating), muscle spasms and more intimate issues like overactive bladder and pelvic floor dysfunction.

Marissa*, a Canadian mother, experienced debilitating pelvic pain due to a bladder prolapse. “Unlike many women who develop prolapse due to weak pelvic floor muscles, my issue was the opposite: my pelvic floor was too strong, and it had forgotten how to relax. The constant tension was a major source of my pain,” says Marissa.

Her care team recommended a treatment plan that included Botox injections, weight loss, and pelvic floor physiotherapy. Today, she’s living with little to no pain.

While instances of pelvic floor disorders in postpartum parents are widespread, our conversations around how to resolve chronic pain and lifestyle hindrances are not. According to one study, 43.5 percent of postpartum parents experience urinary incontinence two years postpartum. Additionally, almost half of the participants in a survey by McGill University researchers experienced pelvic pain in the first three months after delivery.

What is bladder or pelvic floor Botox?

Botox is a neuromodulator, meaning that it temporarily stops muscle movements by blocking nerve signals that cause them to contract. “It’s a tool used by Urogynecologists as a care strategy to address dysfunction of both the bladder and the pelvic floor,” says Dr. Sinead Dufour, an internationally recognized pelvic health physiotherapist and associate clinical professor at McMaster University.

While there are fewer evidence-based use cases for treating pelvic floor dysfunction, there is much more robust evidence to support the use of Botox in bladder dysfunction, says Dr. Dufour, who is also a pelvic health physiotherapy advisor to UROSPOT, a pelvic floor clinic in Toronto.

“Botox really is not a strategy I would ever recommend for the pelvic floor, unless there was a very specific area of neuropathic pain,” says Dufour.

Dr. Sameea Chughtai, a Chicago-based board-certified physician, confirms that there is ample research supporting bladder incontinence, but is more positive about its use for the pelvic floor, saying that it’s been shown by multiple reports to improve symptoms of pelvic floor dysfunction.

Who is Bladder or Pelvic Floor Botox for?

Whether it’s in your face or your pelvic floor, Botox works by relaxing muscles.

“Childbirth can cause muscular damage due to trauma and severe stretching of the pelvic floor muscles,” says Dr. Chughtai. “Later on, women can experience tension, spasms, or pain in the pelvic area. Botox injections help relax these muscles, relieving issues like painful intercourse, pelvic floor spasms and overall vaginal discomfort.”

How does Pelvic Floor Botox work?

While each clinic, practitioner, and patient will have their own experience, Dr. Chughtai explains that their clinic’s procedure includes an application of a numbing cream or local anesthetic for patient comfort.

“Botox injections are precisely placed directly into specific pelvic floor muscles internally, usually about two to four injections,” says Dr. Chughtai. “To treat vaginismus, Botox can be used with vaginal wands.” When treating an “overactive bladder”, a thin tube with a camera, called a cystoscope, is used to inject small aliquots of Botox onto the bladder wall.

Dr. Chughtai says that patients typically experience mild discomfort and that the recovery period is around 48 hours. The cost for the treatment will depend on the clinic and the number of units used.

Why you've never heard of Pelvic Floor Botox

While pelvic floor botox is not new, it remains underresearched and not easily accessible to patients. Combine that with the fact that many people suffer from bladder incontinence and pelvic pain in silence, and it’s clear why many may not have even heard of this option.

Marissa says that it's been 12 years since her first Botox treatment, and since then, she has been able to continue life mostly pain-free, while also avoiding invasive prolapse surgery.

“It's a treatment that improved my quality of life and made more treatment options possible,” says Marissa. “In the field of pelvic prolapse, it's never discussed enough that treatments which improve quality of life are just as important as surgical options.”

Next Steps: So, you want pelvic floor Botox?

Dr. Dufour, who is also a pelvic health physiotherapy advisor to UROSPOT, a pelvic floor clinic in Toronto, says that only physicians can administer Botox to the pelvic floor or bladder. While some urologists or gynecologists can administer the injection, it’s typically a urogynecologist who is most qualified to deliver this type of treatment.

If you’re located in Canada and looking for more information about pelvic floor Botox, ask your doctor for a specialist referral to a urogynecologist, colorectal surgeon or pelvic pain specialist.

In Toronto, Mount Sinai Hospital is home to the only Neuropelveology Clinic in Canada, specializing in pelvic pain. (The fact that it’s the only pelvic pain clinic in the country just goes to show how underresearched and underfunded women’s health is.)

Pelvic and bladder dysfunction is incredibly normal, and the more we talk about it, the more normalized treatment and support will become. While pelvic pain, bladder incontinence, and other pelvic symptoms can be incredibly stressful and impactful to daily life, it is not untreatable.

*Name has been changed.

Experts

• Dr. Sinead Dufour is an internationally recognized pelvic health physiotherapist and advisor to UROSPOT, and associate clinical professor at McMaster University.
• Dr. Sameea Chughtai is a Chicago-based board-certified physician.