Injections (Intravesical & Bulking Agent)

Injections may be recommended for patients with urinary incontinence issues.

The process of moving urine out of the body involves a series of muscle contractions. If anything disrupts this process, urine may be involuntarily released through a tube called the urethra. When this happens on a regular basis, it’s a condition known as urinary incontinence.

Initial treatment usually involves changes to diet, medication, and bladder-control techniques that may include Kegel exercises.
If these treatments aren’t effective, a urologist may suggest injections.

When Injections Are Recommended

Injections may treat both stress and urge incontinence

Leaks may occur when muscles do not function properly

Several injection approaches are available

Both stress and urge incontinence may be managed with injections. Stress incontinence is usually triggered by actions such as laughter or coughing. Urge incontinence refers to an inability to hold urine until getting to a bathroom. There are two types of injections a urologist may use: intravesical OnabotulinumtoxinA injections and urethral bulking agents. Injections are usually recommended when exercises to strengthen pelvic floor and bladder muscles and medications that tighten bladder muscles or reduce contractions of the bladder aren’t preventing leaks or accidents.

Intravesical OnabotulinumtoxinA Injections

The FDA has approved the use of botulinum toxin for bladder leaks caused by nerve damage.

Patients are asked to empty their bladder before the injection.

A local anesthetic gel is applied to reduce sensitivity and discomfort.

The injection is administered with a flexible cystoscope inserted through the urethra.

Sterile water may be pumped into the bladder to improve visibility.

Multiple injections are given during the procedure. The procedure typically lasts about 15–20 minutes.

The procedure may also be used for severe urge incontinence and frequent urination.

Effects and Aftercare

The injected toxin affects nerve endings in a way that prevents muscular contractions.

Burning sensations during urination may occur briefly

Symptoms usually resolve within a day or two

Risks associated with the procedure are minimal

Patients may be asked to watch for signs of infection

Urethral Bulking Agents

Injections add bulk to the urethra

A tighter seal helps prevent leaks

Procedures use cystoscope guidance

Treatment takes about 30 minutes

Administered under either general or local anesthesia, urethral bulking agent injections are placed around the urethra. A urologist may suggest this treatment to add bulk to the sphincter so a tighter seal in the urethra is formed to keep urine from leaking. Bulking agents are injected into the side of the urethra. The injections may be done directly through the skin. In women, injections are sometimes done through the vagina. A cystoscope is inserted into the urethra to provide visual guidance to help with needle placement. After the procedure is completed, patients are often asked to stand up to see if the urine leakage has stopped. If it hasn’t, another injection of the bulking agent may be given.

Additional Treatment Options

Surgical Treatment

Should injections fail to sufficiently manage stress incontinence, surgery is sometimes recommended. The most common procedure involves the placement of a sling to lift the bladder to prevent urine leakage.

Non-Surgical Devices

Other options include the insertion of a latex or silicone device called a pessary into the vagina and the use of adhesive foam pads placed over the urethral opening.

Symptom Management

Some patients prefer to manage the problem with absorbent pads or specialized underclothing.