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Botox Use in the Older Woman: An Advanced Bladder Treatment Option

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Abstract

Purpose of Review

This article focuses on challenges of caring for older women with urgency urinary incontinence (UUI), and asks how treatment algorithms for UUI could be tailored to the needs of older women.

Recent Findings

Urgency urinary incontinence is highly prevalent among older women, and has significant health, social and economic impact for patients, caregivers and society. It is more difficult to treat among older women in part due to interaction with other geriatric syndromes and comorbidities. Also, the existing treatment algorithm, including anticholinergic medications as a mainstay of therapy, is less relevant to older patients due to increased risks and limitations of all therapies. Use of onabotulinumtoxinA treatment may have a more favorable risk/benefit profile compared with other therapies, and merits consideration earlier in the treatment of older women with UUI.

Summary

Urgency urinary incontinence is more difficult to treat among older women, and an updated treatment algorithm is needed to meet existing and increasing need. Use of first-line therapies and beta agonists should be supported among primary care providers to accelerate access to care. Subspecialty providers should give earlier consideration of bladder onabotulintumtoxinA (BOTOX©) treatment prior to or instead of oral medications, in part because of its lower systemic side effects, favorable cost profile, and versatility of dosing. Other third line therapies remain applicable as well but have more fixed disadvantages among older patients. Research is needed to scrutinize the outcomes, side effects, and experience of BTX treatment among older women, and more broadly, to query the influence of factors such as frailty, comorbidities, dementia and polypharmacy on response to treatment of UUI.

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Funding

No funding was received to assist with the preparation of this manuscript. Dr. Gerjevic has no relevant financial or non-financial interests to disclose. Dr. Cooper received an award from the Patient-Centered Outcomes Research Institute (PCORI) to study use of onabotulinumtoxinA (BTX) treatment for older women with UUI, and an investigator-initiated grant from AbbVie to contribute onabotulinumtoxinA drug for the study. AbbVie did not have influence on design, outcomes, conduct or other elements of the study.

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  1. Department of Obstetrics and Gynecology, The Geisel School of Medicine at Dartmouth, Lebanon, NH, USA

    Anne C. Cooper

  2. Department of Obstetrics and Gynecology, Creighton University School of Medicine, Omaha, NE, USA

    Kristen A. Gerjevic

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Cooper, A.C., Gerjevic, K.A. Botox Use in the Older Woman: An Advanced Bladder Treatment Option. Curr Geri Rep 12, 28–39 (2023). https://doi.org/10.1007/s13670-023-00384-6

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