Parents Are Getting Botox in Their Vaginas After Birth To Help With Pelvic Floor Dysfunction

Botox for the bladder and vagina? Doctors, physical therapists, and patients discuss the efficacy of the common cosmetic staple when used in those areas.

Set of syringes with medication
Photo: Getty Images/Anna Efetova

If you've had a baby or ever had any kind of pelvic pain, you've likely heard of pelvic floor dysfunction—it's a term that essentially refers to the inability to properly relax or contract your pelvic floor muscles (the muscles that help you go to the bathroom). It's a common complication of major events like childbirth and injury and it can be common in athletes. (About 13 percent of people who have never given birth have pelvic floor dysfunction.)

Pelvic floor issues can be broad, spanning from muscular issues to problems with bowel and urine control, and pelvic pain. Often, they're treated with a specialized form of physical therapy called pelvic floor physical therapy or with medications like stool softeners, for example, or anticholinergics to help with urinary incontinence, or leaking.

But there's another, more surprising treatment out there, too: Botulinum toxin—aka Botox.

"While we hear of Botox being used for cosmetic reasons, it can also be used for pain or dysfunctions in the body related to increased tightness or what we call spasticity," says Melissa Hines, P.T., D.P.T., owner of Wellest Integrative Health in Boston.

Hines is quick to point out that Botox is not a first-line treatment for pelvic floor issues—and it's not for everybody. But if you've been experiencing pelvic pain for a while and are not sure where to turn anymore, it could be for you.

Here's what providers who use it, patients who have done it, and pelvic floor physical therapists say about the treatment.

Botox for the Pelvic Floor and Bladder

After Rachel A., a 33-year-old distance runner in Connecticut, had surgery on a torn hip labrum muscle, her workout routine and her body never felt the same. She gave up running due to the pain and picked up cycling instead and soon she noticed other issues popping up: pain with sex and an uptick in urinary tract infection (UTI) symptoms.

"As it turns out, my pelvic floor was very tight and always in spasm due to the cycling and the labral tear," she says.

She went to pelvic floor physical therapy but found little relief. She tried antispasmodic medications to try to stop the spasms, but they made her mouth dry and made her tired. Trial and error eventually led her to a urogynecologist who suggested the use of Botox on her pelvic floor.

"Botulinum toxin is a neuromuscular blocking agent that can cause a temporary paralysis of a muscle," explains Diego Illanes, M.D., chief of urogynecology at Tufts Medical Center in Boston, who treats about 200 patients a year with Botox (95 percent of them are parents).

Through this paralysis, it can change connections between the nerves and muscles of the bladder area, he explains, preventing issues such as excess tension or an overactive bladder. In fact, Botox is approved by the Food and Drug Administration (FDA) for use on the bladder. Injections into the bladder's detrusor muscle can help people from feeling like they always have to go, Dr. Illanes says, treating overactive bladder, which can be common after childbirth from the weakening of the pelvic floor muscles. Overactive bladder can also be caused by nerve damage, medication use, urinary tract infections, and more.

For patients like Rachel, injections into the pelvic floor muscles help decrease spasticity or tightness in the muscles, says Hines. "The Botox temporarily paralyzes the muscles in order to break that spastic pain cycle." Botox is used off-label in these cases as it's not yet FDA-approved for use on the pelvic floor muscles. "More long-term efficacy and safety data is required, but I am optimistic ongoing clinical trials will prove its applicability to the pelvic floor muscles," says Dr. Illanes.

Botox use in both the pelvic floor and bladder is what Dr. Illanes calls an "advanced therapy;" it's best reserved for those who have failed other treatments (a "healthy bladder" diet, pelvic floor exercises, bladder retraining) and medication. After all, it comes with costs.

The Downsides to Botox on the Pelvic Floor and Bladder

Botox in the pelvic region, as is true with Botox anywhere else and all medical procedures in general, has risks and side effects. If used on the bladder, for example, the temporary paralysis of the muscle that you use to urinate can sometimes cause people to experience urinary retention (aka you can't go), and because of that, UTIs, says Dr. Illanes.

Rachel notes that after her injections into the pelvic floor, the opposite happened. She says she was "almost incontinent of urine and stool because that area was now paralyzed." After a few months, she said symptoms (pain with sex, her UTIs, and the post-Botox incontinence) subsided.

Another common side effect is feeling pain localized to the area of the injection.

Botox specifically on the pelvic floor muscles (remember: not FDA-approved, so almost always not covered by insurance) can also be expensive, ranging anywhere from hundreds to thousands of dollars.

That's part of the reason providers—even those who perform it—consider Botox a last resort procedure. "It's not something I would recommend for anyone postpartum who has not tried pelvic floor therapy or medical management," says Hines. "There are many other options like valium and baclofen suppositories, along with pelvic floor therapy that would be a first line of treatment." Botox in the pelvic region, she reminds, is an invasive procedure.

Caryn Phillips, P.T., D.P.T., founder of Momlife Health and Wellness in Medfield, Massachusetts, adds: "Many women can improve with conservative measures like pelvic floor physical therapy, relaxation techniques, and stretches." But sometimes, muscles can be more "stubborn," she says, and an intervention such as Botox from a urogynecologist can be reasonable.

If You're Going To Try Botox

If you've had pelvic pain and have not found any helpful treatment from it, maybe Botox could be a good option for you. Hines notes that people with chronic pelvic pain, vaginismus (involuntary contraction of muscles around the vagina), pudendal neuralgia (long-term pelvic pain from damage or irritation of the pudendal nerve), bladder urgency or frequency, constipation, or scar tissue could potentially consider it assuming they've exhausted all other options.

Each treatment provides about 6 to 12 months of relief and sometimes longer.

Rachel, who is currently pregnant, hopes that having a vaginal delivery and multiple Botox injections behind her will "change it all" and she won't need any more treatments.

If you decide you do want to try it, consult with a pelvic floor therapist first to truly make sure it's right for you and consider pairing the procedure with physical therapy. "The idea behind this is that once the Botox 'wears off,' the muscles have a better chance of staying in a relaxed state since they were treated with manual therapy techniques to release any restrictions while the Botox was in effect," explains Phillips.

From there, it's best to have the injection done by a board-certified physician, ideally an OB-GYN or urogynecologist who specializes in female pelvic medicine and reconstructive surgery. And remember, if you're not quite sure what is the right treatment for you, reach out to a pelvic floor physical therapist, your OB, or a specialist. There are many safe and effective treatments for pelvic and bladder dysfunction—with Botox being just one of many to consider down the road.

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