Overactive Bladder

Dr. Freedman offers Medtronic Interstim therapy for patients who have disabling overactive bladder (frequency, urgency, and urinary incontinence) that does not respond to other therapies.

On average, the success rate is 75% in improving the quality of life. Over 50,000 patients have been successfully treated with Interstim therapy. The therapy is also approved for treating urinary retention as long as it is not due to an obstruction.

Dr. Freedman has been performing Interstim procedures since 1998 and he was the first urologist to insert this device on the west coast.

Dr. Freedman also offers botox to treat overactive bladder.


BOTOX® is a prescription medicine that is injected into the bladder muscle and used to treat Overactive Bladder (OAB) symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken.

  • BOTOX® is a different type of treatment option that takes another approach to targeting the source of your OAB: the bladder muscle itself.
    • If you are still experiencing OAB symptoms with or cannot take another type of OAB medication, ask your doctor about BOTOX® (onabotulinumtoxinA).
    • In your body, certain chemicals travel from nerve cells to muscle cells to make your bladder contract so that you can urinate.
    • With OAB, these muscles contract uncontrollably and you frequently feel like you have to empty your bladder.
  • BOTOX® works by calming the nerves that trigger the overactive bladder muscle, helping to:
    • Reduce daily leakage episodes (accidents)
    • Treat the strong need to urinate right away
    • Reduce the number of times you need to empty your bladder daily
  • Treatment with BOTOX® requires 1 hour in the doctor’s office as few as 2 times per year.
    • If you and your doctor decide that BOTOX® (onabotulinumtoxinA) is right for you, very often it can be administered right in the urologist’s or urogynecologist’s office.
    • One BOTOX® treatment can last up to 6 months before the effects wear off.
    • As your symptoms return, you can talk to your doctor about repeating the procedure to help control your symptoms, but no sooner than 12 weeks from prior treatment.
  • These results were reported in two 24-week studies after patients received BOTOX® treatment for their OAB. By week 12:
    • About 3 times fewer accidents were experienced by patients who received BOTOX® than those who did not
    • On average, people who received BOTOX® reduced their bathroom visits by 2 times a day
    • The amount people urinated was increased by an average of about 25% per bathroom visit
  • Results with BOTOX® may not be immediate. In clinical trials, patients taking BOTOX® experienced fewer leakage accidents in as few as 2 weeks.
  • The most common adverse reactions experienced by patients treated with BOTOX® were:
    • UTIs (BOTOX® 18%, placebo 6%)
    • Dysuria (painful or difficult urination) (BOTOX® 9%, placebo 7%)
    • Retention (temporary inability to fully empty the bladder following treatment) (BOTOX® 6%, placebo 0%)

Reference: BOTOX® Prescribing Information, February 2014.

BOTOX® (onabotulinumtoxinA) Important Information


BOTOX® is a prescription medicine that is injected into the bladder muscle and used to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken.


BOTOX® may cause serious side effects that can be life threatening. Call your doctor or get medical help right away if you have any of these problems any time (hours to weeks) after injection of BOTOX®:

  • Problems swallowing, speaking, or breathing, due to weakening of associated muscles, can be severe and result in loss of life. You are at the highest risk if these problems are pre-existing before injection. Swallowing problems may last for several months.
  • Spread of toxin effects. The effect of botulinum toxin may affect areas away from the injection site and cause serious symptoms including: loss of strength and all-over muscle weakness, double vision, blurred vision and drooping eyelids, hoarseness or change or loss of voice (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control, trouble breathing, trouble swallowing. If this happens, do not drive a car, operate machinery, or do other dangerous activities.

Do not take BOTOX® if you: are allergic to any of the ingredients in BOTOX® (see Medication Guide for ingredients); had an allergic reaction to any other botulinum toxin product such as Myobloc® (rimabotulinumtoxinB), Dysport® (abobotulinumtoxinA), or Xeomin® (incobotulinumtoxinA); have a skin infection at the planned injection site.

Do not take BOTOX® for the treatment of urinary incontinence if you: have a urinary tract infection (UTI) or cannot empty your bladder on your own and are not routinely catheterizing.

Due to the risk of urinary retention (not being able to empty the bladder), only patients who are willing and able to initiate catheterization post-treatment, if required, should be considered for treatment.

In clinical trials, 36 of the 552 patients had to self-cathetherize for urinary retention following treatment with BOTOX® compared to 2 of the 542 treated with placebo.

Patients with diabetes mellitus treated with BOTOX® were more likely to develop urinary retention than non-diabetics.

The dose of BOTOX® is not the same as, or comparable to, another botulinum toxin product.

Serious and/or immediate allergic reactions have been reported. These reactions include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you experience any such symptoms; further injection of BOTOX® should be discontinued.

Tell your doctor about all your muscle or nerve conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including severe dysphagia (difficulty swallowing) and respiratory compromise (difficulty breathing) from typical doses of BOTOX®.

Tell your doctor about all your medical conditions, including if you: have or have had bleeding problems; have plans to have surgery; had surgery on your face; weakness of forehead muscles, such as trouble raising your eyebrows; drooping eyelids; any other abnormal facial change; have symptoms of a urinary tract infection (UTI) and are being treated for urinary incontinence (symptoms of a urinary tract infection may include pain or burning with urination, frequent urination, or fever); have problems emptying your bladder on your own and are being treated for urinary incontinence; are pregnant or plan to become pregnant (it is not known if BOTOX® can harm your unborn baby); are breastfeeding or plan to breastfeed (it is not known if BOTOX® passes into breast milk).

Tell your doctor about all the medicines you take, including prescription and nonprescription medicines, vitamins, and herbal products. Using BOTOX® with certain other medicines may cause serious side effects. Do not start any new medicines until you have told your doctor that you have received BOTOX® in the past.

Especially tell your doctor if you: have received any other botulinum toxin product in the last 4 months; have received injections of botulinum toxin such as Myobloc®, Dysport®, or Xeomin® in the past (be sure your doctor knows exactly which product you received); have recently received an antibiotic by injection; take muscle relaxants; take an allergy or cold medicine; take a sleep medicine; take anti-platelets (aspirin-like products) or anti-coagulants (blood thinners).

Other side effects of BOTOX® include: dry mouth, discomfort or pain at the injection site, tiredness, headache, neck pain, and eye problems: double vision, blurred vision, decreased eyesight, drooping eyelids, swelling of your eyelids, and dry eyes. In people being treated for urinary incontinence other side effects include: urinary tract infection, painful urination, and/or inability to empty your bladder on your own. If you have difficulty fully emptying your bladder after receiving BOTOX®, you may need to use disposable self-catheters to empty your bladder up to a few times each day until your bladder is able to start emptying again.

For more information refer to the Medication Guide or talk with your doctor.

To report a side effect, please call Allergan at 1-800-433-8871.

Please see BOTOX® full Product Information including Boxed Warning and Medication Guide.