Botulium toxin A in pelvic floor pain treatments, a review
Botulium toxin A, referred to commonly as Botox, is created from the bacteria Clostridium botulinum. Discovered in the 1890’s and studied extensively during WWII, it wasn’t until the 1960’s when a team of American Army scientists discovered the toxin’s use as a potent paralysing agent which could be used in the treatment of muscle spasms that it became a routine part of medical care.
You likely have heard of its usages in commercial cosmetics surgery. With over 7 million Botox procedures performed each year in the US alone (2017 estimate), it’s an increasingly routine part of dermatological care.
Botox is commonly used for conditions relates to muscle spasms
What you might not know is how commonly Botox is used in the treatment of conditions relating to muscle tone and spasms. That’s where it comes into promising treatments for pelvic floor disorders, including for bladder and pelvic floor dysfunctions postnatally.
Persistent Pelvic Floor Pain is common after birth
Approximately 1 in 10 birthing people will experience persistent pelvic floor pain (PPP) after birth. This pain can stem from a number of issues in the pregnancy and birthing journey. The most common causes are perineal damage from vaginal birth, complications with perineal procedures, organ prolapse, damage to muscular structure of the pelvic floor (vaginal birth) or abdominal tone (caesarean birth), normal separation of pubic bones in pregnancy, or muscle spasms from pregnancy or the birthing process.
As the majority of those conditions have to do with muscle tone, it is no wonder that Botox was considered as part of a potentially helpful treatment.
The postpartum pelvic floor conditions botox has been studied for
Though Botox isn’t going to be right for every person in postpartum or for every pelvic floor dysfunction, there have been promising initial studies around using it for:
- Hypertonic pelvic floor
- Overactive bladder from tight or spasmodic pelvic floor muscles
- Vaginismus (involuntary contractions/spasms of the muscles around the vagina)
- Pudendal neuralgia (long-term pelvic pain from a damaged pudendal nerve)
- Prolonged constipation postnatally
- Painful perineal scar tissue
- Painful sex after birth
Emerging treatments can be good news for some persistent pelvic floor sufferers
Emerging treatments like Botox injections in the bladder or vaginal tissue can be good news for those who have exhausted other pelvic floor therapies without seeing a significant reduction in pain. Participants in one recent, small study in Australia who received Botox injections at 6, 12, and 26 weeks postpartum felt a significant reduction in pain, were able to have pain-free penetrative sex, had reduced use of pain killers, and reported less tender vaginal tissues overall following each course of treatment.
Is Botulium toxin A approved for pelvic floor treatment?
Currently, the American FDA has not yet approved Botulium toxin A for the use of treatment of pelvic floor dysfunction in postpartum or otherwise so it is being limitedly administered off-label by some pelvic health specialists. However, this treatment is gaining popularity amongst pelvic floor therapists and gynaecologists in the UK where many doctors acros are hopeful that this well tolerated and low-risk procedure can be part of a broad and holistic approach to addressing pelvic floor pain.
Take, for example, Dr. Jai Seth of St. George’s University hospital in London, who uses Botox as treatment in very common issues like overactive bladders, noting that it’s “changing the paradigm” of treatment options in a positive way. Speaking on a podcast for Urology Times, Dr. Seth notes that the use of Bladder Botox is growing as large trials have shown favourable outcomes.
Following correct patient selection, user satisfaction remains very high, with patients coming back annually for further rounds of treatment. Unfortunately, it’s not a long-term solution. The bacterial toxin at the root of Botox’s effectiveness works by paralysing nerve endings in muscles. Also the body’s amazing resilience means that new nerve endings form, meaning subsequent Botox therapy treatments are needed. Clinical trials aimed at treating postpartum pelvic floor dysfunction and pain specifically are being conducted to assess what frequency and volume these injections would be needed postnatally to see the most accessible and optimal results.
Pelvic floor treatments are still overlooked in postnatal care
Sadly, pelvic floor treatments are still an overlooked part of routine postnatal care, but things are looking up as more mothers are demanding attention from their care providers and novel treatments are being explored. If you are experiencing ongoing genital or pelvic pain 6-12 months postpartum and have tried other methods of treatment such as physical therapy, emotional therapy, medications, extended rest, and/or exercise without relief, you may want to speak to your doctor about Botox injections.
Want to start your process to a more positive postpartum recovery? MUTU is proud to be part of the pelvic floor health revolution! Over 50% of MUTU users report feeling some to significant improvements in pelvic discomfort, urine control, and overall reduced anxiety around postpartum discomfort by 12 weeks post birth.
