IT IS coveted by celebrities as a miracle drug to keep the wrinkles at bay. But now a million Scots could benefit from Botox injections to cure a far less glamorous problem.
The controversial muscle-freezing drug botulinum toxin A – famed for its ability to smooth out frown lines – has been identified as highly effective for incontinence. One in five Scots are estimated to be affected by the condition, which can cause em
barrassment and inconvenience and in extreme cases can make sufferers prisoners in their own homes.
Laurence Stewart, a consultant urologist at the Spire Murrayfield Hospital in Edinburgh has performed experimental bladder injections on around 100 private and NHS patients and says it is so successful it should be offered on the NHS. Although the £1,800 procedure is uncomfortable, involving around 25 injections into the bladder, women who have undergone it say it has transformed their lives.
Stewart told Scotland on Sunday: "This condition is devastating. Patients affected by it might go to the toilet every one or two hours, day and night, compared to seven times a day for someone who doesn't have the problem."
Stewart decided to test botulinum toxin in patients after reading about similar research overseas, despite the absence of a licence for this use of Botox in the UK. "A licence will be granted at some point. But I am taking a risk because if there are problems it will fall back to me. But it is so successful it would be unethical and immoral of me not to offer it. There have been no complications in the patients I have treated."
Incontinence affects men and women in equal numbers but men are generally better able to control it. The condition has many causes, including the ageing process, previous surgery and illnesses. Traditional treatments include bladder training and pelvic floor exercises; oral medication, which has side effects such as a dry mouth; and surgery.
With the new procedure, patients receive a local anaesthetic and a flexible tube called a cystoscope containing a camera and a needle is inserted into the bladder via the urethra. The toxin works on the nerve ends in the bladder, blocking signals to the muscles.
Studies have also shown the drug to be effective with no major side effects. However, a small number of patients will have an "exaggerated response" which means they will be unable to pass urine at all for a few weeks and will have to use a catheter.
Yesterday, critics welcomed the development but voiced concerns about the use of the drug without a licence.
Botulinum toxin is the most potent neurotoxin known to humans: just one gram is capable of killing a million people if inhaled. Currently it is approved for cosmetic procedures and medical conditions such as strokes and cerebral palsy.
Scottish Tory health spokeswoman Mary Scanlon called for further testing. "While this development is very welcome, I would want to know that it had satisfied all criteria and had been granted a licence. This is a toxin and I would want to know the long-term effects of this procedure before it is made available on the NHS."
However, patient Linda Olverman, a 54-year-old nurse from Edinburgh, said the procedure changed her life.
Olverman suffered five years of "humiliating" incontinence after her bladder was damaged following a hysterectomy. "I would have to cut short shopping trips and I had to wear incontinence pads. My bladder had no capacity to hold urine."
Olverman opted for the injections three years ago, one of the first patients in the UK to do so.
"I was going to the toilet normally and it's no exaggeration to say I got my life back. It's a miracle really."
The full article contains 628 words and appears in Scotland On Sunday newspaper.
