Is Botox a ‘jack of all trades’ remedy?
In today’s ‘dying to stay young’ society, many are looking to Botox for that quick fix and – no pun intended – uplift. But besides cosmetic procedures, are there other safe uses for Botox? Sender Herschorn, Martin Barkin Professor and Chair of the Division of Urology at the University of Toronto and attending Urologist and Head of the Urodynamics Laboratory at Sunnybrook, provides some insight into the toxin.
What is Botox?
It’s used in various parts of the body, specifically muscles. It causes muscles to weaken or become paralyzed.
Was Botox created for cosmetic procedures?
It wasn’t created. Botox is short for Botulinum toxin. It’s a toxin produced by a bacterium called Clostridium botulinum that, if ingested, can kill you. The bacterium is found in mould and rotten meat and produces the toxin which leads to botulism, a rare but serious paralytic illness.
So how on earth did we start using Botox for medical purposes?
About 40 odd years ago, scientists started to wonder if they could harness the good effects of this toxin and use it to treat spasms in various parts of the body. The first place they used it was in muscles that control eye movement. They also used it to treat severe neck stiffness, which couldn’t be relaxed by any other means.
It was later discovered that Botox not only affects muscles, but also sweat glands and nerves. It prevents nerves from releasing neurotransmitters, which are chemicals that relay, magnify and adjust signals between a neuron and another cell.
I heard that Botox is able to stop armpit sweat. Is that true?
Yes, that’s absolutely true. By injecting Botox into the armpit, sweating in that area will cease. This is an effect on the synthetic nerve.
Botox can also have an effect on motor nerves and sensory nerves by causing a change in the way the nerve functions.
As you know, many people use Botox in the face to cause slight paralysis and weakening of the facial muscles to get rid of creases. Lines on the face are caused by tight facial muscles.
What else is Botox used for? How do you apply Botox in your research?
Years ago someone decided to test Botox in the urinary tract to see if it could alter the behaviour of either the bladder or the urinary passage muscle.
About 20 odd years ago it was initially used in the urethra in patients with spinal cord injuries to see if they could overcome the spasm of the urethra. Men who couldn’t empty their bladders had Botox injected into their urethra sphincter, the muscle that naturally constricts fluid passage but relaxes by normal physiological functioning. The results were positive. So that was the initial use.
Since it worked so well on striated muscle – muscle that we have control over – someone then decided to see if it would work on smooth muscle, specifically the bladder. And guess what, it worked.
In our study, we tested it in the bladders of patients with multiple sclerosis or spinal cord injuries to see if it would cause their bladders to relax. These patients suffer from uninhibited spasms of their bladder causing urinary incontinence. These patients had poor responses to currently available treatment so we decided to see if Botox would do the trick. In our experiment, we injected Botox into the bladders of half of our patient population and a placebo into the other half. After a good period of time, we found that our Botox patients were faring far better than our placebo patients. After nine months we gave everybody Botox and they responded quite well. Our placebo patients were doing much better with the Botox than without. We started our study a year ago.
Has your experiment translated into permanent use in the bladder?
The first approved use of Botox was in 1968. Since then the types of problems treated have expanded. Every time you expand the usage you need to get government approval for its use. Botox for the bladder is being used in a number of centres around the world and in most places it’s not yet an approved use. Furthermore, even though it has been around for more than forty years, it’s still synthesized by very few pharmaceutical companies since it requires such a complex process to manufacture.
Over the last seven to nine years, many clinical trials using Botox have been carried out by urologists without direct involvement by pharmaceutical companies. Most of the work published to date has been without any support or participation from these companies. However, over the last three to four years companies are now starting to jump on board and are looking to get the usage of Botox for the urinary tract approved.
So how are we administering Botox in patients with bladder problems now?
Well, we’re doing clinical trials so we’re able to offer it to people. Some insurance companies are even funding it for use in the bladder.
How long do you think it will take for Botox to become an approved usage in patients with bladder problems?
Probably another two to three years.