Today, many people consider Botox a purely aesthetic thing, but the cosmetic use of Botox was really a chance finding. When Botox first emerged on the scene in the 1970s, it was not used to smooth forehead wrinkles but to treat eye misalignments, and relax muscles that go into spasm.

A look behind the needle reveals that Botox boasts a plethora of medical applications. It can be a life-changing treatment for those living with muscular pain and neurological conditions.

Dr Suzanne O’Sullivan: Botox for bladder and pelvic floor

Let’s start in the bladder, where Botox can be injected to treat urge incontinence. This is a type of urinary incontinence that causes an urgent need to urinate, and it is different to stress incontinence (which Irish Country Living reported on in July) where the ligaments that support the bladder neck are weak, the bladder neck slips, and this causes an exertion and leakage.

An overactive bladder causes urge incontinence, explains Dr Suzanne O’Sullivan, obstetrician urogynaecologist at Cork University Maternity Hospital. It is characterised by frequent trips to the toilet, getting up at night to go, not making it to the toilet on time, and having an accident.

“It’s a condition that is more common as people age,” says Dr O’Sullivan. “By our late 50s, both men and women have a one-in-five chance of having overactive bladder and urge incontinence.

“The bladder wall is a smooth muscle that has to be very relaxed as the bladder fills. It’s under the autonomic nervous system, so it’s not under conscious control. The bladder wall relaxes, the bladder fills up, and when it’s full and you sit on the toilet, it sends sensory information to the central nervous system, then the bladder wall contracts and urine is squeezed out.

“If that muscle starts contracting when it shouldn’t, just out of the blue, then people will get this urge to rush to the toilet.”

The first line of treatment for an overactive bladder is lifestyle modification, weight loss, stopping smoking and reducing caffeinated drinks. The second is medication that calms the nerves that supply the bladder wall muscle.

However, if the tablets don’t work, Botox can be used. Botox, Dr O’Sullivan states, can be “great” for people for whom medication fails; “but medication would definitely be preferable and easier to manage.”

The treatment involves the patient going into hospital, having a camera inserted into the bladder, and then multiple injections into the bladder wall. “The problem is it takes two plus weeks to work, but like any Botox, it will wear off and then you have to go back in a list.” It usually wears off between six and 12 months.

Botox is also used for pelvic floor muscle spasm and chronic pain due to over-activity of the pelvic floor muscle. This can be associated with pain, difficulty or impossibility with intercourse.

“Physiotherapy to release the muscles is the first line of treatment,” says Dr O’Sullivan. “But sometimes the condition is resistant to intervention with physio, so we look at using Botox in the pelvic floor muscles.”

Unlike Botox in the bladder, which is recurrent, Botox in the pelvic floor is usually only done once or a few times. “Normally Botox will break the cycle, and at about 10 to 12 weeks before it starts wearing off, then we send the patient to the physio, and the physio works with them,” says Dr O’Sullivan. “Botox does relax pelvic floor muscles, but it seems to have a pain relief effect as well. The pelvic pain patients get a more prolonged pain relief that’s mediated through the spinal cord that we don’t fully understand, but it seems to certainly have an extra added benefit.”

Dentist Dr Neysan Chan: Botox for jaw pain

Botox is used in the area of orofacial pain [pain that occurs in the face, jaw and neck] to reduce the frequency and intensity of migraines, headaches, and dental issues like teeth grinding or jaw locking.

Dentist Dr Neysan Chah uses Botox in his clinic in Roscam, Co Galway which specialises in orofacial pain management, to treat Temporomandibular Joint Disorders [conditions affecting the jaw joint and muscle movement], teeth grinding and jaw locking. “But I wouldn’t consider Botox the first line therapy,” he adds.

“You need a proper evaluation and construction of a treatment plan to suit that individual patient. For Botox, it can be beneficial in reducing muscle tension and also managing the pain the patient is experiencing. But Botox is not a silver bullet that should be used in every case.”

Talking through the effect of Botox on muscle contraction, Dr Chah explains that: “Botox blocks the release of the neurotransmitter, acetylcholine, which is responsible for muscle contraction. This temporarily relaxes muscles, reducing tension and pain but the effects wear off over time, which is why Botox injection needs to be repeated frequently.”

Jaw pain is the second most common source of facial pain in Dr Chah’s practice. “Pain in the face is one of the most debilitating pains you can imagine because it affects all your functions, like eating, chewing, hugging your grandchildren, kissing your spouse.”

Bruxism [which describes teeth grinding and clenching habits] is also common, but Dr Chah is quick to dispel the myth that Botox can cure clenching and grinding.

“This is embedded in a patients’ genes, and it can be activated and affected by a lot of factors, so management becomes very important. In certain patients, Botox can be useful as part of a more comprehensive treatment plan to reduce the load and forces of clenching and grinding and provide some protection to the teeth, the gums and the supporting structures.”

When asked how often Botox is injected with these type of orofacial treatments, Dr Chah responds: “As a general rule, it is recommended to inject about every three to four months, and this is obviously to achieve the benefit but also to reduce the risk of developing resistance to the drug.

“Botox is a toxin, and the body can, over time, start reacting to it and producing antibodies that deactivates the toxin so it becomes ineffective.”

Emma Doran: Botox for excessive sweating

Emma Doran has struggled with excessive sweating her whole life. It’s a condition called hyperhidrosis, where the sweat glands are overly-responsive to stimulation from the sympathetic nervous system – the system that regulates functions such as heart rate and sweating.

As a result, the glands produce more sweat than the body needs for normal temperature control. It can affect any part of your body, most commonly in the armpits, hands and feet; and in Emma’s case, she sweats more than usual in her armpits.

Botox injections target the sweat glands and temporarily block the nerve signals responsible for sweat production. Emma receives these injections every six months in Tallaght University Hospital.

Reflecting on her journey with hyperhidrosis from her home in Clane, Co Kildare, Emma says: “It was just always something that I dealt with, and I never thought there was anything I could do about it.” Over the years, she tried different types of deodorants, had to change her t-shirt multiple times per day and always wear dark colours. “I would wear a jumper and I would be absolutely dripping with sweat because I’d be so warm. But I’d just be so conscious of someone seeing my underarms.

“I didn’t even think there was anything I could do for it and then when I went to college, I was talking to one of the girls and she was saying, ‘oh, my friend, gets Botox for it.’”

Emma was initially paying for injections at a private practice, which cost around €900. Then, she discovered that there was Botox treatment for hyperhidrosis available at Tallaght University Hospital. “It’s a huge waiting list, and I was waiting for two years to get it. But I go there now. I will never not do it. It’s the best thing I’ve ever done. I’m not conscious of it anymore.”

Botox is the trade name for Botulinum Toxin Type A, and it is an injectable treatment used for two main purposes: medical and cosmetic. Most people have heard of Botox to smooth frown lines, but it is used to treat plenty of medical conditions.

The way a Botox shot works is that it blocks certain chemical signals from nerves that cause muscles to contract. This means that the muscle stops moving for a period of time. This is why it has been used successfully to stop muscle spasms or eye twitching.

Botox is a prescription medicine and must be used only under the care of a licensed and skilled healthcare provider. Talk with your GP about whether the procedure fits your needs and condition.