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ShareWrinkles and crow's feet aside, now the botulinum toxin (Botox) is also used to treat bladder control problems, enlarged prostate and cerebral palsy. Geetanjali Jhala reports
When nature calls, you just gotta go. It doesn't matter if the loo is occupied, if you're in the middle of a traffic jam and there isn't a decent restroom in sight, if the person talking to you is in the middle of a sentence, or even if the food on the stove needs immediate attention. That's how it was for Shahida Sayed. She had to relieve herself every 15 minutes. The sight of an available toilet constantly on her mind, the 40-something housewife could barely get any work done. "It was terrible," she recalls. "My husband and I would be on our way out and all I kept thinking was where the closest restroom would be. It was embarrassing."
Her doctor had tried every kind of medication and after all failed he suggested she get Botox shots. "But isn't that the cosmetic treatment for wrinkles," she thought. When her urologist explained how the botulinum toxin (Botox) works, she was less sceptical. Botox is the most toxic protein in the world produced by bacteria. If not injected properly, the toxin can cause botulinum poisoning fatalities. But for medical uses, only small, very dilute quantities of the drug are used. Like Sayed, a number of women have been treated for urge incontinence -- the medical term for leakage of urine when bladder muscles contract involuntarily -- using Botox injections.
Controlling the urge
"Botox injected in the bladder muscle helps stop the involuntary contractions and hence controls urge incontinence," explains Dr Shailesh Raina, consultant urologist at Lilavati and Jaslok hospitals. The drug has helped hundreds of women who suffer from overactive bladders. "Botox is used as a last resort when all other medication fails," says urologist Hemendra Shah. Women suffer from this condition more than men, and studies show that after the age of 70, almost 80 per cent women suffer from this condition. "Seventy to eighty per cent of the cases can be controlled with medicine.
However, when the symptoms become bothersome enough to hinder daily activities, Botox is a safe and sure-shot way of controlling the bladder," adds Dr Shah.
So, in the last two years, naturally the drug has gained popularity among urologists. But because it is toxic, only very small quantities of the powder can be used. "After the effects wear off in about six months, the patient has to come back for another injection of the drug," says Dr Raina. "Because it is a delicate procedure, only a trained and qualified professional can carry it out."
Botox against cancer
The drug is being used to treat prostate, but is only in the trial stages as yet. As they age, most men suffer from an enlarged prostate, studies show this figure could be as much as 50 per cent of men over 60 and 80 per cent of men over 80. "When the prostate gets enlarged, it becomes difficult to pass urine," says Dr Shah. Botox reduces the size of the prostate gland through a process by which the prostate cells die. The reduction in size of the enlarged prostate improves urine flow, he explains.
However, though Botox has received FDA approval for cosmetic uses as well as medical uses like twitching eyes and excessive sweating, the US Food and Drug Administration is yet to approve the drug for overactive bladder and enlarged prostate.
Kids get Botox too
Kids with cerebral palsy (spastic paralysis) -- a condition caused by damage to the movement control centre in the brain -- are given the botulinum toxin too. "When the brain loses control of muscles, movement becomes difficult because some muscles contract more than others," explains paediatric orthopaedic Ashok Johari, president of the Paediatric Orthopaedic Society of India. "The drug is then given to help relax these muscles so that the weaker muscles can contract. It helps the child make use of the limbs."
In India, Botox has been used for cerebral palsy since 2000. "A very large proportion of the cases we have seen need the drug to help the child move her/his limbs," says Dr Johari. "Botox for cerebral palsy works best when complemented with physiotherapy. Depending on how devoted the family is to the child's exercise, and the extent of brain damage, the child may need another shot after two or six years." This, he explains, is better than surgery because surgery is irreversible. However, Botox can't reverse brain damage, he warns. "The goals for the child's development have to be realistic, and a lot of progress can be made."
j_geetanjali@dnaindia.net
