Using botulinum toxin for pelvic indications in women
Article first published online: 29 JUL 2009
© 2009 The Authors. Journal compilation © 2009 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Australian and New Zealand Journal of Obstetrics and Gynaecology
Volume 49, Issue 4, pages 352–357, August 2009
How to Cite
RAO, A. and ABBOTT, J. (2009), Using botulinum toxin for pelvic indications in women. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49: 352–357. doi: 10.1111/j.1479-828X.2009.01028.x
- Issue published online: 29 JUL 2009
- Article first published online: 29 JUL 2009
- Received 27 October 2008; accepted 7 May 2009.
- botulinum toxin;
- pelvic floor;
- pelvic pain
Background: Botulinum toxin (BoNT) is a potent neurotoxin. Its ability to cause muscle paralysis is increasingly being utilised for the management of a number of conditions of interest to the gynaecologist.
Aims: This review aims to give the reader an overview of the use of BoNT for conditions presenting a management challenge for the gynaecologist, such as chronic pelvic pain and idiopathic detrusor overactivity.
Methods: The literature was reviewed regarding the use, side-effects and complications of BoNT in the pelvis, focussing on chronic pelvic pain, provoked vestibulodynia, conditions involving the lower gastrointestinal tract and detrusor overactivity.
Results: In terms of pain caused by pelvic floor spasm, daily pelvic pain and dyspareunia are the symptoms most likely to be improved by BoNT. Limited data regarding use for provoked vestibulodynia indicate an improvement in pain scores. In the lower gastrointestinal tract, injection into puborectalis has been showed to objectively improve intravaginal pressures, though there are no randomised controlled trials (class I studies) validating its use in this setting. Class I studies demonstrate a role for BoNT in the management of idiopathic detrusor overactivity, though long-term follow-up data are lacking. Potential problems with BoNT injection include toxin reactions, urinary and faecal incontinence, urinary retention and secondary treatment failure due to antibody production.
Conclusions: A single class I study supports the use of BoNT for refractory pelvic floor spasm; however, further adequately powered class I studies for this indication and for provoked vestibulodynia are warranted.