Bladder Botox injections are typically done under local anesthetic, though you also have the option to undergo the procedure with a general anesthetic.

Botox injections are a relatively common treatment for bladder issues like overactive bladder or incontinence, especially when traditional treatments like medication have not worked. The injections can dramatically relieve symptoms and day-to-day quality of life.

But when getting injections in the bladder area, you may understandably have some concerns. Here’s what to know about the anesthetic process.

In most cases, Botox injections in the bladder are safe to administer under local anesthesia. The doctor will inject anesthesia directly into the bladder region, fully numbing it while you are awake and aware during the procedure.

Local anesthetic (LA) tends to be preferable due to a lower risk of complications and low price. Since one needs to repeat bladder Botox injections roughly every 6–12 months, taking general anesthetic (GA) regularly can be an economic issue. Repeated general anesthesia administration may have lasting side effects such as anxiety, depression, cognitive issues, and headaches.

That being said, you always have the option to request that you be put to sleep under general anesthesia. For example, if you have a fear of needles, you may want to consider going under GA completely. Those who are concerned they can’t stay still during the injections may also want to consider GA.

If you think you have low pain tolerance, you can consider a GA. According to a 2022 review, some people find the injections to be too painful under LA.

It’s also important to note that your doctor and anesthesiologist will also consider your overall health, including any allergies, current medications, or other conditions you may have, before deciding between local or general anesthetic. They’ll discuss your options with you and provide the safest options.

Bladder Botox is typically performed under LA with lidocaine. The process involves injecting the bladder with lidocaine with a catheter through the urethra. The lidocaine will then remain there for about 30 minutes until the lining of the bladder is fully numb.

After about half an hour, a small scope attached to a camera will be placed in your bladder through the urethra, which will allow the doctor to correctly inject Botox into the appropriate bladder muscles.

The procedure may also sometimes be done under GA. Though what the doctor may use will vary, GA typically consists of:

You may receive medication to relieve pain, relax your body, or put you to sleep during the procedure.

Another option that’s becoming more common with office-based urology procedures like this one, is with the use of nitrous oxide (laughing gas).

In a 2022 review, scientists say that Botox injections done in the bladder under localized lidocaine are generally well-tolerated according to participants’ pain scores.

The injections may feel anywhere from slight pressure to medium-sharp jabs.

According to scientists, the more injections you have, the more pain and soreness you may experience. So talk with your doctor about what to expect as well as any concerns you may have. In some cases, your doctor may be able to provide you with in-office nitrous oxide in addition to local anesthetic to help soothe any discomfort.

It’s also worth keeping in mind that the actual Botox injection process will only take about 5 minutes. So it will be over before you know it.

If you opt for general anesthesia during the procedure, you likely won’t feel any pain.

Most people won’t feel any pain or discomfort immediately following the procedure.

If you underwent LA, sometimes you can safely drive yourself home from the doctor. Your healthcare team will let you know the policies of the hospital or doctor’s office. If you underwent GA, you will need someone to drive you home as the effects of the drugs wear off.

Some people may experience temporary issues urinating in the weeks following the procedure. The bladder may not empty completely when you go, which can be frustrating. However, for most people, this won’t be an issue and will be resolved on its own.

A small percentage of those with voiding problems following Botox may temporarily need to use a catheter to fully empty the bladder.

Ultimately, most people will feel relief following bladder Botox as their overactive bladder or incontinence issues resolve.

Bladder botox is typically done under LA, but people may also undergo it under GA. Though general anesthetic carries a higher risk of complications, patients with low pain tolerances or who are needle-phobic may prefer it.

If you’re concerned about pain during Botox injections, talk with your doctor about what’s right for you. For instance, nitrous oxide may be coupled with a local anesthetic to help ease the process.