Botox for Pelvic Pain and Bladder Issues
Updated: Aug 6
When most people hear 'Botox' they think of cosmetic injections, but Botox is increasingly being used to help manage two conditions that can significantly affect quality of life: chronic pelvic pain, which is persistent pain in the lower abdomen and pelvis lasting six months or more, and overactive bladder, which is a condition causing a sudden, urgent and often frequent need to urinate that can be difficult to control and sometimes result in leaking urine before reaching the toilet (incontinence).
How does Botox work in the pelvis?
Botox (Botulinum toxin A) is an injectable medication that works by blocking signals between nerve endings and muscles, resulting in relaxation of the targeted muscle. Botox has a temporary effect and gradually wears off over three to six months.
In the pelvic floor, it's used to reduce excessive tension in overactive or overly tight pelvic floor muscles (pelvic floor hypertonicity), which is a common cause of chronic pelvic pain. For overactive bladder, the injection is placed into the bladder wall muscle, where it calms the overactive nerve signals that cause the sudden and urgent need to urinate.
When would Botox be used for pelvic pain or overactive bladder?
Botox is not a first-line treatment for pelvic pain or overactive bladder. Current research suggests it is considered once conservative management has been tried and has not provided enough relief. For pelvic pain, this usually means pelvic floor physiotherapy and sometimes psychological support or sex therapy have been tried first. For overactive bladder, pelvic floor physiotherapy and medications are usually the first lines of treatment offered, with Botox considered when these are not effective or well tolerated.
What does the research say?
The evidence for Botox in pelvic pain is promising but still developing. It works best for people with overactive or overly tight pelvic floor muscles who haven't responded to pelvic floor physiotherapy.
A 2025 study recruited 94 women aged 16 and over with chronic pelvic pain and increased pelvic floor muscle tone who had tried physiotherapy previously. Participants received either Botox injections or a placebo, followed by four pelvic floor physiotherapy sessions. Around one in three people in the Botox group reported at least a 33% reduction in pain compared to one in five in the placebo group. While positive, this difference was not large enough to be considered conclusive.
However, a 2022 study that pooled data from eight studies and 289 participants with chronic pelvic pain found a significant positive effect on pain reduction from Botox injection in the pelvic floor muscles and improved quality of life after 6 months. An Australian study that recruited 60 women and treated 23 with Botox also found that Botox produced reductions in pain during sex and non-menstrual pelvic pain in women with pelvic floor muscle spasm. It concluded Botox may be a useful option for those who do not respond to conservative treatment.
The evidence for Botox for overactive bladder is much stronger. A study that pooled data from 12 studies involving over 1,000 participants found Botox was associated with fewer episodes of urinary urgency and incontinence, and improved quality of life. A review of bladder diaries found improvements of around 29% in urinary frequency, 38% in urgency, and 59% in incontinence episodes. Botox is recommended in Australian clinical guidelines (USANZ/UGSA) as a treatment for overactive bladder that has not responded to conservative treatments.
What is the role of a pelvic floor physiotherapist after a Botox injection?
Pelvic floor physiotherapy is an important component of Botox treatment for pelvic pain or overactive bladder, especially within the first few months. That is because the injection reduces muscle tension and allows physiotherapy treatment to achieve things that may have previously been too painful or difficult. This may include:
Manual therapy and muscle stretching
Retraining of muscle coordination and movement patterns
Breathing techniques and calming the nervous system
Strategies for returning to activity and exercise
Bladder retraining strategies for those with urgency or incontinence
Is it safe?
Botox for pelvic pain and bladder issues is generally well tolerated. Like all procedures, it's not suitable for everyone and does carry some risks. It is not suitable for:
People who are pregnant or breastfeeding
People with certain neuromuscular conditions
Those with an infection at the injection site
Those with a known allergy to Botox
Possible side effects from Botox include:
For pelvic floor injections: temporary bowel or bladder changes (constipation, urinary incontinence), which are more common at higher doses
For bladder injections: urinary tract infection and urinary retention (difficulty fully emptying the bladder), which may require temporary use of a catheter
Pain, bruising, or bleeding at the injection site
The bottom line
Botox injections can be a helpful option for people with chronic pelvic pain or overactive bladder who haven't found enough relief through first-line treatments. Botox works best as part of a combined approach with a pelvic floor physiotherapist, as the injection provides a window of opportunity to maximise and maintain the benefits of physiotherapy. If you think this might be relevant for you, speak to your pelvic floor physiotherapist, GP, or specialist.
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