Can Botox Injections Help with Pelvic Floor Symptoms?

When you hear the word "botox," the first thing that comes to mind are its cosmetic benefits. Those well-known, wrinkle-smoothing effects that can roll the years back on mature skin in a matter of days, and produce results that last for months.

However, botox’s ability to tame muscle tension has many applications that go beyond skin deep. For those suffering from overactive (aka tight) pelvic floor muscle dysfunction, botox injections can be a game-changer — especially when combined with other treatments like pelvic physical therapy. If you have chronic pelvic pain, urinary dysfunction, or painful sex, it may be worth considering pelvic floor Botox.

Botox for pelvic floor dysfunction

Overactive pelvic floor muscle dysfunction (PFMD) happens when the pelvic floor muscles develop excessive tension and struggle to relax fully. This overactivity can lead to a loss of flexibility, coordination, and even cause pain. Common symptoms include:

• Constipation
• Urinary urgency and frequency
• Chronic pelvic pain
• Painful sex (which can range from mild dyspareunia to severe vaginismus)

Pelvic floor physical therapy (PT) is often the first-line treatment for all types of pelvic floor dysfunction. However, tight and painful pelvic floor muscles can create a self-perpetuating pain cycle that is challenging to break with PT alone. In this cycle, muscle tension causes pain, leading to further muscle guarding and tension driven by fear and your central nervous system’s protective mechanisms.

How botox works on you pelvic floor

Botox — also known as botulinum toxin A or onabotulinumtoxinA — works by stopping a chemical message that tells your muscles to tighten. It does this by blocking a substance called acetylcholine from being released at nerve endings. As a result, muscles injected with Botox can't contract as strongly. This helps reduce muscle spasms, tension, and even pain. Beyond smoothing wrinkles, botox’s ability to ease muscle tension makes it a helpful therapeutic treatment option for:

• Chronic migraines
• Cervical dystonia
• Muscle spasticity
• Overactive bladder (frequency, urgency, and incontinence related to detrusor muscle overactivity)
• Strabismus and blepharospasm
• Temporomandibular Joint (TMJ) Dysfunction

For overactive pelvic floor muscles that don’t respond to conservative treatment, botox injections may help by relaxing the affected muscles, reducing pain signals, and allowing better progress during physical therapy. By temporarily stopping contractions in these muscles, Botox can provide relief, improve quality of life, and complement other treatments like physical therapy.

What the research says about pelvic floor and botox

A growing body of evidence supports the use of botox (specifically botulinum toxin A) for chronic pelvic pain and related pelvic floor dysfunctions.

• A 2022 systematic review and meta-analysis of 18 studies involving 896 patients found that botox significantly improved pain levels in various chronic pelvic pain syndrome subtypes.
• Another 2022 review found that botox injections in pelvic floor muscles significantly reduce pain levels and improve quality of life in women with chronic pelvic pain at 6 months follow-up, though the evidence quality was limited.
• A 2024 literature review covering 1,108 patients across multiple studies indicated significant improvements in sexual and orgasmic dysfunction, successful intercourse rates, and reduction of vaginal pain, highlighting botox’s efficacy for sexual pain disorders like vaginismus and vulvodynia.

These studies collectively support botox as a valuable treatment option for various types of pelvic and sexual pain, especially when conservative treatments have been ineffective. While these results are encouraging, ongoing research is needed to fully understand the long-term effects and optimal treatment protocols.

How are pelvic floor botox injections done?

Botox injections can be administered by a gynecologist or urogynecologist with special training on this specific treatment. Because this application is so new, there is no standardized procedure for pelvic floor botox, so your specific treatment may vary.

Injections are typically administered into specific pelvic floor muscles depending on the muscles involved and your symptoms. These may include the superficial pelvic floor muscles, and muscles of the deeper pelvic floor (levator ani). Some healthcare providers may use EMG guidance for more precise injection placement.

The amount of botox is likely to vary from person to person as well. For chronic pelvic pain, the dose of Botox used in some studies ranged from 40 to 300 units, with no clear consensus on optimal dosing. A recent comparative study explored the effectiveness of different botox doses for treating vaginismus, a specific form of pelvic floor dysfunction. The study compared 150 units versus 200 units of botox and found both dosages to be effective in treating vaginismus.

Wondering if pelvic floor botox will hurt? Botox injections can be done using a local or general anesthesia, and this can depend on the provider and patients preferences. Topical lidocaine may also be used to make injections more comfortable.

The cost of pelvic floor botox injections

Botox injections for pelvic floor dysfunction are not FDA-approved, which often means they aren’t covered by insurance. Costs can vary based on your insurance, the provider, practice location, and the number of units needed for your symptoms.

Potential side effects of pelvic floor botox

As with any medical treatment, there are potential side effects to consider if you get pelvic floor botox. In general, common side effects of botox include:

• Mild flu-like symptoms
• Temporary muscle weakness
• Localized injection site pain
• Infection at the injection site

Side effects may also depend on where you’re getting botox, and the indications for the treatment. In studies on botox injections in the vaginal and vulvar area, side effects included:

• Transient urinary incontinence
• Transient fecal incontinence
• Constipation
• Rectal pain

Luckily, side effects are usually temporary, resolving as the botox wears off.

Is pelvic floor botox right for you?

Pelvic floor botox isn’t for everyone, not even everyone with overactive pelvic floor dysfunction. There are side effects and costs to consider. Generally speaking, contraindications for botox include:

• Keloidal scarring
• Neuromuscular disorders
• Botulinum toxin allergies
• Body dysmorphic disorder
• Pregnancy and/or breastfeeding
• Amyotrophic lateralizing sclerosis myopathies

But when more conservative treatments aren’t providing you the relief from your symptoms that you deserve, botox might be a helpful option.

It’s essential to consult with a medical healthcare provider who specializes in pelvic health to determine if this treatment is appropriate for your specific condition. They can provide a thorough evaluation and discuss the potential benefits and risks based on your medical history and symptoms.

Pelvic floor botox is not just a cosmetic fix; it’s a powerful tool in the fight against chronic pelvic pain and muscle dysfunction. If you’re tired of living with discomfort and are looking for a new solution, pelvic floor botox might just be the answer you’ve been searching for.