From the FDA Drug Label
to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency) and urinating often (frequency) in adults when another type of medicine (anticholinergic) does not work well enough or cannot be taken to treat leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease when another type of medicine (anticholinergic) does not work well enough or cannot be taken loss of bladder control
The urinary bladder can be affected by onabotulinumtoxinA (IM) from an orthopedics view, as it can cause loss of bladder control. This is a potential side effect of the medication, and it is also used to treat overactive bladder symptoms and leakage of urine in adults. Key points to consider:
- Overactive bladder symptoms: strong need to urinate, leaking or wetting accidents, urgency, and frequency
- Leakage of urine: in adults with overactive bladder due to neurologic disease
- Loss of bladder control: a potential side effect of the medication 1
From the Research
From an orthopedic perspective, the urinary bladder is primarily a concern during pelvic and acetabular surgeries or trauma, and orthopedic surgeons must be vigilant about bladder protection during these procedures to prevent iatrogenic bladder injuries, as highlighted in various studies 2, 3, 4, 5, 6. When performing anterior approaches to the pelvis or acetabulum, careful retraction and identification of the bladder are essential to prevent perforation. In cases of pelvic fractures, particularly those involving the pubic rami or symphysis pubis, associated bladder injuries should be suspected and evaluated with cystography if blood is present at the urethral meatus or if hematuria is observed. Some key points to consider include:
- Orthopedic hardware placement near the bladder requires careful planning to avoid impingement or erosion into the bladder wall.
- Postoperatively, patients with pelvic or acetabular surgeries may experience temporary urinary retention requiring catheterization.
- For patients with spinal cord injuries affecting bladder function, orthopedic management must include consideration of neurogenic bladder issues, with intermittent catheterization often needed to prevent complications like urinary tract infections and renal damage, as noted in a study from 6. The close anatomical relationship between orthopedic structures of the pelvis and the urinary bladder necessitates this cross-specialty awareness for optimal patient care, and recent studies such as 5 published in 2025, emphasize the importance of considering pelvic floor muscle function in women with urinary incontinence. Key considerations for orthopedic surgeons and healthcare staff include:
- Being aware of the risk of urinary incontinence in patients aged 65 and older undergoing hip surgery, as discussed in 6.
- Understanding the importance of evidence-based guidelines for assessing, managing, and preventing urinary incontinence, as highlighted in 3 and 4.
- Recognizing the need for a team approach to preventing and managing urinary incontinence, including patient education and involvement, as emphasized in 6.