Table.

Clinical Applications of Botox in the Treatment of Urogenital and Pelvic Floor Disorders

DisorderTreatment, IULocationLevel of Recommendation
Urologic
 Idiopathic detrusor overactivity100BladderA
 Neurogenic detrusor overactivity200BladderA
 Dyssynergic sphincter deficiency200BladderC
 Interstitial cystitis/painful bladder syndrome100-200BladderC
Gynecologic
 Pudendal neuralgia15-60MuscleC
 High tone pelvic floor dysfunction20-100MuscleC
 Vestibulodynia20-100PerineumB
Colorectal
 Anal fissure20-300Internal anal sphincterB
 Puborectalis syndrome (anismus)12-1003 and 9 o’clock by puborectalis muscleB
 Hemorrhoids and healing20-100Internal anal sphincterB
 Anal pain20-200Muscle and/or internal anal sphincterB
  • Note: Levels of recommendation are (A) based on at least one randomized clinical trial as part of the scientific evidence and overall represents good and consistent scientific evidence; (B) methodologically correct, but nonrandomized clinical trials on the topic overall are based on limited and inconsistent scientific evidence; and (C) consensus and expert opinions or committee recommendations, but high-quality directly applicable clinical studies are lacking.