Overactive bladder and associated incontinence are increasingly treated with onabotulinumtoxinA (Botox®) intradetrusor injections. An observed but poorly understood side effect is generalized abdominal pain that simulates cramps.
Here, we describe a patient with lower left quadrant abdominal pain beginning 16 days after treatment that worsened in severity over several days and persisted for an additional 5 weeks before abating over 3 more weeks. The unique pain symptoms mimicked the acute condition known as exercise-induced transient abdominal pain (ETAP), rendering the patient's exertion and supine position intolerant due to pain intensity.
The hypothesis is that the Botox spread from bladder injection sites impacts the same ill-defined visceral-somatic abdominal neuronal-muscular circuitry underlying the ETAP phenomenon or complex regional pain syndromes.
Pain medicine case reports. 2026 Apr [Epub]
Jeffery D Molkentin, Luis F Queme, Jack Rubinstein
Division of Molecular Cardiovascular Biology, Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, OH., Department of Biomedical Sciences, University of New England College of Osteopathic Medicine, Biddeford, ME., Division of Cardiovascular Health and Disease, Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH.