Botox, for Down There?

Let's Discuss, shall we?

You’ve probably heard of Botox for crows or the "11's"—but did you know it’s also being used for the pelvic floor? While it’s not a first-line treatment and doesn’t work for everyone, here’s how it works and when it might be considered.

What is pelvic floor Botox? Botulinum toxin (Botox) is a medication that temporarily relaxes muscles. For those of us who want the scientific details:

• Botulinum toxin type A is a purified neurotoxin from Clostridium botulinum

• It’s FDA-approved for several muscle spasm conditions (e.g., cervical dystonia), but pelvic floor use is off-label (AKA probably not covered by insurance)

When used to treat pelvic floor dysfunction, it’s injected into tight or overactive muscles—often the levator ani group—to help reduce muscle tension and spasms.

How does it work? Botox blocks the nerve signals that tell muscles to contract.

• Botulinum toxin blocks acetylcholine release at the neuromuscular junction

• Without acetylcholine, the targeted muscle can’t contract normally—resulting in temporary paralysis or significant relaxation

This can potentially help break the cycle of pain and tension, making it easier to move, stretch, and participate in pelvic floor physical therapy. However, not without potential drawbacks...

Potential benefits:

• Relief from chronic pelvic muscle spasm

• Reduced pain with sitting, exercise, or intimacy

• Greater muscle flexibility during pelvic PT

Things to keep in mind:

• Effects usually start in a few days, peak in 2–4 weeks, and last 3–6 months

• Botox is not a cure—it’s a temporary tool, often used in conjunction with pelvic floor PT

• It’s not effective for all causes of pelvic pain, especially if the main problem isn’t muscle overactivity

• Side effects can include temporary urinary or bowel changes, soreness at the injection site, and—in rare cases—worsening symptoms

• Pain may not be purely from muscle overactivity—it could stem from:

  • Nerve injury

  • Endometriosis or scar tissue

  • Central sensitization (nervous system amplifying pain signals)  

    If muscle spasm is not the primary driver, Botox relaxation won’t resolve symptoms

Sincerely,

Dr. Jamie Bennett, PT, DPT