Delayed Abdominal Pain Following Botox® Bladder Injection Mimics Exercise-Induced Transient Abdominal Pain: A Case Report

Abstract

Background: 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.

Case report: 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.

Conclusions: 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.

Keywords: Abdominal pain; Botox spread; exercise-induced transient abdominal pain; intradetrusor injection; overactive bladder.

Molkentin JD, Queme LF, Rubinstein J. Delayed Abdominal Pain Following Botox® Bladder Injection Mimics Exercise-InducedTransient Abdominal Pain: A Case Report. Pain Med Case Rep. 2026 Apr;10(2):187-189. PMID: 42066277.