“The Botox Made It Worse”: Pelvic Floor Botox, Side Effects and Consent
Summary
Botox injections into the pelvic floor muscles are sometimes offered for pelvic pain caused by tight, overactive muscles. For some people they help. This guide is for people who were left with leaking, constipation, worse pain or other problems afterwards, or who feel they weren’t told enough before agreeing. It explains what the treatment is, what the evidence says, the warning signs, and when harm might point to care that fell short.
Quick answer · updated November 2026
Pelvic floor Botox is usually given alongside physiotherapy, takes a couple of weeks to work and wears off over months. Pelvic pain is not one of its approved uses in Australia, so it is given “off label”, and that should be explained to you. New leaking, trouble emptying your bladder or bowel, or weakness elsewhere needs prompt review.
Pelvic floor Botox at a glance
- 1BeforeOptions, evidence, off-label use and side effects should be explained.
- 2The procedureInjections into the pelvic floor muscles, often under anaesthetic.
- 3First two weeksSoreness and some bleeding are common. The effect builds slowly.
- 4Weeks to monthsEffects usually last about 4 to 6 months, alongside physio.
- 5If problems appearLeaking, constipation or worse pain need review and a plan.
At any stage: being unable to pass urine, trouble swallowing, speaking or breathing, or weakness away from the injection site needs same-day care. Call 000 for trouble breathing.
For six years sex hurt. Tampons hurt. Sitting through a long meeting hurt. When a pelvic physio finally told me my pelvic floor was “clenched like a fist”, I cried in her car park from relief that it had a name.
After a year of physio, my gynaecologist suggested Botox. “It’s very safe. Just a few injections, and it relaxes the muscle.” I signed the form on the day of the procedure, in a gown, with a cannula already in my hand.
Ten days later I stood up from my desk and felt warmth spread down my leg. I made it to the bathroom and sat there shaking, holding a wad of paper towel. It happened again the next day, and the next. I started wearing pads to work and stopped drinking water after lunch.
I kept thinking: nobody said this could happen. Or did they, and I missed it?
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
If you are reading this after pelvic floor Botox that left you worse off, you are not ungrateful and you are not alone. Many people try this treatment after years of pain, and many are told it is simple. It may well have been the right thing to try. You were still entitled to understand the risks first.
This guide is for anyone who has had, or is considering, botulinum toxin injections into the pelvic floor muscles for pelvic pain, painful sex or vaginismus. It covers how the treatment is used, what the evidence shows, what “off-label” means, the warning signs, what your records should show, and how the law looks at it.
Why I can write this
I have been a medical negligence lawyer since 2014 and have worked on many hundreds of claims, including many involving gynaecology and pelvic pain. My doctorate looked at patterns of failure in medical negligence. I am not medically qualified. The clinical facts in this article are checked against named sources, listed in the references, and I explain how I work in our editorial standards.
Start with your question
- What is pelvic floor Botox and who is it for?
- Does Botox for hypertonic pelvic floor actually work?
- Is pelvic floor Botox approved in Australia?
- What are the side effects of pelvic floor Botox?
- When should I worry after Botox?
- Will leaking or constipation after Botox go away?
- Could this be medical negligence?
What pelvic floor Botox is
Definition
A hypertonic or overactive pelvic floor is one where the muscles at the base of the pelvis stay tight and don’t relax properly. It can cause pelvic pain, painful sex, vaginismus, and bladder or bowel symptoms. Botulinum toxin A (best known by the brand Botox) temporarily weakens muscle by blocking the nerve signal that tells it to contract.
In plain terms: the aim is to make the clenched muscles let go for a while, so physiotherapy and other treatment can work better.
In Australia, pelvic floor Botox is usually given under anaesthetic and is described as an addition to pelvic physiotherapy, not a replacement for it. It takes a couple of weeks to work and is usually effective for about four to six months, after which pain may return. Some bleeding and increased pain for a day or two afterwards is commonly expected.1
Before treatment: what you should be told
Because the evidence for this treatment is still developing, and because it is given outside its approved uses, what you are told beforehand matters a great deal.
What the evidence says
A 2022 review and meta-analysis found that pain scores fell at 12 weeks and at about six months after injection, and painful sex improved. But the authors described the evidence as low quality, noted that the two randomised trials included found no significant difference from placebo, and said the clinical relevance remains largely unclear.2 A Canadian health technology review in 2019 reached a similar view. In the trials it looked at, Botox did not significantly reduce pain compared with placebo, there was a significant placebo effect, and adding Botox to physiotherapy did not clearly improve results.3
None of that means the treatment can’t help you. It means that whether to try it is a real choice, and you should have been given the information to make it.
What “off-label” means
In Australia, Botox’s approved uses include overactive bladder and bladder problems caused by neurological conditions, chronic migraine, some eye and muscle conditions, spasticity and excessive sweating. Chronic pelvic pain and pelvic floor muscle spasm are not on the list.4 Using a medicine outside its approved uses is called “off-label” prescribing. It is legal and can be entirely appropriate, but you should be told that it is off-label and what that means for the evidence behind it.
Questions to ask before treatment
- Is this an approved use of Botox, or off-label?
- What does the evidence show for people like me?
- What are the chances of leaking urine or bowel, constipation or difficulty emptying my bladder?
- How long would side effects last if they happen?
- What dose will you use, and where will you inject?
- Who do I call if something goes wrong, and what is the follow-up plan?
- How does this fit with my physiotherapy?
The procedure
The injections are placed into the pelvic floor muscles, usually through the vagina, often under a light general anaesthetic. Some people also have a nerve block at the same time.1 Pain at the injection site is common in the first day or so.3
Side effects
The trials summarised in the Canadian review reported adverse events including constipation, urinary incontinence, recurrent urinary tract infection, faecal incontinence and urinary retention. In those small trials, side effects were limited and similar to placebo, but the trials were short, so long-term safety is uncertain.3
The Australian product information also warns that the effects of botulinum toxin may sometimes be seen beyond the site of injection, and advises patients to seek immediate medical attention if symptoms of this occur.4
Definition
Urinary retention means being unable to empty your bladder fully, or at all. Incontinence means leaking urine or bowel motions without meaning to.
In plain terms: the same relaxing effect that helps tight muscles can, if it goes too far, make it harder to hold on, or harder to let go.
Expected, worth a review, or same-day help
A general guide only. Your treating team’s instructions come first.
Usually expected
- Soreness for a day or two
- A little bleeding after the procedure
- Pain that eases as the effect builds
- Continuing your physio plan
In plain terms: tender at first, then settling.
Ask for a review
- New leaking of urine or wind
- Constipation or straining that’s new
- Feeling you can’t empty your bladder
- Pain that is worse after two weeks
In plain terms: tell your doctor and physio now, not at the next routine visit.
Same-day help
- You can’t pass urine at all
- Fever, or burning with a high temperature
- Weakness away from the injection site
- Trouble swallowing, speaking or breathing (call 000)
In plain terms: don’t wait. Get help today.
If side effects happen
Because the effect of Botox wears off over months, many side effects improve with time. That is a reason for hope, but it is not a reason for you to be left managing on your own. A good plan might include review by your treating doctor, a continence or pelvic health physiotherapist, bladder or bowel tests if needed, and practical help with pads, medication or other support while you wait.
If you have also been dealing with years of pelvic pain before this, you may find our guide to delayed diagnosis of endometriosis helpful. Pelvic floor problems after childbirth are a separate issue, covered in living with a pelvic floor injury after birth and when your pelvic floor symptoms are dismissed.
If you raised concerns and felt brushed off, see when being dismissed by a doctor becomes a legal issue.
It was the pelvic health physio, again, who made sense of it. She sat with me and drew a diagram on the back of an appointment card: the muscles, the toxin, how it would slowly wear off. “This should ease over the next few months,” she said. “And we’re going to work on it together.”
I asked for my records. The consent form said “Botox injection to pelvic floor”. There was no mention of leaking, of constipation, or that Botox isn’t actually approved for this in Australia. The operation note listed the dose. The discharge sheet said to call if I had a fever.
My sister, who’s a pharmacist, read it and frowned. “They should have told you it was off-label. That’s not a small thing.”
By the fourth month the leaking had mostly stopped. My pain is still there, but now I understand what was done, and I make my own choices about what comes next.
A composite story, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What to look for in the records
Your records are often where the story becomes clear. You have a right to access your own health information. In NSW the Health Records and Information Privacy Act 2002 covers both public and private providers, and the Information and Privacy Commission explains how to ask.5 Our step-by-step guide to getting your medical records in Australia walks you through it.
| Record | Why it matters |
|---|---|
| Consent form and pre-procedure notes | Shows whether off-label use, the evidence, and risks such as incontinence and urinary retention were explained, and when you signed. |
| Referral and treatment plan | Shows why Botox was recommended and how it fitted with physiotherapy. |
| Operation or procedure note | Records the product, dose, injection sites and who gave it. |
| Discharge information | Shows what you were told to watch for and who to contact. |
| Follow-up and physiotherapy notes | Show what happened when you reported side effects, and the plan made. |
| Bladder or bowel test results | If done, show how your function was affected. |
| Your own diary, photos and messages | Notes made at the time are evidence too. Keep them. |
How the law looks at it
Side effects after pelvic floor Botox are not, on their own, negligence. Even with careful treatment, some people react badly. The legal questions are about whether the care, including the information you were given, met the standard expected, and whether any shortfall caused harm.
A claim usually turns on three questions: whether the care fell below what peers would widely accept as competent practice (section 5O of the Civil Liability Act 2002 (NSW))6, whether that shortfall probably caused harm you wouldn't otherwise have had (Tabet v Gett)7, and, where it matters, whether you were told the material risks first (Rogers v Whitaker)89. Our guide to how a medical negligence claim works explains each one in plain terms.
In a pelvic floor Botox case, the questions might be: was this a reasonable treatment to offer you, given your history and the evidence? Was the dose and technique appropriate? Was there a follow-up plan, and were side effects responded to properly when you reported them?
In plain terms, the question is whether the harm you suffered would probably not have happened, or would have been less, with proper care. In consent cases, it can also be whether you would have chosen differently if you had been properly informed.
For pelvic floor Botox, that would usually include that it is an off-label use, what the evidence shows, the chance of incontinence, constipation or urinary retention, and how long those effects might last. Signing a form in a gown on the day is not, by itself, the same as an informed choice.
Who can claim, and when
The person who had the treatment can claim. In NSW, time usually runs from when you knew, or ought to have known, enough to claim, not from the treatment itself, and courts can sometimes extend it, so an old injury may still count. See time limits in NSW or other states, and ask early.
More: complaint or claim? · how a claim is paid for · what a claim can cover
In my practice
In files about treatments like pelvic floor Botox, the gap I see most often is not in the procedure itself but in the conversation before it. People with long-standing pelvic pain are often exhausted and hopeful, and a treatment described as “very safe” is easy to say yes to. When I read the consent forms, they are often a single line naming the procedure. There may be nothing about the treatment being off-label, nothing about the limited evidence, and nothing about bladder or bowel side effects. Then, when side effects appear, the follow-up can be patchy: a phone call returned days later, a suggestion to wait it out. Each of those gaps may seem small. Together, they leave someone who already lives with pain feeling that they walked into something blind.
Both things can be true
Your gynaecologist may genuinely have wanted to help you, and you may still not have been told enough to make a real choice. The treatment may help many people, and it may still have harmed you. You can be grateful to the people who have helped with your pain and still ask questions about this part of your care.
The bigger picture
The research on pelvic floor Botox is still thin. Reviews in 2019 and 2022 found low-quality evidence, small trials, a strong placebo effect and uncertainty about long-term safety.23 Pelvic pain is not an approved indication for Botox in Australia, so most use in the pelvic floor is off-label.4
Patient organisations such as QENDO describe it as one tool alongside pelvic physiotherapy.1 You can check any practitioner’s registration on the Ahpra public register,10 and complaints about care in NSW can go to the Health Care Complaints Commission.11 Medicines used outside their approved uses are also covered in our guide to medication, drug and device harm.
Support
You don't have to work through this alone. These services can help:
- Lifeline, 24-hour crisis support: 13 11 14 (listed on healthdirect's helplines page)12
- Beyond Blue, anxiety and depression support: 1300 22 4636
- Medicare Mental Health, help finding mental health support: 1800 595 212
- healthdirect, 24-hour nurse advice: 1800 022 222
- Health Care Complaints Commission (NSW): 1800 043 159
A woman who stopped drinking water after lunch so she wouldn’t leak at work found someone who explained what had happened and made a plan with her. You deserve the same.
With care,
Rosemary
Frequently asked questions
What are the side effects of pelvic floor Botox?
Reported side effects include pain at the injection site, constipation, leaking urine or bowel motions, urinary tract infections and difficulty emptying the bladder.
Does Botox for hypertonic pelvic floor work?
Some people improve, but the evidence is low quality and trials have not clearly shown it works better than placebo.
Is pelvic floor Botox approved in Australia?
Pelvic pain is not an approved use of Botox in Australia, so it is given off-label, which should be explained to you.
How long do side effects of pelvic floor Botox last?
The effect usually wears off over about four to six months, and many side effects ease as it does.
Can I still have physio after pelvic floor Botox?
Yes. Botox is generally used alongside pelvic physiotherapy, not instead of it.
Can I claim if Botox caused incontinence?
Possibly. It depends on whether the care, including the information you were given, fell below the accepted standard and caused harm.
Questions about pelvic floor Botox?
When you're ready, and not before, I can look at what happened and help you understand your options.
Contraception and gynaecology guides
- “I can’t feel my implant anymore”: Nexplanon (Implanon NXT) problems
- “Was that pain normal?” When an IUD insertion goes wrong
- “The Botox made it worse”: Pelvic floor Botox side effects (you are here)
- Depo-Provera and brain tumours: delayed warnings and harm
- Can you sue a doctor for delayed diagnosis of endometriosis?
Part of our guide to endometriosis and gynaecology. Not sure where you stand? Try the free claim checker.
References
- QENDO. What’s the deal with pelvic Botox?
- Spruijt MA, Klerkx WM, Kelder JC, Kluivers KB, Kerkhof MH. The efficacy of botulinum toxin A injections in pelvic floor muscles in chronic pelvic pain patients: a systematic review and meta-analysis. Int Urogynecol J. 2022;33:2951–2961.
- Canadian Agency for Drugs and Technologies in Health. Injectable botulinum toxin for pelvic pain: a review of clinical effectiveness, cost-effectiveness, and guidelines. August 2019.
- Therapeutic Goods Administration. Product information: BOTOX (botulinum toxin type A) (AusPAR attachment).
- Information and Privacy Commission NSW. Fact sheet: Accessing your health information in NSW.
- Civil Liability Act 2002 (NSW) s 5O, Standard of care for professionals.
- Tabet v Gett [2010] HCA 12.
- Rogers v Whitaker [1992] HCA 58; (1992) 175 CLR 479.
- Australian Commission on Safety and Quality in Health Care. Informed consent.
- Australian Health Practitioner Regulation Agency. Register of practitioners.
- Health Care Complaints Commission NSW. Home page.
- healthdirect Australia. Mental health helplines.
Stories in this article are composites, drawn from the experiences of many families I have worked with, combined and changed so that no one can be identified. They do not describe any individual client.
Dr Rosemary Listing, PhD (Law), Medical negligence lawyer since 2014 · Of Counsel, Peter Evans & Associates. Rosemary's doctorate examined patterns of failure in medical negligence, and she teaches health law at the University of Newcastle. She is not medically qualified. About Rosemary.
Last updated: 10 November 2026 · First published: 10 November 2026 · Next review: May 2027
Cite this article: Listing R. “The Botox made it worse”: Pelvic floor Botox, side effects and consent. Reframe Legal. Published 10 November 2026. https://reframelegal.com/botox-for-pelvic-floor-side-effects/
This article is general information, not legal or medical advice. It does not create a lawyer–client relationship. Speak to your treating clinicians about your health, and get legal advice about your own situation.
If you are in danger or need urgent medical help, call 000. For crisis support, call Lifeline on 13 11 14.
Legal services are provided by Peter Evans & Associates.