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