When Laughing Empties a Child’s Bladder, Botox Stopped the Episodes in 11 of 17 Kids

Ozempic and Zepbound Makers Report Slower Aging Clocks, but Unreviewed Data Do Not Prove Patients Age SlowerNovo Nordisk and Eli Lilly say GLP-1 drugs slowed aging clocks, but the data are early and unreviewed. Here is what patients should know. Had Gestational Diabetes or Postpartum Depression? Large Study Links Pregnancy History to Later Heart and Kidney RiskA study of 1.4 million women links pregnancy complications to later heart, diabetes, and kidney risk. What to tell your doctor at checkups. Dementia Patients Overweight or Obese at Diagnosis Had Up to 27% Lower Death Risk, Raising Caregiver Nutrition QuestionsA national study of 4,523 U.S. adults with dementia linked higher weight at diagnosis to longer survival. Here is what it means for caregivers. Nonprofit Hospitals Charging $5,500 or More for Longevity Checkups Face Questions Over Tax Breaks and Charity CareTax-exempt hospitals now sell longevity programs from $5,500 to as much as $45,000 a year. Here’s what’s included, what insurance covers, and what critics ask. Mental Health Childhood Abuse Linked to Brain Structure Differences in 3,711 Brain Scans, with Stronger Patterns Seen in Young WomenA UCLA-led study of 3,711 brain scans links childhood abuse to brain structure differences. It shows an association, not a cause, and needs follow-up. She Loved the Smell of Bricks So Much She Started Eating Them, and Severe Iron Deficiency May Be WhyA 56-year-old woman in Portugal ground bricks into powder and ate them after their smell became irresistible. Doctors suspect low iron. A Brown Rice Diet and Total Silence Looked Like Catatonia, but She Was Choosing Not to SpeakA 42-year-old woman stopped speaking and ate only brown rice. Doctors feared catatonia, but her silence was a deliberate act of defiance. A Strong Smell Could Set Off His Sneezing Fits, but His Muscles Told a Stranger StoryStrong smells set off a teacher’s sneeze-like fits for nine years. Muscle recordings showed rapid jerks unlike a textbook sneeze reflex. Innovation A Routine Checkup Murmur Led Doctors to a Child’s Sword-Shaped Lung Vein and a Hidden Liver ShuntA child with no symptoms had a heart murmur. Scans revealed scimitar syndrome, a rare lung vein defect, plus an unexpected shunt inside the liver. Only a Newborn’s Right Side Turned Blue, and Doctors Traced the Split to a Rare Aortic ArchA newborn’s right arm, chest, and upper belly turned blue while the rest stayed pink. Toronto doctors traced it to a rare aortic arch layout. A Newborn’s Swollen Scrotum Looked Like Fluid, but It Was Air Escaping From a Hole in His ColonA day-old boy’s scrotal swelling first looked like a harmless hydrocele. Scans later traced it to air leaking from a 2- to 3-cm hole in his colon. A Woman Folded Blankets and Wiped Tables in Her Sleep Until Surgeons Removed a Rare Pancreas GrowthA 58-year-old woman’s 4 a.m. chores and shouting looked like a sleep disorder. Severe low blood sugar and a rare pancreatic hamartoma were found. Healthy Living A Woman Passed a Uterus-Shaped Piece of Tissue Without the Hormone Drugs Often Linked to ItA 36-year-old woman shed her uterine lining as one intact, womb-shaped cast, a rare event doctors say happened without any hormone drugs. Plano COVID Testing Clinics Agree to Pay $20 Million Over Allegations Nasal Swabs Were Billed as Office VisitsHeal 360 clinics in Plano will pay $20 million in claims for COVID nasal swabs that were billed as office visits. How the uninsured program was billed. PhRMA Sues to Block Medicare GLOBE Model Tying Some Part B Drug Rebates to Prices in 19 CountriesPhRMA sued to block Medicare’s GLOBE model tying Part B drug rebates to 19 countries. What the case means for Original Medicare patients’ costs. Houston Physician Indicted in Alleged $30 Million Scheme Billing Federal COVID Program for Office Visits That Never HappenedA Houston doctor faces fraud charges over an alleged $30 million scheme billing a federal COVID program for uninsured patients. What the case alleges. Covid – 19 FDA Proposes Requiring Companies to Report Food Additives That Now Reach Grocery Shelves Without Federal ReviewFDA has released its proposed GRAS rule requiring companies to notify the agency about food additives. Here is what the proposal does and does not do. Federal Regulators Warn Some Hair Dryer Brushes Lack the Part That Stops ElectrocutionCPSC warns hair dryer brushes sold on Walmart.com and TikTok Shop lack immersion protection. The seller has not agreed to a recall or refund. A Recalled Teething Toy Broke the Pattern Parents Were Told to Look ForA newly recalled pull-string teething toy has a different model number and design from earlier recalls, and one choking incident has been reported. Trying to Lower Blood Sugar, Cholesterol or Blood Pressure? Different Workouts Suited Different MarkersA pooled analysis of 53 trials found that different exercise types helped different metabolic markers. Most of the evidence was low certainty. Editorial Illustration via AI Share on Twitter Share on Facebook Share on Pocket For a small group of children, a fit of laughter can mean a fully emptied bladder, sometimes in front of classmates. Doctors in Melbourne, Australia, now report that injecting botulinum toxin directly into the bladder muscle stopped laughter-triggered wetting in 11 of 17 children with giggle incontinence, most of whom had already tried other treatments.

The results appear in a 2026 paper in Pediatric Surgery International that looked back over 12 years of procedures. The authors are E. Szwarcberg, C. Kimber, and K. Taghavi. Kimber heads pediatric urology and pediatric surgery at Monash Children’s Hospital, Taghavi is a consultant pediatric urologist, and Szwarcberg is a medical intern at the hospital. They call the treatment effective and well tolerated, but they also say larger studies are needed.

Giggle incontinence is not the small leak many adults notice when they sneeze. ERIC, the U.K. children’s bladder and bowel charity, describes it as complete or almost complete emptying of the bladder caused by a bladder-muscle contraction in response to laughter. It affects children over age 5, is most common before puberty, and occurs more often in girls than boys.

There is no clear single cause. A 2002 study in the Journal of Urology identified giggle incontinence in 109 of 1,421 children referred to a pediatric kidney clinic. Nearly all of them (95%) also had daytime bladder symptoms, and the researchers concluded that laughter sets off an unstable, overactive bladder muscle.

ERIC notes that the condition usually fades as children get older. Until then, it can be hard to live with, because children cannot simply stop laughing.

The Monash team reviewed records from January 2013 through December 2024. Nineteen children received the injections, and 17 had enough follow-up to be included. Together they underwent 34 procedures, with individual children receiving between one and five.

Under general anesthesia, surgeons used a small camera scope to inject the drug into the bladder wall at multiple points. Most procedures used 200 units of onabotulinumtoxinA, the active ingredient in Botox; one procedure used 300 units. The children’s median age at first treatment was 11, with a range of 6 to 17. Boys outnumbered girls 10 to 7, the reverse of the usual pattern ERIC describes.

These were difficult cases. Before Botox, 11 children had tried the bladder drug oxybutynin and nine had done continence physiotherapy. One child each had tried mirabegron, tolterodine, and methylphenidate. Symptoms were rated moderate in 71% of the children and severe in 29%.

After treatment, 65% of the children had a complete response, meaning their giggle incontinence episodes stopped, and another 18% saw episodes drop by at least half. Three children did not respond. Of the 11 complete responders, six had no relapse over a median follow-up of five years. In those whose symptoms returned, the benefit lasted a median of 12 months.

The team reported no complications during surgery and no urinary tract infections or urinary retention afterward. One girl had abdominal pain after her second procedure that cleared up within a month.

Bladder Botox requires anesthesia and a scope procedure, and some children in the series needed repeat treatments. ERIC lists more conservative approaches, including teaching children to brace their pelvic floor muscles when they laugh, a trial of anticholinergic medicine when urgency is also present, and methylphenidate, which is not licensed for this use. The charity also cautions that there is no good evidence to recommend any one specific treatment.

In the United States, the FDA approved Botox for children 5 and older only for bladder overactivity tied to a neurologic condition, such as spina bifida. Using it for giggle incontinence is off-label.

Szwarcberg has also worked on a larger review of more than 140 children who received bladder Botox for functional urinary incontinence, including giggle incontinence. “Overall, it is a safe treatment with very few complications,” she said in a Monash Health news story. That work was presented at the Pacific Association of Pediatric Surgeons conference.

The authors suggest that laughter may trigger a bladder-muscle contraction the child does not feel, along with a brief relaxation of the pelvic floor. Botox may act on the bladder end of that chain, though the authors say it remains unclear exactly how.

The authors list several limitations. The study reviewed past records rather than comparing Botox with a control group, and multiple surgeons performed the procedures. Children received different numbers of treatments, and outcomes were measured after each child’s final procedure.

The group was also mixed. About three-quarters of the children (76%) had bladder problems unrelated to laughter, and only four had giggle incontinence alone. That raises the question of whether Botox was treating giggle incontinence itself or a broader overactive bladder.

That distinction is getting fresh attention. In an abstract presented at ICS 2026 on Wednesday, Turkish doctors reported that only 14 of 28 children with leakage during laughter had isolated giggle incontinence; the rest had other bladder or bowel symptoms. They urged a full bladder and bowel assessment before assigning the label. The findings have not yet appeared as a full peer-reviewed paper.

The Monash authors also note that the natural history of giggle incontinence is unknown, so they cannot say whether lasting improvement reflects the treatment or the condition easing on its own. Parents worried about a child’s wetting should talk with a pediatrician or pediatric urologist, who can sort out what kind of bladder problem is present before discussing options.

What is giggle incontinence? It is a childhood condition in which laughter triggers complete or almost complete emptying of the bladder, rather than a small leak. It is most common before puberty and more common in girls.

How was Botox used in the Monash study? Surgeons injected onabotulinumtoxinA, usually 200 units, into the bladder wall through a scope while children were under general anesthesia. Some children were treated up to five times.

How well did it work? Of 17 children, 11 (65%) stopped having giggle incontinence episodes and three (18%) improved by at least half. Six of the 11 complete responders had no relapse over a median follow-up of five years.

Is bladder Botox safe for children? The study found no surgical complications, infections, or urinary retention, and one case of temporary abdominal pain. The group was small, so rarer side effects could have been missed.

Should Botox be the first treatment? No. The children in the study had mostly tried other treatments first, and in the U.S. this use is off-label. Pelvic floor training and medication are typically considered before a procedure.

Does giggle incontinence go away on its own? It usually improves as children get older, according to ERIC, which is one reason the study cannot prove that Botox, rather than time, explains lasting improvement.