In a word "yes". Botox is an excellent treatment for overactive bladder symptoms secondary to neurological disease like a stroke - it may be that the original dose could be increased?

If you have had bladder outlet obstruction diagnosed (presuming this because you are on Tamsulosin) then this can be a cause of the symptoms you describe. Saw palmetto is a natural product that may shrink the prostate and reduce your symptoms but the evidence to support its use is patchy. In about 2...

Perhaps you should talk to a urologist about sacral neuromodulation if you are not keen on Botox. Just to clarify Botox is not associated with impotence.

Sometimes urge incontinence can develop after prolapse surgery and your history is suggestive. A continence advisor would be the logical first step for you and can be accessed via your GP.

I would advise a consultation with a Urologist or Urogynaecologist as the history is very suggestive of mixed incontinence and you may need bladder pressure tests (urodynamics) in order to demonstrate the predominant component prior to treatment planning.

I would advise seeking an appointment with a urologist or urogynaecologist for a full discussion of second-line treatments for stress incontinence. There are many options available so I'm sure there will be something to suit you.

Thanks for the question. If you have failed the simple measures described then it is probably time to see your GP and discuss tablet treatments for what sound very much like Overactive Bladder Syndrome.

Oestrogen is very important for vaginal tissues and hence Tamoxifen worsening your symptoms makes sense. I would advise assessment by a continence specialist as you may benefit from pelvic floor muscle training and possibly urge suppression techniques.

Thanks for the question. I would advise that you seek an assessment from a pelvic floor physiotherapist or continence advisor. If appropriate you may be referred to a urologist or urogynaecologist.

I sometimes see patients with urgency symptoms after bladder outlet surgery (such as TVT) - my first line investigation is often urodynamics to see what the cause of the incontinence is and treatment can be directed from there.