What are the first-line medications for managing bladder spasms?

From the Guidelines

Behavioral therapies, such as bladder training, bladder control strategies, pelvic floor muscle training, and fluid management, should be offered as first-line therapy to all patients with bladder spasms. According to the AUA/SUFU guideline 1, these therapies are as effective in reducing symptom levels as anti-muscarinic medications and are considered first-line treatments due to their risk-free and tailor-made nature. Some key points to consider when implementing behavioral therapies include:

• Bladder training: This involves gradually increasing the intervals between voiding to help the patient regain control over their bladder
• Bladder control strategies: These may include techniques such as pelvic floor muscle contractions to suppress the urge to void
• Pelvic floor muscle training: This can help strengthen the muscles that support the bladder and improve bladder control
• Fluid management: This involves modifying fluid intake to reduce symptoms of bladder spasms. It's essential to note that while medications like anticholinergic drugs and beta-3 adrenergic agonists may be effective in managing bladder spasms, they should not be considered first-line therapy due to their potential side effects and the availability of effective behavioral therapies 1.

From the FDA Drug Label

BOTOX is a prescription medicine that is injected into muscles and used: to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency) and urinating often (frequency) in adults when another type of medicine (anticholinergic) does not work well enough or cannot be taken. Solifenacin succinate was evaluated in four twelve-week, double-blind, randomized, placebo-controlled, parallel group, multicenter clinical trials for the treatment of overactive bladder in patients having symptoms of urinary frequency, urgency, and/or urge or mixed incontinence (with a predominance of urge)

The first-line medications for managing bladder spasms include:

• OnabotulinumtoxinA (BOTOX): used to treat overactive bladder symptoms, including urge urinary incontinence, urgency, and frequency in adults when anticholinergic medications do not work well enough or cannot be taken 2.
• Solifenacin (PO): used to treat overactive bladder symptoms, including urinary frequency, urgency, and incontinence in patients with a predominance of urge incontinence 3. These medications are used to treat overactive bladder symptoms, which can include bladder spasms. However, it is essential to consult a healthcare professional to determine the best course of treatment for individual cases.

From the Research

First-Line Medications for Bladder Spasms

The first-line medications for managing bladder spasms include:

• Antimuscarinic agents, such as oxybutynin, propiverine, tolterodine, solifenacin, darifenacin, trospium, imidafenacin, and fesoterodine, which are widely used to treat overactive bladder (OAB) 4
• Beta 3 adrenergic agonists, such as mirabegron, which have a similar efficacy profile to first-line antimuscarinics with a favorable adverse effects profile 5

Treatment Approach

A stepped-care approach is recommended for managing urinary incontinence, including bladder spasms, with:

• Behavioral modification as the first-line treatment 6, 7
• Pharmacologic therapy, including anticholinergic medications and beta 3 adrenergic agonists, as second-line treatment 6, 5, 7
• Other options, such as neuromodulation devices and sacral nerve stimulators, as third-line therapy for patients refractory or intolerant to first- and second-line treatments 6, 7

Medication Options

The choice of medication depends on the individual patient's needs and medical history, with considerations including:

• Efficacy and tolerability of the medication 8, 5
• Potential adverse effects, such as dry mouth, constipation, and CNS adverse events 4, 8
• Cost-effectiveness of the medication 5