From the Guidelines
Common medications for bladder spasms in patients with gross hematuria include anticholinergics such as oxybutynin (5-10 mg 2-3 times daily), solifenacin (5-10 mg once daily), and tolterodine (2-4 mg daily). These medications are used to relax the detrusor muscle of the bladder, reducing involuntary contractions that cause spasms and pain 1. Beta-3 agonists like mirabegron (25-50 mg daily) are also effective and may cause fewer side effects than anticholinergics. For immediate relief, antispasmodics such as flavoxate (100-200 mg 3-4 times daily) or hyoscyamine (0.125-0.25 mg every 4 hours) can be used. Pain management may include phenazopyridine (200 mg three times daily for 2 days) for urinary discomfort. It's essential to investigate and treat the underlying cause of hematuria simultaneously, as bladder spasms may be secondary to conditions like urinary tract infections, bladder stones, or tumors 1. Some key points to consider when treating bladder spasms in patients with gross hematuria include:
- Increasing fluid intake to help flush out blood clots, which can trigger spasms
- Monitoring for side effects of anticholinergics, such as dry mouth, constipation, and blurred vision
- Being aware that mirabegron may cause hypertension in some patients
- Considering the use of cystoscopy to diagnose and treat underlying conditions, particularly in patients with painless gross hematuria or those at risk of urinary tract irritation or catheter trauma 1.
From the Research
Common Bladder Spasm Medications
For patients with gross hematuria, common medications for bladder spasms are typically antimuscarinic agents, which help relax the bladder muscle and increase bladder capacity.
- Antimuscarinic agents such as oxybutynin, tolterodine, propiverine, trospium, darifenacin, and solifenacin are used to treat overactive bladder symptoms, including bladder spasms 2, 3, 4.
- Tolterodine has been shown to be effective in improving micturition diary variables and is associated with a lower incidence and intensity of dry mouth compared to oxybutynin 3, 5.
- The choice of medication depends on the individual patient's symptoms, medical history, and tolerance to potential side effects, such as dry mouth, constipation, and blurred vision 2, 4.
Treatment Considerations
When treating bladder spasms in patients with gross hematuria, it is essential to consider the potential causes of hematuria and the risk of malignancy, as noted in a study on hematuria 6.
- A thorough history and physical examination should be performed to determine potential causes and assess risk factors for malignancy 6.
- Antimuscarinic agents should be used with caution in patients with certain medical conditions, such as benign prostatic hyperplasia, and in elderly patients, who may be more susceptible to adverse events 2, 4.