From the Guidelines
Medications for bladder spasms should include anticholinergics, such as oxybutynin, tolterodine, solifenacin, and trospium, as they have been shown to be effective in managing urgency UI and improving continence rates 1.
Treatment Options
- Anticholinergics: oxybutynin (5-10mg daily), tolterodine (2-4mg daily), solifenacin (5-10mg daily), and trospium (20mg twice daily) work by blocking acetylcholine receptors, reducing involuntary bladder contractions.
- Beta-3 agonists: mirabegron (25-50mg daily) relax the bladder muscle through a different mechanism and may cause fewer dry mouth side effects.
- Muscle relaxants: baclofen (5-10mg three times daily) or diazepam (2-5mg as needed) might be prescribed short-term for acute, severe spasms.
- Tricyclic antidepressants: amitriptyline (10-25mg at bedtime) can also help by providing both anticholinergic effects and pain relief.
Considerations
- Treatment typically starts with lower doses and increases as needed based on symptom improvement and side effect tolerance.
- Patients should stay well-hydrated but avoid bladder irritants like caffeine, alcohol, and spicy foods while taking these medications.
- The choice of pharmacologic agents should be based on tolerability, adverse effect profile, ease of use, and cost of medication, as recommended by the American College of Physicians 1.
Key Points
- Pharmacologic treatment should be considered in women with urgency UI if bladder training was unsuccessful 1.
- Anticholinergics and beta-3 agonists have been shown to be effective in managing urgency UI and improving continence rates.
- Adverse effects, such as dry mouth, constipation, and blurred vision, should be carefully monitored and managed.
From the FDA Drug Label
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 Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency
Medications for Bladder Spasms:
- Botulinum toxin (INTRAVESICAL): used to treat overactive bladder symptoms, including urge urinary incontinence, urgency, and frequency 2
- Mirabegron (PO): indicated for the treatment of Overactive Bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency 3
From the Research
Medications for Bladder Spasms
Medications used to treat bladder spasms, also known as overactive bladder (OAB), include:
- Antimuscarinic agents, which are considered the mainstay of pharmacologic treatment for OAB 4, 5, 6
- Beta 3 adrenergic agonists, which have a similar efficacy profile to first-line antimuscarinics with a favorable adverse effects profile 7
- Other pharmacologic treatments, such as onabotulinumtoxinA, peripheral tibial nerve stimulation, and sacral nerve stimulation, which are recommended as third-line therapy for patients refractory or intolerant to first- and second-line treatments 8
Antimuscarinic Agents
Antimuscarinic agents work by blocking the action of certain muscarinic receptors in the bladder, which helps to reduce abnormal contractions of the bladder detrusor muscle. Examples of antimuscarinic agents used to treat OAB include:
Beta 3 Adrenergic Agonists
Beta 3 adrenergic agonists, such as mirabegron, have been shown to be effective in treating OAB with a favorable adverse effects profile 7. They work by relaxing the bladder muscle and increasing bladder capacity.
Treatment Approach
A stepwise approach to treatment is recommended, with behavioral therapy as a first choice, pharmacologic treatment as second-line treatment, and other therapies as third-line treatment for patients refractory or intolerant to first- and second-line treatments 8. Patients should be carefully monitored and counseled appropriately on available treatment options to optimize symptom control and set realistic expectations.