From the FDA Drug Label
Oxybutynin chloride exerts a direct antispasmodic effect on smooth muscle and inhibits the muscarinic action of acetylcholine on smooth muscle. Oxybutynin chloride relaxes bladder smooth muscle In patients with conditions characterized by involuntary bladder contractions, cystometric studies have demonstrated that oxybutynin chloride increases bladder (vesical) capacity, diminishes the frequency of uninhibited contractions of the detrusor muscle, and delays the initial desire to void
The initial management for a patient with bladder spasms is oxybutynin (PO), which relaxes bladder smooth muscle and decreases urgency and the frequency of both incontinent episodes and voluntary urination 1.
From the Research
The initial management for a patient with bladder spasms involves a stepwise approach starting with conservative measures, prioritizing patient-specific treatment and targeting the most bothersome symptoms, as recommended in the most recent study 2. The management of bladder spasms should focus on reducing symptoms and improving quality of life.
- Identify and treat any underlying causes such as urinary tract infections, bladder stones, or catheter irritation.
- Conservative management includes adequate hydration, timed voiding, and warm sitz baths to relieve discomfort. For medication therapy, anticholinergics are the first-line pharmacological treatment, with oxybutynin being commonly prescribed at 5 mg orally two to three times daily, as supported by earlier studies 3, 4.
- Alternative anticholinergics include tolterodine (2 mg twice daily), solifenacin (5-10 mg daily), or darifenacin (7.5-15 mg daily).
- For patients with indwelling catheters experiencing spasms, ensuring proper catheter placement and size is essential, and irrigation with normal saline may help remove irritants. If spasms are severe and persistent, muscle relaxants such as baclofen (5-10 mg three times daily) or diazepam (2-5 mg as needed) can provide temporary relief, as noted in various treatment options 2, 5. Pain management with NSAIDs or acetaminophen may also be beneficial. These medications work by blocking muscarinic receptors in the bladder, reducing involuntary detrusor muscle contractions that cause spasms. Patients should be monitored for common anticholinergic side effects including dry mouth, constipation, and blurred vision, with dosage adjustments made as needed, highlighting the importance of personalized treatment plans 4, 2.