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. Treatment for bladder spasms typically involves a combination of medications, lifestyle changes, and sometimes procedures. According to the most recent and highest quality study 1, behavioral therapies are a group of risk-free tailor-made therapies that improve individual symptoms by changing patient behavior or the patient’s environment, and are as effective in reducing symptom levels as are anti-muscarinic medications. Some key lifestyle modifications include:
- Reducing caffeine and alcohol intake
- Scheduled voiding every 2-3 hours
- Pelvic floor exercises (Kegels)
- Bladder training
- Avoiding certain foods known to be common bladder irritants, such as coffee or citrus products 1 For immediate relief, antispasmodics like flavoxate or dicyclomine may be prescribed, while beta-3 agonists such as mirabegron may be considered for those who can't tolerate anticholinergics. Patients should drink adequate water but avoid excessive fluid intake, especially before bedtime, to help manage symptoms. It's also important to note that other controllable behaviors or conditions, such as certain types of exercise, sexual intercourse, wearing of tight-fitting clothing, and constipation, may worsen symptoms in some patients 1.
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 Oxybutynin chloride is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (i.e., urgency, frequency, urinary leakage, urge incontinence, dysuria).
Treatment for Bladder Spasms:
- Oxybutynin chloride is used to relieve symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder.
- It exerts a direct antispasmodic effect on smooth muscle and inhibits the muscarinic action of acetylcholine on smooth muscle, which helps to relax bladder smooth muscle and reduce involuntary bladder contractions. 2 2
From the Research
Treatment for Bladder Spasms
The treatment for bladder spasms typically involves the use of anticholinergic medications, which help to suppress involuntary detrusor contractions by blocking the binding of acetylcholine to muscarinic receptors in the bladder 3. Some of the commonly used medications for this condition include:
- Oxybutynin: This is a tertiary amine possessing anticholinergic and papaverine-like, direct muscular antispasmodic effects, and has been shown to be effective in the management of reflex neurovesical dysfunction, enuresis, and bladder spasm 4.
- Tolterodine: This medication has been compared to oxybutynin in several studies, and has been found to have similar efficacy, but with a lower risk of dry mouth 5.
- Solifenacin: This medication has been shown to be more effective than tolterodine in some studies, with a lower risk of dry mouth 5.
- Fesoterodine: This medication has been shown to be more effective than extended release tolterodine, but with a higher risk of withdrawal due to adverse events and dry mouth 5.
Alternative Formulations
Alternative formulations of these medications, such as extended release preparations, may also be available, and have been shown to have a lower risk of dry mouth compared to immediate release preparations 5. Transdermal preparations, such as transdermal oxybutynin, may also be an option, and have been shown to have a lower risk of dry mouth compared to oral immediate release preparations 5.
Dosage and Administration
The dosage and administration of these medications may vary depending on the specific medication and formulation being used. For example, the standard recommended starting dose of tolterodine is 2 mg twice daily, but a 1 mg twice daily dose may be equally effective, with less risk of dry mouth 5. Similarly, the standard recommended starting dose of solifenacin is 5 mg once daily, but this may be increased to 10 mg once daily for better efficacy, although with an increased risk of dry mouth 5.