How to manage constipation causing bladder spasms?

Managing Constipation Causing Bladder Spasms

Treatment of constipation is essential to relieve bladder spasms, with a stepwise approach starting with osmotic laxatives like polyethylene glycol (17-34g daily) as first-line therapy, followed by stimulant laxatives if needed. 1

Assessment of Constipation and Bladder Symptoms

When constipation is causing bladder spasms, assessment should focus on:

• Performing a digital rectal examination to assess for fecal impaction 2
• Evaluating medication list for drugs that may contribute to both constipation and bladder symptoms (e.g., opioids, anticholinergics) 2, 1
• Ruling out other causes of bladder spasms through physical examination 2
• Determining the severity of constipation and its relationship to bladder symptoms 1

Treatment Algorithm

Step 1: Address Underlying Constipation

• First-line treatment: Osmotic laxatives

  • Polyethylene glycol (PEG) 17-34g daily 1
  • Alternatives: Lactulose or magnesium hydroxide (avoid in renal impairment) 2, 1

• If inadequate response: Add stimulant laxatives

  • Bisacodyl 10-15 mg, 2-3 times daily 2, 1
  • Senna 2-3 tablets twice daily 1

• For fecal impaction:

  • Glycerin suppositories or manual disimpaction 2
  • Follow with maintenance bowel regimen to prevent recurrence 2

Step 2: Manage Bladder Spasms

• For persistent bladder spasms after addressing constipation:
  • Consider antimuscarinic agents like hyoscine butylbromide 2
  • Note: Anticholinergics like oxybutynin should be used cautiously as they may worsen constipation 3

Special Considerations

For Opioid-Induced Constipation

• Prophylactic laxative therapy is essential when starting opioids 2
• If standard laxatives fail, consider:
  • Methylnaltrexone 0.15 mg/kg subcutaneously every other day 2, 1
  • Naloxegol as an oral alternative 2, 1

For Elderly Patients

• Particular attention to assessment is needed 2
• Start with lower doses of medications 1
• Avoid magnesium-based laxatives in renal impairment 2, 1

For Defecatory Disorders

• Consider biofeedback therapy rather than continued laxative use 2
• Pelvic floor retraining has shown >70% improvement in symptoms 2

Lifestyle Modifications

• Ensure adequate fluid intake 2, 1
• Increase physical activity within patient limits 2, 1
• Ensure privacy and comfort for defecation 2, 1
• Consider abdominal massage, particularly helpful for patients with neurogenic problems 2

Common Pitfalls to Avoid

• Relying solely on stool softeners without addressing motility 1
• Using bulk laxatives for opioid-induced constipation (not recommended) 2, 1
• Using anticholinergic bladder medications (like oxybutynin) without addressing constipation first, as these can worsen constipation 3
• Failing to provide prophylactic laxatives when starting opioid therapy 2, 1

Treatment Goals

The goal of management is to achieve one non-forced bowel movement every 1-2 days 2, which should significantly reduce or eliminate bladder spasms caused by constipation. Reassess in 4-6 weeks to evaluate response to treatment 1.