What is the treatment for bladder spasms or pain?

Treatment of Bladder Spasms and Pain

Bladder spasms and pain should be treated with a stepwise approach starting with behavioral therapies as first-line treatment, followed by oral medications, intravesical therapies, and procedures for refractory cases. 1, 2

Initial Assessment and Diagnosis

• Rule out infection with urinalysis and urine culture 1
• Consider cystoscopy if:
  • Hematuria is present
  • Hunner lesions are suspected (in interstitial cystitis/bladder pain syndrome)
  • Symptoms are refractory to initial treatment 1
• Document baseline symptoms using bladder diaries to track frequency, urgency, and pain 1, 2

First-Line Treatment: Behavioral and Non-Pharmacologic Therapies

• Pelvic floor physical therapy for patients with pelvic floor tenderness 2
• Bladder training and urge suppression techniques 1
• Dietary modifications:
  • Eliminate bladder irritants (coffee, citrus, spicy foods, alcohol) 2
  • Consider an elimination diet to identify trigger foods 2
• Fluid management:
  • Modify concentration/volume of urine through fluid restriction or hydration 1, 2
  • Reduce caffeine intake to decrease voiding frequency 1
• Stress management techniques:
  • Meditation, imagery, and relaxation techniques for flare-ups 2
• Physical techniques:
  • Application of heat or cold over bladder/perineum 2
  • Transcutaneous electrical stimulation of somatic nerves (shown to reduce bladder spasm symptoms) 3

Second-Line Treatment: Oral Medications

• Anticholinergics (for overactive bladder symptoms):

  • Oxybutynin (indicated for bladder instability with urgency, frequency, urinary leakage) 4, 5
  • Darifenacin, fesoterodine, solifenacin, tolterodine, or trospium 1
  • Monitor for side effects: dry mouth, constipation, blurred vision
  • Use transdermal oxybutynin if dry mouth is a concern 1

• For interstitial cystitis/bladder pain syndrome:

  • Amitriptyline (start 10mg daily, titrate up to 75-100mg if tolerated) 2
  • Pentosan polysulfate sodium (only FDA-approved oral medication for IC/BPS) 2
  • Cimetidine (for pain and nocturia) 2
  • Hydroxyzine (for allergic components) 2
  • Non-steroidal anti-inflammatory drugs for pain relief 1

Third-Line Treatment: Intravesical Therapies

• For interstitial cystitis/bladder pain syndrome:

  • Dimethyl sulfoxide (DMSO) - FDA-approved intravesical therapy 2
  • Heparin bladder irrigation (20,000-40,000 units in 50ml solution) 2
  • Lidocaine for temporary pain relief 2
  • Combination therapy (heparin + lidocaine + sodium bicarbonate) 2

• For post-surgical bladder spasms:

  • Intravesical instillation therapy with quinolones and anti-inflammatory drugs 1

Fourth-Line Treatment: Procedures

• Botulinum toxin A injections:

  • For overactive bladder symptoms refractory to other treatments 6, 5
  • 100 units recommended for intradetrusor injection 2
  • Patients must accept possibility of intermittent self-catheterization 2

• For interstitial cystitis/bladder pain syndrome with Hunner lesions:

  • Cystoscopy with fulguration of Hunner lesions 1
  • Hydrodistention of the bladder 1

• Neuromodulation:

  • Sacral or pudendal neuromodulation for refractory cases 7
  • Lumbar sympathetic blockade at L4 (shown effective for malignancy-related bladder spasms) 8

Special Considerations

• For bladder spasms related to BCG treatment:

  • If symptoms are mild: drugs for relieving bladder irritation (e.g., finapyridine), anticholinergics, and NSAIDs
  • If symptoms persist >48 hours: postpone instillation, perform urine culture, start empirical antibiotic treatment
  • With persistent symptoms and negative culture: intravesical instillation with quinolones and anti-inflammatory drugs 1

• For post-surgical bladder spasms:

  • Anticholinergics and analgesics
  • Consider transcutaneous electrical stimulation of the foot (shown to reduce Visual Analogue Scale pain scores and frequency of spasms) 3

Treatment Monitoring

• Assess treatment efficacy every 4-12 weeks using validated symptom scores 2
• Discontinue ineffective treatments and adjust therapy based on symptom response and side effects 2
• Consider referral to pain specialists for intractable pain 2
• Prioritize non-opioid alternatives for pain management 2

Caution

• Use anticholinergics with caution in patients with post-void residual >250-300 mL 1
• Monitor patients on pentosan polysulfate for potential macular damage with long-term use 2
• Surgical treatments (other than fulguration of Hunner lesions) should only be considered after all other treatment options have been exhausted 1