What is the treatment for bladder spasms?

Treatment for Bladder Spasms

Behavioral therapies should be offered as first-line treatment for bladder spasms, followed by pharmacological options such as antimuscarinic medications or beta-3 adrenergic receptor agonists if symptoms persist. 1, 2

Diagnostic Approach

• Perform urinalysis to rule out urinary tract infection and hematuria 1, 2
• Consider urine culture even with negative urinalysis to detect clinically significant bacteria 1
• Review current medications that may contribute to symptoms 1
• Assess for co-morbid conditions (neurologic diseases, genitourinary conditions) 1
• Measure post-void residual in patients with obstructive symptoms, history of incontinence or prostatic surgery 1
• Note: Urodynamics, cystoscopy, and diagnostic ultrasound are NOT recommended in initial workup of uncomplicated cases 1, 2

First-Line Treatment: Behavioral Therapies

Behavioral therapies are recommended as first-line treatment due to their effectiveness and lack of adverse effects 1, 2:

1. Bladder Training:

   • Establish timed voiding schedule based on bladder diary
   • Start with short intervals (1-2 hours) and gradually increase as control improves 2
   • Teach urge suppression techniques

2. Pelvic Floor Muscle Training:

   • Teach proper contraction techniques for regular practice 2
   • Can be as effective as antimuscarinic medications 2

3. Fluid Management:

   • Reduce fluid intake by approximately 25% 2
   • Eliminate or significantly reduce caffeine intake 2
   • Avoid known bladder irritants (coffee, citrus products) 1, 2

4. Other Behavioral Modifications:

   • Weight loss (8% reduction can decrease incontinence episodes by up to 47% in overweight patients) 2
   • Application of local heat or cold over the bladder or perineum 1
   • Strategies to manage flare-ups (meditation, imagery) 1

Second-Line Treatment: Pharmacological Options

Antimuscarinic Medications

• Oxybutynin (5mg twice daily) 2, 3, 4:

  • Mechanism: Direct antispasmodic effect on smooth muscle and inhibits muscarinic action of acetylcholine 3
  • Effects: Increases bladder capacity, diminishes frequency of uninhibited contractions, delays initial desire to void 3
  • Caution: Use with care in patients with PVR 250-300 mL 1
  • Special populations: Start with lower doses (2.5mg twice daily) in elderly patients 2
  • Common side effects: Dry mouth, constipation

• Tolterodine (2mg twice daily) 5:

  • Demonstrated effectiveness in managing bladder spasms in post-prostate surgery patients
  • After 72 hours of treatment, complete relief in 54.9% of patients, partial relief in 36.6% 5

Beta-3 Adrenergic Receptor Agonists

• Mirabegron 2:
  • Preferred first-line medication, especially in elderly patients
  • Lower risk of cognitive side effects
  • Effective within 8 weeks at 25mg dose and within 4 weeks at 50mg dose
  • Dosage adjustments needed for renal impairment (max 25mg daily if GFR <30 mL/min) 2
  • Dosage adjustments needed for hepatic impairment (max 25mg daily for moderate impairment, avoid in severe impairment) 2

Third-Line Options for Refractory Cases

• Combination therapy: Mirabegron and oxybutynin together 2
• Intravesical treatments: Dimethyl sulfoxide, heparin, or lidocaine 1
• Multimodal pain management approaches for bladder pain syndrome 1
• Rectal diazepam (10mg) may help prevent bladder spasms in specific clinical scenarios 6

Fourth-Line Options

• Neuromodulation therapies 2:
  • Sacral neuromodulation (SNS)
  • Peripheral tibial nerve stimulation (PTNS) - typically 30 minutes once weekly for 12 weeks
• Intradetrusor onabotulinumtoxinA injections 2
• Lumbar sympathetic blockade at L4 (for malignancy-related bladder spasms) 7

When to Refer to a Specialist

• Patients with neurogenic bladder disorders
• Refractory symptoms despite behavioral and pharmacologic therapy
• Presence of Hunner's lesions requiring fulguration or triamcinolone injection 1
• Consideration for surgical interventions in end-stage fibrotic bladder 1

Management of Common Side Effects

• Dry mouth: Switch to extended-release or transdermal formulation of oxybutynin 2
• Constipation: Increase fluid and fiber intake, consider stool softeners 2
• Urinary retention: Check post-void residual, consider dose reduction or discontinuation if >200 mL 2

Remember that while bladder spasms affect quality of life, they generally do not affect survival, so treatment plans should carefully weigh potential benefits against risks of adverse effects 1.