What is the treatment for bladder spasms?

Treatment of Bladder Spasms

Bladder spasms should be treated using a stepwise approach beginning with behavioral modifications, followed by pharmacological therapy with anticholinergics like oxybutynin, and advancing to minimally invasive procedures for refractory cases. 1

First-Line Treatment: Behavioral Modifications

• Implement bladder training and delayed voiding techniques to improve bladder capacity and reduce frequency and urgency 1
• Reduce fluid intake by approximately 25% to help manage symptoms 1
• Avoid bladder irritants such as caffeine, alcohol, and spicy foods 1
• Apply heat or cold over the bladder or perineum to alleviate trigger points and reduce spasm symptoms 1
• Perform pelvic floor muscle training (Kegel exercises) to strengthen the pelvic floor and improve control 1, 2

Second-Line Treatment: Pharmacological Management

• Oxybutynin is the first-line pharmacological treatment for bladder spasms, with typical dosing of 5 mg 2-3 times daily 1, 3
• Oxybutynin works by exerting a direct antispasmodic effect on smooth muscle and inhibiting the muscarinic action of acetylcholine 3
• Clinical studies show oxybutynin increases bladder capacity, diminishes the frequency of uninhibited contractions, and delays the initial desire to void 3, 4
• For patients experiencing significant dry mouth with oral oxybutynin, consider transdermal formulations which produce less N-desethyloxybutynin (responsible for anticholinergic side effects) 5
• Other anticholinergic options (tolterodine, solifenacin, fesoterodine) may be considered if oxybutynin is not tolerated 1

Third-Line Treatment: Minimally Invasive Procedures

• For patients with inadequate response to or intolerable side effects from behavioral and pharmacological therapies, offer minimally invasive options 2
• Sacral neuromodulation (SNS) is recommended for severe refractory bladder spasms 2
• Peripheral tibial nerve stimulation (PTNS) can be effective in reducing voiding frequency, urgency episodes, and incontinence episodes 2
• Intradetrusor botulinum toxin injection is effective for managing refractory bladder spasms 2
• Post-void residual should be measured prior to botulinum toxin therapy to assess risk of urinary retention 2

Special Considerations

• Anticholinergics should be used with extreme caution in patients with narrow-angle glaucoma, impaired gastric emptying, or history of urinary retention 2, 1
• For patients with indwelling catheters experiencing bladder spasms, ensure proper catheter size and positioning to minimize irritation 6
• For cancer-related bladder spasms refractory to standard treatments, lumbar sympathetic blockade at L4 may provide relief 7
• Rectal diazepam (10 mg) may be used to prevent bladder spasms during specific procedures like intravesical medication administration 8

Treatment Algorithm

1. Start with behavioral modifications for 4-6 weeks 1
2. If inadequate response, add anticholinergic medication (oxybutynin 5 mg 2-3 times daily) 1, 3
3. If side effects occur, consider transdermal formulation or alternative anticholinergic 1, 5
4. For inadequate response after 8-12 weeks of optimized pharmacotherapy, consider minimally invasive options (SNS, PTNS, or botulinum toxin) 2
5. Combination approaches should be assembled methodically, adding therapies one at a time 2

Monitoring and Follow-up

• Allow adequate trial periods (8-12 weeks) to determine efficacy before changing therapies 1
• Monitor for anticholinergic side effects including dry mouth, constipation, blurred vision, and cognitive effects 1
• Measure post-void residual in patients at risk for urinary retention, particularly before and after botulinum toxin therapy 2
• Educate patients that treatment effects typically persist only as long as therapy is continued 1