What medications can be used for dysuria (painful urination) or bladder spasms associated with Urinary Tract Infection (UTI)?

From the Guidelines

For dysuria and bladder spasms associated with UTIs, phenazopyridine is the primary over-the-counter medication that specifically targets urinary discomfort, typically taken at 100-200mg three times daily for 2 days maximum, while prescription options include anticholinergics like oxybutynin or tolterodine to reduce bladder spasms, as evidenced by the most recent guidelines 1. The treatment of dysuria and bladder spasms associated with UTIs involves a combination of medications that target the symptoms and the underlying infection.

Over-the-counter medications

• Phenazopyridine (AZO, Pyridium) is the primary over-the-counter medication for urinary discomfort, taken at 100-200mg three times daily for 2 days maximum, as it numbs the urinary tract lining but can turn urine orange-red 1.

Prescription medications

• Anticholinergics like oxybutynin (5mg twice daily) or tolterodine (2mg twice daily) can reduce bladder spasms, as they relax the bladder muscle to reduce spasms, with oxybutynin dosing also considered in other populations, such as children with spina bifida, at 0.2 mg/kg TID 1.
• NSAIDs such as ibuprofen (400mg every 6-8 hours) can help with both pain and inflammation, providing relief for patients with UTIs.
• Antispasmodics like flavoxate (100-200mg three times daily) may be prescribed for severe pain, offering additional options for symptom management. It is essential to note that these medications only address symptoms, while antibiotics treat the underlying infection, and completing the full course of prescribed antibiotics is crucial, even after symptoms improve, along with increasing fluid intake to help flush bacteria from the urinary tract, as emphasized in various guidelines, including those for the treatment of acute uncomplicated cystitis and pyelonephritis in women 1.

From the FDA Drug Label

Phenazopyridine HCl is indicated for the symptomatic relief of pain, burning, urgency, frequency, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, endoscopic procedures, or the passage of sounds or catheters 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)

The medications that can be used for dysuria (painful urination) or bladder spasms associated with Urinary Tract Infection (UTI) are:

• Phenazopyridine (2) for symptomatic relief of pain and discomfort
• Oxybutynin (3) for relief of symptoms of bladder instability, including dysuria

From the Research

Medications for Dysuria and Bladder Spasms

• Phenazopyridine is an effective and well-tolerated drug for symptomatic therapy in patients with acute uncomplicated cystitis, providing relief from pain, dysuria, and discomfort 4, 5.
• The combination of fosfomycin and phenazopyridine is more effective than the combination of fosfomycin and drotaverine in treating acute uncomplicated cystitis 5.
• Antibiotics targeted toward Escherichia coli, Proteus, Klebsiella, and Staphylococcus saprophyticus are the recommended treatment for urinary tract infections, including cystitis and pyelonephritis 6.
• Anti-muscarinic agents and beta 3-adrenoceptor agonists, such as flavoxate, oxybutynin, propiverine, solifenacin, tolterodine, trospium, and mirabegron, are used to treat overactive bladder syndrome, which may be associated with urinary tract infections 7.
• Herbal medicine, such as isothiocyanates (ITC) from horseradish and cress, can be used as an alternative to antibiotics for uncomplicated urinary tract infections, providing anti-inflammatory effects and a broad spectrum of species coverage, including multiresistant bacteria 8.

Treatment Options

• Phenazopyridine can be prescribed orally, 200 mg 3 times a day for 2 days, in combination with fosfomycin trometamol, for the treatment of acute uncomplicated cystitis 5.
• Antibiotics, such as fosfomycin, can be prescribed for 3 to 5 days for uncomplicated cystitis and 7 to 14 days for pyelonephritis 6.
• Anti-muscarinic agents and beta 3-adrenoceptor agonists can be prescribed for the treatment of overactive bladder syndrome, with the goal of reducing the risk of urinary tract infections 7.
• Isothiocyanates (ITC) from horseradish and cress can be used for the therapy and prophylaxis of uncomplicated urinary tract infections, providing a rational approach to saving antibiotics 8.