What is the recommended treatment for bladder spasms?

Treatment of Bladder Spasms

Behavioral modifications including bladder training, pelvic floor muscle training, fluid management, and avoidance of bladder irritants should be implemented as first-line therapy for bladder spasms, followed by pharmacological management with oxybutynin as the primary medication option. 1, 2

First-Line Treatment Options

• Bladder training and delayed voiding techniques improve bladder capacity and reduce frequency and urgency of urination 1, 2
• Pelvic floor muscle training enhances control over bladder function and reduces spasm frequency 1, 2
• Fluid management with 25% reduction in fluid intake helps reduce frequency and urgency 1
• Avoidance of bladder irritants such as caffeine, alcohol, and spicy foods decreases symptom severity 1, 2
• Application of heat or cold over the bladder or perineum can alleviate trigger points and reduce spasm symptoms 1

Pharmacological Management

• Oxybutynin is the first-line pharmacological treatment for bladder spasms, with a typical dosing regimen of 5 mg 2-3 times daily, titrated as needed 1, 2
• Oxybutynin exerts a direct antispasmodic effect on smooth muscle and inhibits the muscarinic action of acetylcholine, relaxing bladder smooth muscle 3
• Oxybutynin increases bladder capacity, diminishes the frequency of uninhibited contractions of the detrusor muscle, and delays the initial desire to void 3
• Alternative anticholinergic options include tolterodine, solifenacin, and fesoterodine if oxybutynin is not tolerated 1, 2

Managing Side Effects and Special Considerations

• Common anticholinergic side effects include dry mouth, constipation, dry eyes, blurred vision, and cognitive effects 1, 2
• To minimize side effects, consider switching to a lower dose, using extended-release formulations, or trying transdermal delivery systems 1
• Anticholinergics are contraindicated in patients with narrow-angle glaucoma, impaired gastric emptying, or history of urinary retention 1, 2
• Use anticholinergics with caution in patients with post-void residual (PVR) >250-300 mL 1, 2

Second-Line and Advanced Treatment Options

• For inadequate response after 8-12 weeks of optimized therapy, consider combination of anticholinergics with behavioral therapies 1, 2
• Add therapies methodically, one at a time, to determine efficacy 1
• For severe refractory bladder spasms, consider minimally invasive procedures such as:
  • Sacral neuromodulation (SNS) 1
  • Peripheral tibial nerve stimulation (PTNS) 1
  • Intradetrusor botulinum toxin injection 1

Monitoring and Follow-up

• Allow adequate trial periods (8-12 weeks) to determine efficacy before changing therapies 1, 2
• Educate patients that treatment effects are typically maintained only as long as therapy is continued 1
• Monitor post-void residual in patients at risk for urinary retention, particularly before and after botulinum toxin therapy 1
• Periodically reassess treatment efficacy and discontinue ineffective treatments 2

Common Pitfalls and Caveats

• Anticholinergic medications can cause cognitive impairment, especially in elderly patients; consider alternatives like trospium or darifenacin which have lower CNS penetration 4
• Prophylaxis with belladonna and opium suppositories has not been shown to significantly reduce bladder spasms following urologic procedures 5
• Untreated constipation can exacerbate bladder spasms in catheterized patients and should be addressed 6
• For catheter-related bladder spasms, ensure proper catheter size and support drainage bags to prevent traction and trauma 6