What is the recommended treatment for bladder spasms?

Treatment of Bladder Spasms

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

First-Line Treatment Approach

Behavioral Modifications

• Implement bladder training and delayed voiding techniques to improve bladder capacity and reduce frequency and urgency 1, 3
• Perform pelvic floor muscle training to improve control over bladder function 1, 3
• Reduce fluid intake by approximately 25% to help decrease frequency and urgency 1, 3
• Avoid bladder irritants such as caffeine, alcohol, and spicy foods 1, 3
• Apply heat or cold over the bladder or perineum to help alleviate trigger points and reduce symptoms 1, 3

Pharmacological Management

• Oxybutynin is indicated for relief of symptoms of bladder instability, including urgency, frequency, urinary leakage, and urge incontinence 2
• Oxybutynin works by exerting a direct antispasmodic effect on smooth muscle and inhibiting the muscarinic action of acetylcholine 2
• Alternative anticholinergic options if oxybutynin is not tolerated include:
  • Tolterodine (shown effective for post-operative bladder spasms) 1, 4
  • Solifenacin (associated with lowest risk for discontinuation due to adverse effects) 5, 1
  • Trospium and fesoterodine 1, 3

Management of Side Effects and Special Considerations

• Common anticholinergic side effects include dry mouth, constipation, dry eyes, blurred vision, and cognitive effects 5, 1
• Strategies to manage side effects include:
  • Switching to a lower dose
  • Using extended-release formulations
  • Trying transdermal delivery systems 1
• Anticholinergics are contraindicated in:
  • Patients with narrow-angle glaucoma
  • Impaired gastric emptying
  • History of urinary retention 1, 3
• Use anticholinergics with caution in patients with post-void residual (PVR) >250-300 mL 1, 3

Second-Line and Advanced Treatment Options

• For inadequate response after 8-12 weeks of optimized pharmacotherapy, consider:
  • Combination therapy with anticholinergics and behavioral therapies 1, 3
  • Intradetrusor onabotulinumtoxinA (100 U) for refractory cases 5, 6
  • Sacral neuromodulation (SNS) for severe refractory bladder spasms 5, 1
  • Peripheral tibial nerve stimulation (PTNS) 5, 1

Special Clinical Scenarios

Post-operative Bladder Spasms

• Tolterodine (2 mg twice daily) has been shown effective for bladder spasms caused by indwelling catheters after prostate operations 4
• In one study, after 72 hours of treatment, bladder spasm was alleviated totally in 54.9% of patients, partially in 36.6%, and unrelieved in 8.5% 4

Malignancy-related Bladder Spasms

• For cancer-related bladder spasms refractory to standard treatments, lumbar sympathetic blockade at L4 may be considered 7

Neurogenic Bladder with Severe Spasms

• In patients with spinal cord injury and severe bladder spasms, intrathecal baclofen may be effective when other treatments fail 8

Monitoring and Follow-up

• Allow adequate trial periods (8-12 weeks) to determine efficacy before changing therapies 1
• Educate patients that treatment effects are typically maintained only as long as therapy is continued 1
• Post-void residual monitoring may be necessary in patients at risk for urinary retention, particularly before and after botulinum toxin therapy 1, 3
• Periodically reassess efficacy of treatment and discontinue ineffective treatments 3