From the Guidelines
Bladder spasms should be treated with a combination of lifestyle modifications and pharmacologic therapies, prioritizing beta-3 agonists like mirabegron (25-50mg daily) as a first-line treatment due to their efficacy and safety profile, as recommended by the latest guidelines 1. When considering treatment options for bladder spasms, it's essential to evaluate the severity of symptoms and the patient's overall health status.
- Lifestyle modifications play a crucial role in managing bladder spasms, including:
- Reducing caffeine and alcohol intake
- Practicing timed voiding every 2-3 hours
- Performing pelvic floor exercises (10 contractions held for 10 seconds, three times daily)
- Managing fluid intake by drinking 6-8 glasses of water daily but limiting evening consumption
- Pharmacologic therapies, as outlined in the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1, include:
- Beta-3 agonists like mirabegron (25-50mg daily)
- Antimuscarinic medications such as oxybutynin (5-10mg daily), tolterodine (2-4mg daily), or solifenacin (5-10mg daily)
- Antispasmodic medications like flavoxate (100-200mg three times daily) for severe spasms These treatments aim to address both the symptoms and underlying causes of bladder spasms, prioritizing patient morbidity, mortality, and quality of life as the primary outcomes.
- Non-invasive therapies, such as pelvic floor muscle training, biofeedback, and transcutaneous tibial nerve stimulation, may also be considered as adjunctive treatments or for patients who do not respond to pharmacologic therapies, as suggested by the guideline 1.
- In severe cases, minimally invasive therapies like botulinum toxin injection of the bladder or sacral neuromodulation may be necessary, but these options should be reserved for patients who have failed other treatments and have significant symptoms, as indicated by the guideline 1.
From the FDA Drug Label
Tolterodine tartrate tablets are indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. 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).
Treatment for bladder spasm may include medications such as:
- Tolterodine (2)
- Oxybutynin (3) These medications are indicated for the treatment of overactive bladder and bladder instability, which may be associated with symptoms of bladder spasm.
From the Research
Bladder Spasm Treatment Options
- Anticholinergic drugs are a common treatment for overactive bladder symptoms, including bladder spasm 4
- Examples of anticholinergic drugs used to treat bladder spasm include oxybutynin, tolterodine, solifenacin, and fesoterodine 4, 5
- Botulinum toxin A is also an effective treatment for bladder dysfunction, including neurogenic detrusor overactivity and overactive bladder/idiopathic detrusor overactivity 6, 7
Comparison of Treatment Options
- Tolterodine and oxybutynin have similar efficacy, but tolterodine may have a lower risk of dry mouth 4
- Solifenacin may be preferred over immediate release tolterodine for better efficacy and lower risk of dry mouth 4
- Fesoterodine may be preferred over extended release tolterodine for superior efficacy, but has a higher risk of withdrawal due to adverse events and dry mouth 4
- Botulinum toxin A is a recommended third-line treatment for overactive bladder and urgency incontinence in selected patients refractory to pharmacological therapy 6
Safety and Efficacy of Treatment Options
- Oxybutynin has been shown to be effective in managing reflex neurovesical dysfunction, enuresis, and bladder spasm 5
- Intravesical oxybutynin treatment was observed to be safe, but may not be sufficient to increase bladder capacity 8
- Intravesical use of trospium and tolterodine at high doses caused epithelial destruction and diffuse inflammation in the bladder mucosa 8