What medication is effective for treating detrusor (detrusor muscle) overactivity and resultant bladder spasm pain, also known as overactive bladder (OAB) syndrome?

From the Guidelines

For bladder spasm pain, oral anti-muscarinics such as darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium are recommended as second-line therapy, as they can reduce symptoms but may be associated with non-life-threatening side effects 1. These medications work by blocking certain nerve signals that trigger bladder muscle contractions, thereby reducing spasms and associated pain. Some key points to consider when prescribing these medications include:

• Patients with more severe symptoms may experience greater symptom reductions 1
• Patients with relatively low baseline symptom levels are more likely to experience complete symptom relief 1
• If a patient experiences inadequate symptom control and/or unacceptable adverse drug events with one anti-muscarinic medication, a dose modification or a different anti-muscarinic medication or a beta-3 adrenoceptor agonist like mirabegron may be tried 1
• Mirabegron has an efficacy profile similar to anti-muscarinics but with a relatively lower adverse effect profile 1 It's also important to note that alongside medication, lifestyle changes such as increasing water intake, avoiding bladder irritants like caffeine and alcohol, and applying heat to the lower abdomen can help manage symptoms. If symptoms persist beyond a few days or are accompanied by fever or blood in urine, medical attention should be sought promptly as this could indicate infection or other serious conditions.

From the FDA Drug Label

Oxybutynin chloride exerts a direct antispasmodic effect on smooth muscle and inhibits the muscarinic action of acetylcholine on smooth muscle. Oxybutynin chloride exhibits only one fifth of the anticholinergic activity of atropine on the rabbit detrusor muscle, but four to ten times the antispasmodic activity Oxybutynin chloride relaxes bladder smooth muscle In patients with conditions characterized by involuntary bladder contractions, cystometric studies have demonstrated that oxybutynin chloride increases bladder (vesical) capacity, diminishes the frequency of uninhibited contractions of the detrusor muscle, and delays the initial desire to void Trospium Chloride Extended-Release Capsules are a muscarinic antagonist indicated for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency.

Medications for Bladder Spasm Pain:

• Oxybutynin: is a medication that can help with bladder spasm pain by relaxing the bladder smooth muscle and increasing bladder capacity.
• Trospium: is a muscarinic antagonist that can help with overactive bladder symptoms, including urge urinary incontinence, urgency, and urinary frequency.

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From the Research

Medications for Bladder Spasm Pain

• Antimuscarinic agents are considered the mainstay of pharmacologic treatment for overactive bladder (OAB) symptoms, including bladder spasm pain 4.
• The following antimuscarinic agents are approved for the management of OAB in the United States: oxybutynin, tolterodine, trospium, solifenacin, and darifenacin 4, 5.
• These medications work by preventing involuntary bladder contractions and/or urgency by inhibiting the muscarinic receptors within the urothelium and detrusor muscle 6.
• Studies have shown that these newer agents, such as solifenacin and fesoterodine, are at least as effective as their predecessors, with some having better tolerability profiles 5, 7.
• Oxybutynin, in particular, is well established for the treatment of OAB and is available in various formulations, including oral, transdermal, and topical gel 8, 6.
• The choice of medication depends on individual factors, such as cost, tolerability, and efficacy, with some studies suggesting that solifenacin and fesoterodine may be preferred for better efficacy, while tolterodine may be preferred for reduced risk of dry mouth 7.

Comparison of Medications

• Tolterodine versus oxybutynin: no statistically significant differences in quality of life, patient-reported cure or improvement, leakage episodes, or voids in 24 hours, but fewer withdrawals due to adverse events with tolterodine 7.
• Solifenacin versus tolterodine: statistically significant differences in quality of life, patient-reported cure/improvement, leakage episodes, and urgency episodes, all favoring solifenacin 7.
• Fesoterodine versus extended-release tolterodine: statistically significant differences in quality of life, patient-reported cure/improvement, leakage episodes, and urgency episodes, all favoring fesoterodine, but with higher risk of withdrawal due to adverse events and dry mouth 7.