BLADDER SPASMS

Bladder spasms (hyperactivity of detrusor muscle) cause intermittent suprapubic pain together with urinary urgency. Bladder spasms occur due to radiation cystitis or tumors (bladder, prostate). An indwelling urinary catheter usually worsens the discomfort. It is important to exclude urinary tract infection or fecal impaction.

The most useful drug is oxybutynin, a powerful antispasmodic with local anesthetic properties. Oxybutynin 5mg to 10mg 3 times a day can be very effective in reducing bladder spasms. Anti-cholinergic side effects (particularly a dry mouth) can be severe.

The tricyclic drugs also reduce bladder spasms (for example, imipramine 25mg to 50mg at bedtime). NSAIDs can sometimes reduce detrusor hyperactivity (naproxen 500mg 2 times a day). Bromocriptine, starting at 1.25mg per day and increasing up to 2.5mg 2 times a day can reduce urinary urgency and frequency (presumably via its dopamine agonist effect) but may cause nausea, headache and postural hypotension.

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