Chances are we have all crossed our legs a time or two in hopes of making it to the closest restroom in time. But there's a big difference between having to go, and always feeling like you have to go. For those who live with bladder spasms, that feeling is a painful reality that can lead to embarrassing wetting accidents and an unwanted shift in lifestyle. However, there are a variety of treatment options available to manage the symptoms. Here's what you need to know about bladder spasms, from the causes to what you can do to ease the pain.
What Do Bladder Spasms Feel Like?
Normally, the bladder gently fills with urine and you slowly become aware of the need to urinate. This feeling is your cue to start looking for a bathroom.
But in people who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
People who have had such spasms describe them as a cramping pain and sometimes as a burning sensation. Some women with severe bladder spasms compared the muscle contractions to severe menstrual cramps and even labor pains experienced during childbirth.
Who Is Most Likely to Develop Bladder Spasms?
Anyone at any age can have bladder spasms. In children, bladder spasms (also called pediatric unstable bladder or uninhibited bladder) are the leading cause of daytime incontinence.
However, you are more likely to have bladder spasms with urine leakage if you:
- Are elderly
- Are going through menopause
- Have diabetes
- Are obese
- Recently had a baby or are pregnant
- Have a urinary tract infection
- Have recently had lower abdominal or pelvic surgery
- Have bladder muscle damage caused by disease or injury
- Have a neurologic disease such as stroke or spinal cord injury
What Causes Bladder Spasms?
There are a number of different causes of bladder spasms. The cramping pain could be due to something as simple as your diet or a medication that you are taking, or it could be associated with changes in blood supply and function of the nerves controlling the bladder.
However, bladder spasms may be the result of an infection or a recent surgery, or they may occur if you have nerve or muscle damage. So it's important to see a doctor to determine the cause.
In some cases, your doctor may not be able to identify the cause. When this happens, the condition is called idiopathic bladder spasms.
Some common causes of bladder spasms are:
- Urinary tract infection (UTI): Bladder pain and burning are a common symptom of a UTI.
- Interstitial cystitis (IC), also called painful bladder syndrome: This condition refers to bladder and urinary pain that is not due to other causes, such as a urinary tract infection. Pain is recurring and often severe.
- Catheter use: A catheter is a thin tube used to drain urine from the body, often after surgery. It is placed into the urethra and up into your bladder. Bladder spasms are a common and sometimes distressing complication of catheter usage.
Nervous System Disorders That Lead to Bladder Spasms
The feeling you get when you need to empty your bladder is normally an involuntary response. The brain signals the bladder muscle when it is time to tighten (contract) and release urine. However, certain nervous system disorders cause damage to the nerves that send signals between the brain and the bladder. When this happens, the bladder does not work properly. "Neurogenic bladder" is the general term for bladder problems due to nerve damage.
Nervous system disorders and injury that can cause bladder spasms include:
- Brain tumor
- Cerebral palsy
- Herpes zoster infection that affects the nerves in the sacrum
- Multiple sclerosis
- Parkinson's disease
- Multiple system atrophy (Shy-Drager syndrome)
- Spinal cord injury
- Stroke that has caused brain damage
- Diabetic neuropathy (when the nerves are damaged by longstanding diabetes)
Surgery That Leads to Bladder Spasms
Surgery to the lower abdominal area may weaken the bladder or pelvic floor muscles, or cause damage to the nerves that control the bladder. Bladder spasms may occur following certain surgeries, including:
- Bladder surgery (a common cause of bladder spasms in both children and adults)
- Cesarean section
- Hysterectomy (removal of the uterus, or womb, and sometimes the surrounding female organs, including the ovaries and fallopian tubes.)
- Prostatectomy (prostate removal)
- Other lower abdominal surgery
Other Causes of Bladder Spasms
Some medications may cause bladder spasms as a side effect. Medications that commonly cause bladder spasms include:
- Bethanechol (urecholine)
- A chemotherapy drug called valrubicin (Valstar)
- Medicines called diuretics, such as furosemide (Lasix) or hydrochlorothiazide, which help the body remove excess water
What you eat or drink can sometimes bother a fragile bladder and cause it to go into a spasm. This is especially true in patients who have a condition called interstitial cystitis.
Spicy, acidic, or citrusy foods and the chemicals in certain preservatives and food additives may irritate the lining of the bladder in some people. Such products may include:
- Artificial sweeteners
- Caffeinated beverages such as soda, coffee, and tea
- Citrus fruits and drinks, such as oranges and orange juice
- Pickled foods
Treatment of Bladder Spasms
How your doctor treats your bladder spasms depends on what exactly is causing your painful symptoms. But in general, therapy may involve one or more of the following treatments. A combination of treatments often works best.
Botox. Botulinum-A toxin has been shown to reduce nerve-related bladder spasms in children and adults. Botox prevents nerves from releasing chemicals that tell muscles to contract. The Botox is injected directly into the bladder muscle wall.
Change in diet. This may help prevent bladder pain if certain foods and beverages are the culprit behind your spasms. Keeping a food diary, which tracks your meals and your symptoms, can be helpful.
Timed voiding. This involves timed trips to the bathroom to urinate, usually every 1.5 to 2 hours. Timed voiding is especially helpful for children. As the bladder spasms get better and fewer wetting accidents occur, you can extend the time between trips to the bathroom.
Pelvic floor exercises ("Kegels"). Kegels and other forms of physical therapy help strengthen the bladder and other muscles that help the body hold in urine. Kegels, combined with biofeedback, are often a good way to help reduce bladder spasms in children. To tighten your pelvic muscles, squeeze your muscles in the same way as if you were trying to stop the flow of urine or prevent yourself from passing gas. Kegel exercises take practice, and tightening the wrong muscles can put more pressure on your bladder. Ask your doctor for specific instructions.
Medicines to relax the bladder. The most commonly prescribed drugs to relax the bladder and prevent spasms are called anticholinergics. They include tolterodine tartrate (Detrol LA), oxybutynin chloride (Ditropan), darifenacin (Enablex), oxybutynin (Oxytrol), trospium chloride (Sanctura XR), and solifenacin (Vesicare). Common side effects are constipation and dry mouth.
An antidepressant called imipramine hydrochloride (Tofranil) also helps relax the bladder and reduces bladder spasms.
Medicines called alpha-blockers (such as terazosin or doxazosin) may be given to help the bladder relax and allow the bladder to empty completely.
TENS. Electrical stimulation through the skin (transcutaneous electrical nerve stimulation, or TENS) sends mild electrical pulses to the bladder through patches applied to the skin. It's believed the electric signals help you feel better by increasing blood flow and releasing hormones that block pain. TENS is sometimes used to relieve muscle or back pain. In the case of bladder spasms, doctors think the increased blood flow makes the bladder muscle stronger, which reduces spasms and leakage.
Electrical stimulation implant (Inter-Stim). This is placed under the skin to deliver gentle electrical pulses to the bladder at regularly timed intervals. Your doctor may recommend this therapy if you have severe bladder spasms and urge incontinence that does not get better with other treatments.
Pain medicines and sedatives. These may be given to patients who have catheter-related bladder spasms after surgery. But they don't always take away all the discomfort. Some research suggests that a prescription anti-inflammatory medicine called ketorolac may help relieve or prevent catheter- or surgery-related bladder spasms in children.
Complementary and Alternative Therapies
Acupuncture. Some research has suggested that bladder-specific acupuncture may significantly reduce bladder muscle contractions and the urge to use the bathroom.
Biofeedback. Biofeedback is a method that teaches the mind how to control normally automated body functions. Bladder training is a type of biofeedback. Some doctors believe biofeedback and behavioral changes work better than medicines for treating urge incontinence. A combination of biofeedback and medications may work best.
When to See a Doctor
Call your doctor if you have:
- Pain or cramping in your pelvic or lower abdominal area
- Pain or burning while urinating
- Urgent or frequent need to use the bathroom
- Leakage of urine
- Blood in your urine
If you have or think you are having bladder spasms, it is important that you see a doctor for a proper diagnosis. Your symptoms may be due to an infection that can be treated. In rare cases, bladder spasms may be a sign of a serious underlying condition.