Living with a urinary catheter

Bladder spasms

Bladder spasms are contractions of the bladder. They may be caused by a urinary tract infection (UTI) or irritation from a catheter. They may also occur in any disease that affects the nervous system, such as multiple sclerosis (MS). People who have had surgery in this area of the body might also have bladder spasms. Certain medicines such as the diuretic frusemide (Lasix), spicy and acidic foods, and drinks such as coffee may also cause them.
 
Bladder spasms can be painful and often lead to an urge to urinate. Incontinence may occur if the bladder spasms continue because the contractions will force urine out. If a catheter is in place, the spasm can occasionally force the drainage bag off the end of the catheter. Spasms may also make it difficult to remove a catheter (see ‘Catheter changes’).
Roger had a spinal cord injury, his neurological problem made his bladder worse:
Jade had Fowler’s Syndrome.
Bladder spasms can be treated conservatively with pelvic floor exercises, and changes to fluid intake and diet, and often medicines. If these treatments don’t work, electrical stimulation through the skin (transcutaneous electrical nerve stimulation, ‘TENS’) might be used, sending mild electrical pulses to the bladder through patches applied to the skin.
 
In other cases, doctors may suggest a procedure called sacral nerve stimulation (also called sacral neuromodulation). A device is placed under the skin to deliver gentle electrical pulses to the bladder at regularly timed intervals. This may be used for severe bladder spasms and urge incontinence that does not respond to other treatments. It is not suitable for everyone. In rare cases, doctors may suggest surgery.
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Complementary therapies include acupuncture, biofeedback (a method that teaches the mind to control normally automated body functions) and Botox (see below). Many people we interviewed talked about what had been prescribed to control bladder spasms.
A few other medicines were mentioned too. For example, Frances, with multiple sclerosis, had used Sativex®, a spray made from cannabis, to prevent bladder spasms. Before a medicine can be marketed in the UK, it must be licensed by either the European Medicines Agency (EMA) or the British Medicines and Healthcare products Regulatory Agency (MHRA). Sativex is licensed by the EMA, allowing specialists to prescribe it. Frances used the spray before the district nurse comes to change her catheter.  
 
All medicines have side effects which may not be obvious. In some people oxybutynin caused a dry mouth. Jennifer found oxybutynin patches better than the tablets, but thought doctors might not tell people about them because they are expensive. Other people were not sure which of their medicines caused which side effects.
Medicines controlled Iain’s bladder spasms reasonably well (see above), but sometimes he had ‘intractable spasms’ which didn’t respond. He plans to have some injections of botulinum toxin (Botox) which can reduce nerve-related bladder spasms in children and adults. It prevents nerves from releasing the transmitter substance that tell muscles to contract. Botox is injected directly into the bladder muscle wall. The doctor examines the bladder via the urethra, using a cystoscope, and then injects the Botox into the bladder wall using a special needle passed through the cystoscope. The procedure is done under local or general anaesthetic.

While Botox injections reduce the frequency and severity of bladder spasms in many patients, in some people they don’t and, occasionally, symptoms get worse. Other side effects include difficulty in passing urine. Some people cannot pass urine at all and have to self catheterise or have an indwelling catheter until Botox wears off. How long the effects of the injection last varies among patients.  

Last reviewed June 2015.

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