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’).
When Iain first had bladder spasms, he didn’t know what they were. He had bad pain in the abdomen...
When Iain first had bladder spasms, he didn’t know what they were. He had bad pain in the abdomen...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Over the years, at different stages, what have been the important questions for you?
It’s just basically things, simple things like you know, these problems I’ve got here, describe your symptoms to the doctor and getting the answer back. And I think when I got the original bladder spasms, I didn’t know what it was. I had a very painful sensation in my abdomen. I didn’t know what it was.
Once I’d explained that to the doctor, he said, “Oh that sounds like this.” So you should have this medication, which should maybe help that problem. So I tried about three or four different medications for that problem, and finally got the right one that fixed it. And it was fantastic. I got a new lease of life.
In terms of medications, what kinds of medication do you have to take on a daily basis now?
Well one, the primary one I take for my bladder situation is, I take one called Detrusitol®, which is one tablet a day for my bladder spasm and it works generally very well.
I do still get bladder spasms now and again, when that medication doesn’t seem to work any longer properly. I still always take it but if I get what’s called an intractable spasm, I have to take diazepam to break the cycle of the spasm. So I’m taking medication to stop it, it doesn’t, so I have to take diazepam just to break the sensation, break the cycle altogether and that generally fixes it altogether.
Yes. And any other medications during the day?
I take about ten or so different medications due to other symptoms of MS. Mainly primarily pain relief, I’ve a lot of chronic pain.
Yes. And they’ve generally been pretty good?
Yeah.
Roger had a spinal cord injury, his neurological problem made his bladder worse:
Roger said that he was always in some sort of pain, either mild or more serious. He took baclofen...
Roger said that he was always in some sort of pain, either mild or more serious. He took baclofen...
SHOW TEXT VERSION
PRINT TRANSCRIPT
It’s quite an extensive, problematical thing and a constant burden, as I say, because there’s always some sort of pain, whether it’s mild pain or worse pain.
In the catheter area?
In the bladder, catheter area, yes.
Do you have bladder spasms?
I have spasms naturally from my spinal injury. I don’t know about bladder spasms particularly, but I thought a bit like having an epileptic fit sometimes, you just shake. This hand, you see, if I pick up the hand, I can’t do that without the hand shaking. So it’s a neurological problem as well, which exacerbates any bladder problem, catheter problem.
I can feel the left side of my body, well it’s a bit hypersensitive. I can’t move this arm, apart from doing that. I can move, I have movement, slight movement in this arm, although the hand’s mangled and I can’t write properly. I might be able to do some sort of sort of baby writing with this hand.
So you don’t have to take any specific medicines for the bladder?
No, I have to take baclofen for the spasms, it’s a tablet called baclofen for the spasms. Ah yes, I do take oxybutynin …
Jade had Fowler’s Syndrome.
Jade’s bladder spasms sometimes forced the bag off the end of the catheter, particularly when she...
Jade’s bladder spasms sometimes forced the bag off the end of the catheter, particularly when she...
SHOW TEXT VERSION
PRINT TRANSCRIPT
When you’re having bladder spasms, sometimes it used to, the pressure of the spasms used to force the bag off the end of the catheter. You couldn’t, you can’t stop it. You don’t know when it’s going to happen.
When I was pregnant also that happened a lot of times at the hospital. Three times in one day. I thought my waters had broken. Because I’d be sitting there and I’d just be soaked where the end of the catheter had, like where it must have been pulling round so much and the bladder spasm, and it used to just force the end off of the bag.
And so then I felt that must, I realised then that, what it must feel like to be incontinent. Like it’s not nice getting covered in urine. And that’s why I much prefer self-catheterising.
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.
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.
To help control her bladder spasms, Jade’s consultant found a good combination of medicines,...
To help control her bladder spasms, Jade’s consultant found a good combination of medicines,...
SHOW TEXT VERSION
PRINT TRANSCRIPT
My consultant managed to get me on the right cocktail of drugs and things to kind of slow my bladder spasms down. And then he said, “Right, now your bladder spasms aren’t so bad, would you like to self-catheterise?” And I was like, “Yes, please.”
What drugs did he give you?
Oxybutynin and Vesicare®. He gave me prophylactic antibiotics as well, two different ones, at the same time to try to stop the infections. That would hopefully calm down my bladder. Because obviously I’d heard about self-catheterising and I wanted to do that. But every time that I’d asked to do it previously, it wasn’t the right time. He didn’t want me to end up with things worse and having to have an emergency suprapubic or urethral put back in. He wanted to say, “Right, when we manage to self-catheterise, it’s going to be a long-term thing. It’s not going to just be temporary.”
So then we managed to get the right lot of drugs and things. And then he said to me, “Right, you could, I’ll teach you, we’ll teach you how to self-catheterise. But you’ll still have to keep your suprapubic catheter in til we’re very sure and convinced that when we take it out you’ll still be able to manage.” And so I said, “Okay.” And so then a lady [nurse] taught me how to self-catheterise.
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.
Frances, with MS, described the ‘horrendous’ side effects of oxybutynin. It dried her mouth and...
Frances, with MS, described the ‘horrendous’ side effects of oxybutynin. It dried her mouth and...
SHOW TEXT VERSION
PRINT TRANSCRIPT
Well the tablets have such a dreadful side effect. They dry your mouth up so that you gag and you choke. And it even dries your eyes as well. They were horrendous but they didn’t do what they were supposed to do, by stopping your bladder from working. And I can remember saying to the urologist, you know “Before you prescribe these to anybody else, will you just please take them yourself?” Because they are dreadful.
In the end, I got my GP to refer me to another urologist and he said straight away that I could have this suprapubic catheter done. And I didn’t really know anything about it then.
Can you tell me what the name of these tablets were?
Oxybutynin, yes.
The side effects that you had were the dry eyes?
It was the gag, I couldn’t speak to anybody. My mouth was so dry that if I tried to speak I would be, you know, I would gag all the time. It was horrendous.
Richard took several medicines for bladder spasms, including baclofen, oxybutynin and diazepam....
Richard took several medicines for bladder spasms, including baclofen, oxybutynin and diazepam....
SHOW TEXT VERSION
PRINT TRANSCRIPT
Were you ever given any medication to take daily?
Well I am on daily, I’m on anti-spasmodics, baclofen antispasmodics and oxybutynin for bladder spasms. And that’s it. Oh I have painkillers, of course, if I need them but I try not to use them. And diazepam, occasionally I’m diagnosed diazepam to help with night time spasms really.
Have you had any side effects with any of them?
I don’t think I have. But it’s hard for me to tell because I don’t know if I’m, if it’s giving me stomach ache. I don’t know other than spasms again. If it causes diarrhoea or constipation, again you know it’s hard to know if it is coming from the change of medication for me really.
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 October 2018.
Copyright © 2024 University of Oxford. All rights reserved.