Introduction
Infection of the urinary system involving the upper and lower urinary tract or only the lower urinary tract is called a urinary tract infection. The risk of developing urinary tract infections increases with age, and it is among the most common infections in elderly people, especially those above 65 years. It is also frequently seen in long-term care resident patients due to nursing home infections. The incidence is higher in women compared to men and may be challenging to treat compared to younger adults due to asymptomatic bacteriuria (ASB).
What Are Bladder Spasms?
Sudden involuntary contractions or tightening of the detrusor muscle (bladder muscle), causing an urgent sensation for urination, is a bladder spasm. It is sometimes associated with pain and burning sensation and can be embarrassing in some situations. If the contractions continue, it may even cause leakage of the urine. Bladder spasms can lead to social isolation and depression in some individuals; and impact the quality of life. However, bladder spasms are common with aging and may indicate health issues. Urinary tract infections may also lead to bladder spasms when bacteria enter the urinary tract. It is associated with pain in the lower abdomen and back, a burning sensation while urinating, and fever.
What Are the Causes of Bladder Spasms?
Bladder spasms in elderly people can occur due to the following conditions:
-
Urinary tract infections in elderly people occur due to decreased immunity, exposure to nosocomial microorganisms (hospital or healthcare-associated infections), presence of a urinary catheter, and underlying comorbidities such as stroke, dementia, etc.
-
Enlarged prostate gland.
-
Neurological diseases such as Parkinson’s disease, Alzheimer's disease, multiple sclerosis, stroke, cerebral palsy, etc
-
Interstitial cystitis.
-
Certain medications, such as Bethanechol, Furosemide, Valrubicin, etc.
-
Impaired kidney functions.
How Can Urine Infections in Elderly People Be Prevented?
-
Prevention of urinary tract infections can help reduce bladder spasms in elderly people. Antibiotic prophylaxis and non-antimicrobial therapies, such as estrogen therapy administered in females, can be beneficial.
-
Increasing the fluid intake can flush out the bacteria and reduce the infection.
-
Maintaining proper personal hygiene by washing and wiping the area after urination.
-
If the patients are on adult diapers, they must be regularly checked and replaced.
-
Regular exercises, meditation, adequate rest, and a healthy diet helps to improve immunity and prevent infections.
When Should Patients Seek Medical Help for Bladder Spasms?
Bladder spasms require immediate management if associated with fever, severe pelvic pain, and the presence of blood in the urine. Patients with bladder spasms associated with urine leakage must contact a doctor as early as possible and must get evaluated to determine the underlying cause. If the doctor suspects the bladder spasms are due to a urinary infection, a urine test and urine analysis are recommended, which helps in treatment planning.
How to Stop Bladder Spasms Associated With Urinary Tract Infections in Elderly People?
Management of bladder spasms in elderly people depends on the severity and the underlying cause. Combination therapy is usually preferred, and the doctor will treat the cause and symptoms, followed by the treatment of bladder spasms. The first line of treatment for bladder spasms due to UTI includes antimicrobial agents to treat the underlying cause.
The most common organism responsible for urinary tract infection is Escherichia coli, followed by Klebsiella, Enterobacteriaceae, Proteus mirabilis, etc., or some gram-positive organisms such as Staphylococcus aureus and Enterococcus.
Treatment of UTI: Nitrofurantoin monohydrate 100 mg is recommended twice daily for five days, or Trimethoprim-Sulfamethoxazole 169/800 mg twice daily for three days. Nitrofurantoin is contraindicated in patients with chronic kidney disease; therefore, Trimethoprim-Sulfamethoxazole is preferred. The lower UTI is often managed with a three to a five-day regimen of any one of the following drugs:
- Ciprofloxacin 250 - 500 mg every 12 hours.
- Ofloxacin 200 - 400 mg twice a day.
- Cephalosporins like Cephalexin 250 - 500 mg sixth hourly.
- Amoxicillin 500 mg with Clavulanic acid 125 mg.
The upper UTI needs more aggressive management with parenteral antimicrobial agents such as Ceftriaxone and Cefuroxime for around 10 to 14 days. Antimicrobials used for prophylaxis are Cotrimoxazole, Nitrofurantoin, and Norfloxacin may be advised for long-term treatment.
Treatment of Bladder Spasms: Medications, such as antimuscarinic drugs, play a pivotal role in the management of bladder spasms in elderly people. Oxybutynin was used in the 1970s but led to side effects such as blurred vision, constipation, and dry mouth. This led to the discontinuation of the drug, and to overcome the same, specific muscarinic agents which act by blocking the M2 and M3 muscarinic receptors were introduced after the year 2000. These include Solifenacin, Trospium, Fesoterodine, Darifenacin, etc. These drugs are more specific compared to Oxybutynin but were associated with similar adverse effects. Miracegron, a beta-agonist, has been approved recently to treat bladder spasms. It can be used alone or in combination with Solifenacin, which is known to reduce the symptoms more effectively when compared to monotherapy. These drugs relax the bladder muscles and prevent the leakage of urine.
With the administration of pharmacotherapy, the bladder spasms can be effectively managed; however, some patients with predominant symptoms of bladder spasms may require non-pharmacological interventions along with medications such as:
Lifestyle Modifications: Avoiding alcohol, caffeine, and acidic foods may be recommended to regain control over the bladder. Pelvic floor exercises may be advised, which help to strengthen the pelvic muscles and help control urination.
Electrical Stimulation: Electrodes are inserted temporarily into the rectum or vagina, which act by stimulating and strengthening the pelvic floor muscles. It can also be effective for stress incontinence and may require treatment for a few months.
If medical treatments are ineffective in treating bladder spasms, drip collectors, pads, or protective garments are advised to help manage urine leakage and prevent discomfort. Drip collector devices have absorbent padding, which helps absorb the urine.
Conclusion
Sudden involuntary contractions of the detrusor muscle, causing an urgent sensation for urination, is a bladder spasm. It can be caused due to various reasons, and one of those is urinary tract infections. It is associated with pain and burning sensation, can be embarrassing in some situations, and affects the quality of life. It is managed by a combination of drugs through pharmacotherapy, along with lifestyle modifications.
