Medications and injections

Authors: SCIRE Community Team | Reviewer: Bonnie Nybo | Published: 18 January 2018 | Updated: 16 October 2024

Several medications may be used to help manage bladder problems after SCI. These may help to relax overactive muscles or cause the bladder muscles to contract, depending on the type of bladder change experienced. A number of other medications may also be used for different aspects of bladder treatment after SCI.

Some medications may be dissolved in a liquid solution and introduced into the bladder through a catheter after emptying. The solution is then left in the bladder until the next urination. This is called an intravesical instillation. Intravesical instillations may be used because their effects are more specific to the bladder, instead of throughout the whole body as with oral medications.

Anticholinergic medications

(sometimes called

antimuscarinic medications

) are used to relax muscle spasms in the bladder wall muscle. This can help to reduce pressure within the bladder, increase the ability of the bladder to hold urine, and help reduce incontinence.

There are many different types of anticholinergic medications, with the most common being:

• oxybutynin (Ditropan, Ditropal XL, Oxytrol, Uromax)
• tolterodine (Detrol)
• fesoterodine (Toviaz)
• trospium chloride (TCL, Trosec)
• propiverine hydrochloride (Mictonorm)
• darifenacin (Enablex)
• solifenacin (Vesicare)

These can be taken by mouth or administered directly into the bladder in a liquid form.

Alpha-adrenergic blockers are medications that are used to encourage the bladder sphincter muscles to relax to allow urine to flow out of the body. This can help with bladder emptying and help prevent urinary retention. Common alpha-adrenergic blockers that may be used include tamulosin, mosixylyte, terazosin, and phenoxybenzamine.

Injecting small doses of some strains of

botulinum toxin

(

Botox

) into muscles can help to reduce muscle spasms. Injections into the bladder wall muscle or the external sphincter muscle can help to relax these muscles to help prevent leaking and incontinence or to improve bladder emptying. The effects of these injections can last for 6 to 12 months.

Read our article on Botulinum Toxin for more information!

Capsaicin is commonly found in hot peppers.⁷

Capsaicin, a chemical commonly found in hot peppers, and its derivative resiniferatoxin, may be administered as a liquid into the bladder to help reduce urinary frequency, leaking, and bladder pressures related to bladder wall muscle overactivity, and increase bladder capacity.

Nociceptin/orphanin phenylalanine glutamine

is another medication with effects similar to capsaicin and resiniferatoxin. It may also be given into the bladder to reduce overactivity in the bladder wall muscle.

Medications that are normally used to treat spasticity may also help with bladder problems related to spastic bladder. For example,

baclofen

and

clonidine

may help with bladder function after SCI.

Phosphodiesterase-5 (PDE5) inhibitors

such as

tadalafil

and

vardenafil

may help to reduce overactivity in the bladder wall muscle and increase bladder capacity.

4-Aminopyridine

(

fampridine

) improves the transfer of nerve signals, which may help individuals regain sensation and control of the bladder sphincter muscles to improve emptying.