Post-void suprapubic pain

Specialty: Nephrology and urology.

• bladder pain after urinating
• post-void bladder spasm

Why it occurs

• Acute bacterial cystitis with severe bladder urgency (the final and sudden contraction of the inflamed detrusor against the denuded bladder trigone generates a residual painful spasm)
• Impacted bladder stone in the bladder neck (the stone obstructs the funnel of the bladder neck at the end of urination and mechanically tears the surrounding mucosa when the detrusor contracts)
• Pelvic floor dysfunction or levator ani hypertonia (reflex spasm of the perineal striated muscles triggered by the urinary emptying reflex)
• Carcinoma in situ of the bladder (the neoplasm erodes the mucosa, the total emptying exposes the sensory nerve endings to direct contact with the opposite epithelium causing burning pain)

Initial workup

Microbiological analysis of urine with sediment and urine culture; pre- and post-void bladder ultrasound (search for bladder stones or tumors); diagnostic cystoscopy with biopsy if the pain is refractory or associated with persistent microhematuria; Urodynamic study in suspected muscle dysfunction.

Standard management

• Butylscopolamine bromide — 10-20 mg every 8 hours orally or intravenously as a spasmolytic to control pain due to bladder contraction
• Ibuprofen — 400 mg every 8 hours orally with food to reduce the inflammatory component
• Tamsulosin (0.4 mg daily orally to facilitate the opening of the bladder neck by reducing the terminal contractile force required by the bladder).