What is Fowler’s Syndrome?
First described in 1985, Fowlers Syndrome is a cause of urinary retention (inability to pass water normally) in young women. Urinary retention in young women is not common but can be quite debilitating. The abnormality lies in the urethral sphincter (the muscle that keeps you continent). The problem is caused by the sphincter’s failure to relax to allow urine to be passed normally. There is no neurological disorder associated with the condition and up to half the women have associated polycystic ovaries.
Fowler’s Syndrome Symptoms
The typical woman who is seen with the condition is in her 20-30s and may infrequently pass urine with an intermittent stream. The normal sensation of urinary urgency expected with a full bladder are not present but as the bladder reaches capacity there may be pain and discomfort, and she finds that she is not able to pass urine.
Some women may experience back pain, suprapubic pain (pain over the bladder) or dysuria (discomfort/burning whilst passing urine) due to the urinary infections.
Classically, the woman presents to the hospital as they have been unable to pass urine for many hours and a catheter (tube that drains the bladder) is inserted, and usually over a litre is drained with consequent relief of the pain.
If the retention occurs after an operation in hospital, urinary retention may occur during the night after the operation when the patient develops pain over their bladder.
Initial hospital management is carried out by the urology team at the local hospital but if the symptoms do not resolve, the patient may be referred on.
There is a spectrum in the severity of the condition, with some patients being able to pass urine with difficulty but leaving significant amounts, and some not being able to pass any (complete retention).
Many women who are not in complete retention, may present to they doctors complaining of recurrent cystitis (bladder infections) or even kidney infections.
What causes Fowler’s Syndome?
The cause and process which gives rise to Fowler’s Syndrome is not yet known and is still under research. However, it can happen spontaneously or following an operative procedure (gynaecological, urological or even ENT) or following childbirth.
Treatment for Fowler’s Syndrome
The treatments for Fowler’s Syndrome are currently being researched and developed. Although, there are some limited options available, but they depend on the severity of the condition.
Most commonly patients tend to have a poor urine stream but can still go to the toilet almost normally. These patients will have their residual volume monitored and if its found to be low, no intervention is necessary.
Some patients have a large residual volume which can cause urinary infections and a large bladder. These patients can manage their condition with regular intermittent catheterisation. This involves putting a sterile catheter into the bladder at regular intervals to empty the bladder.
The most severe patients, those in complete retention may be suitable candidates for sacral nerve stimulation, which is the only treatment shown to restore voiding.
For more information on Fowler’s Syndrome please visit The Institute of Neurology at University College London