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Fowler's Syndrome or Fowlers Disease is a lesser known health condition that causes urinary retention in women who do not have any existing urological, gynecological or neurological disease. This condition is named after Professor Clare J Fowler who was the first person to describe it in the year 1985. In this condition, retention volume of urine is usually in excess of 1000 ml. Despite the high bladder volumes, the patient experiences no sense of urinary urgency. Urinary retention is caused due to the failure of the bladder's sphincter muscles to relax. This condition usually affects young women and is more common in women with polycystic ovarian syndrome (PCOS) and endometriosis.
Symptoms of Fowler's Syndrome
The severity of the symptoms varies from one woman to another. While some patients are unable to pass urine completely, others may be able to pass urine with some difficulty, but retaining significant amount in the bladder. The symptoms such as pain, discomfort and recurrent infections can be quite distressing for the patient.
- The patient may pass urine infrequently with an intermittent stream
- The normal sensation of urinary urgency experienced with a full bladder are absent
- There may be pain and discomfort as the bladder nears full capacity
- The patient is unable to urinate
- Some women may experience dysuria (discomfort or burning while passing urine) due to urine infection
- Back pain and suprapubic pain (pain over the bladder) may also be present
- Recurrent cystitis (bladder infections) and kidney infections
Causes of Fowler's Syndrome
Well, the exact cause or factor that gives rise to Fowler's Syndrome is not yet known and it is still in the stage of research. But it has been seen that this condition occurs simultaneously or following childbirth or an operative procedure (urological, gynecological or even ENT).
Diagnosis of Fowler's Syndrome
Some of the common tests that are done to diagnose Fowler's Syndrome are as follows:
Sphincter Electromyogram (EMG):
This is the most important diagnostic test for Fowler's Syndrome. During this test, a small needle is used to record a small area of the sphincter. A local anesthetic is administered into the sphincter region before this test. This test records characteristic waveforms and sounds. This test is done only by specialists who have expertise in this field.
Flow Rate: (Uroflometry)
This test measures the speed of the stream and how long it takes for the patient to pass urine. For this test, the patient has to sit on a special toilet and urinate normally. A computer measures the rate of flow of urine and represents it as a graph. This test helps to understand whether the patient's stream is interrupted and how bad the urinary retention is.
This test provides valuable information on the rate of emptying of the bladder. An ultrasound scanner is used to measure the amount of urine retained in the bladder after a patient has passed urine. In normal cases, the bladder should be totally empty right after urinating.
This test is also known as Cystometry and it is especially beneficial if the patient is unable to pass urine completely. During this test, two small catheters or tubes are placed, one in the bladder and another in the rectum. The bladder is filled with saline water and then it is monitored to identify any irregular spasms. The patient is asked to pass urine with the catheters which provides information about the pressure that the bladder muscles are generating for a particular urine flow rate.
Urethral Pressure Profile:
This test provides information about the amount of pressure that is generated by the sphincter and measures the rate of over activity of the muscle. For this test, a catheter is inserted into the urethra and saline is slowly infused through the catheter. Then the catheter is withdrawn and re-inserted several times into the bladder while the pressure of the sphincter is measured.
Ultrasound Sphincter Volume Measurement:
In this test the volume of urethral sphincter is measured using an ultrasound. For this test, a small probe is inserted in the vagina in order to identify the sphincter in order to take the measurements and calculate the volume. An overactive sphincter may be enlarged due to constant muscle engagement.
Treatments for Fowler's Syndrome
The treatment options for Fowler's Syndrome are still at a stage of research and development. The bladder function may recover spontaneously in some patients while in others it can be a life-long condition for which special treatment may be required to manage the condition.
Intermittent Self Catheterisation:
In this procedure, a catheter is inserted into the bladder for emptying it. This emptying is done at regular intervals in order to ensure that no urine is stagnant or retained in the bladder. Stagnant urine can lead to bladder and kidney infections.
Sacral Nerve Stimulation:
It is a process in which small electrical pulses are administered to stimulate the nerves present in the lower back (just above the tail bone). These nerves are involved in controlling the sensation of the bladder. This treatment can be a life changing therapy because it can help to restore normal bladder function. This therapy addresses the problem in communication between the bladder and the brain, but it is not suitable for everyone.
Sacral Nerve Stimulation is performed in 2 stages:
The first stage consists of evaluation and test that allows the doctor to understand whether the symptoms will be reduced by the procedure and the second stage includes an implant.
So, if you experience any discomfort while passing urine or notice that you don't feel the urge to urinate for hours at a stretch then it may be time to get in touch with a Continence Advisor or Consultant Urologist who have specialized experience on Fowlerâ€™s Syndrome and catheterization techniques.
If you are on the lookout for a Urologist in Patna then you can contact Dr. Anoop Kumar Mishra, who has a vast experience in urology and andrology.