WHAT IS FOWLER’S SYNDROME?
Fowler’s syndrome is a rare condition characterized by the disability to pass urine freely in women traceable to the neurological or anatomical abnormality of the urethral sphincter that makes it unable to relax properly. Hence, urine flow is distorted.
It was first described in 1988. It is found in young women but more prevalent in women between menarche and menopause. Most cases of fowler’s syndrome in young women were reported to have started in their 26th year with about one-third of most cases of urinary retention in women resulting from fowler’s syndrome.
People with this condition often complain about having no urge to urinate and may not do so for a day or more. A normal person feels the urge to urinate when the bladder is at a volume of 400-500ml but people with fowler’s syndrome even when the bladder is more than 1litre hardly feel the urgency to urinate. This could lead to a progressive increase in abdominal pain. This condition is mostly associated with polycystic ovary syndrome and endometriosis.
Recent studies have shown that although the exact number is not yet known, it is estimated that 0.3 percent of cases of urinary retention is caused by Fowler syndrome.
RISK FACTORS OF FOWLER’S SYNDROME
Certain factors increase the risk of developing fowler’s syndrome in women. They include:
COMPLICATIONS OF FOWLER’S SYNDROME
Some complications of fowler’s syndrome are bladder infections, polycystic ovaries, endometriosis, chronic back pains, urinary tract infections, etc
Their quality of life may also be affected. fowler’s syndrome in women 50 years old and elderly women often leads to complications such as hip fracture, and urinary tract infections, sometimes suprapubic pains, etc due to the retention of urine.
Fowler’s syndrome and pregnancy could be quite uncomfortable and affect the health of the fetus and the mother, leading to death in severe cases.
DIAGNOSIS OF FOWLER’S SYNDROME
The diagnosis of fowler’s syndrome can be done by carrying out some tests in the lab.
Your personal medical history will be examined. The doctor will also conduct a physical examination on you.
Some other tests can also be conducted. Such test includes:
This includes cystometry and urethral pressure profilometry.
This is a procedure that involves placing two small catheters, one is places at the bladder and the other at the rectum, then saline water is passed into the bladder and monitored for any irregularities. Then you are asked to pass urine with the catheter in, this is done in order to ascertain the pressure of which your bladder muscles generate at a particular flow rate. This may take 30 to 40 minutes.
- Complications of surgery procedure.
- Use of opiates.
- Medical history of urinary abnormalities in childhood.
In this procedure, you are asked to lie on your back, a catheter will be inserted into your urethral, and saline water is infused slowly into the bladder. Then the pressure of the urethral sphincter is measured, the urethral pressure profilometry shows an abnormally high urethral pressure profile, then the presence of fowler’s syndrome is suspected.
This is also carried out but for those who can still urinate. You sit to urinate normally but in a special toilet and the speed of your urine is measured and the time it takes to flow is measured and a graph drawn.it is relatively easy to do.
This is done using ultrasound. It helps gives information on how well the bladder was able to be empty after passing urine.
- Urethral Pressure Profilometry
This is to check the excitability level of the muscle. If it is not normal and is very high, with a low deceleration of the excited muscles, then fowler syndrome is suspected.
FOWLER’S DISEASE TREATMENT
The treatment of fowler’s syndrome is mainly in managing its symptoms and aiding urinary flow.
One of the major ways this is done is by sacral neuromodulation therapy. This procedure involves planting a device into the body, which helps stimulate the nerve reflexes of the bladder that is associated with the lower urinary function. This procedure is done surgically and it is quite effective. Medications can also be administered such as Sphincter injections of botulinum toxin, etc
Catheterization such as suprapubic catheter may be used. Women with fowler’s syndrome may experience pain whilst putting the catheter themselves and may need someone to assist them with it.
The recovery and success rate using sacral neuromodulation is relatively 70 percent although this line of medication is conducive for everyone depending on the medical need of the person involved
- Testing the Electromyography of the External Urethral Sphincter
FOWLER'S SYNDROME SYMPTOMS
The symptoms of fowler's syndrome could differ from person to person depending on their body system as some persons might experience mild symptoms and others experience severe symptoms.
Some general symptoms of fowler's syndrome include:
- Inability to urinate
- Lack of urge to urinate even when the bladder is full
- Abdominal pains
- Abnormalities in the urethral
- Painful urination
FOWLER'S SYNDROME CAUSES
During the early times in 1988 when the disease was first described, its cause was not apparent and it was mostly thought to be psychological but in recent times, it can be traced to the poorly relaxing of the external urethral sphincter but the exact cause of why the external urethral sphincter becomes affected has not been known yet although there have been some theories as to why the external urethral sphincter may be affected.
Ine of such theories claims it could be due to an abnormality in the muscle membrane that could be hormonal, which then results in the excess excitability of the urethral sphincter. The urethral sphincter is a circular muscle that aids in controlling urine passage from the bladder through the urethra and out of the body. This could also result in fowler's syndrome disability.
Sometimes, this disability could be characterized by impaired voiding, voiding difficulties with incomplete bladder emptying, occasional impairment in urination. Catheterization is often very painful.
Women with fowler's syndrome usually find this condition disabling. Fowler's syndrome is a disability that could effects the quality of life women with this condition live due to the limitations that comes with it as over 50% of women with fowler's syndrome complains of unexplainable chronic pains that sometimes spread to the back.
- Can Fowler's syndrome lead to death?
Fowler's syndrome can lead to death in severe cases, especially in the elderly and pregnant women, who are not given adequate and proper treatment
- Can men have fowler's syndrome?
Fowler's syndrome is the inability of a person to pass urine adequately and lack of urge to empty the bladder even when it is filled up. It is not gender relative and can occur in any gender but it is more prevalent in females.
- Can pregnant women have fowler syndrome?
Fowler's syndrome which is rarely rare and characterized by the inability to pass out urine adequately can occur in pregnant women also and this could result in serious complications, and an increased risk of urinary infections, which could result in the death of the mother and fetus.
- Is fowler's syndrome a disability?
Fowler's syndrome is a clinical condition characterized by the lack of urge to empty the bladder even when it is filled up. It is not a disability in itself but could lead to other disabilities and limit one's quality of life.
- How can I relax my bladder naturally?
You can relax your bladder naturally through exercises, recording how frequently you go to the bathroom. Try retraining your bladder by delaying urine in small intervals when you feel the need to urinate.