Fowler's syndrome

This condition affects women, often under the age of 30 years. The predominant complaint is the inability to urinate for a day or more with no urgency to urinate, in spite of a large bladder volume of more than 1 liters. Normally a person feels the need to urinate at a bladder volume of 400-500ml. The person usually has a progressively increasing lower abdominal pain. The condition is commonly seen in women with Polycystic ovary Syndrome and Endometriosis.[2] It is seen in about one third of women having complaints of urinary retention.[3] They will have no neurological or other urological complaints.

Alternatively, women with FS can also present with impairment in urination, like obstructed urination or increased frequency of urination but rarely becoming incontinent.[2]

The exact cause of Fowler's syndrome is not yet known. The probable cause is an abnormality in muscle membrane, possibly due to a hormonally dependent channelopathy.[4] This may cause an excessive excitability of the external urethral sphincter which prevents the adequate relaxation of the muscle necessary for voiding .[5]

Cystometrogram shows large bladder capacity and absence of sensations during the filling phase. The maximum urethral closure pressure (MUCP) is raised.[6] The diagnosis is done by testing the electromyographic (EMG) activity of external striated urethral sphincter. The usual findings are complex repetitive discharges without and with deceleration (decelerating bursts), suggesting an impairment in sphincter muscle relaxation.[7][4]

Sacral neuro modulation is the commonly practiced treatment for restoration of normal micturition. This technique involves modulation of micturition reflex by stimulating S3 nerve root.[8][9]

This disease was described first by Fowler et al in 1985.[10]