Hinman Syndrome
What is it?
Hinman Syndrome is a condition where the bladder fails to empty properly due to excessive tension in the pelvic floor muscles and lack of coordination in the digestive muscles during voiding. In this syndrome, even though the bladder is physically full, the person may not feel the urge to urinate, or the urge may be impaired. As a result, patients struggle to empty their bladder. It is not a neurological finding but mimics neurogenic bladder, hence also known as "non-neurogenic neurogenic bladder."
Hinman Syndrome is typically diagnosed in childhood and is more common in boys. It can also occur in individuals who have other conditions impacting bladder emptying.
Symptoms may occur together or on their own.
Main symptoms include:
- Difficulty initiating urination or a weak urine stream
- Sensation of urgency or frequent urge but passing only small amounts
- Urinary incontinence and sudden involuntary voiding
- Constipation and related digestive issues
- Abdominal pain and pelvic discomfort
History and Physical Examination:
- Detailed review of symptoms such as voiding difficulties, incontinence, urgency, constipation, and pelvic pain.
- Physical exam assessing bladder and rectal function.
Uroflowmetry:
- Measures urinary flow rate, duration, and volume; often shows low flow patterns in Hinman Syndrome.
Urodynamic Studies:
- Assesses bladder pressure, capacity, and pelvic muscle coordination during filling and voiding.
Cystoscopy:
- Endoscopic visualization of the bladder and urethra to exclude structural abnormalities.
Electromyography (EMG):
- Records pelvic floor muscle activity; irregular contractions or increased tension support the diagnosis.
Urinalysis and Culture:
- Rules out infection that may mimic bladder dysfunction.
Treatment is individualized based on the child’s age, symptom severity, and kidney function. Key approaches include:
Behavioral Therapy (Urotherapy):
- Timed voiding schedules (e.g., every 2–3 hours).
- Regulated fluid intake.
- Bladder training to develop awareness of fullness.
- Proper toileting posture and routine.
Pelvic Floor Physiotherapy:
- Biofeedback to teach correct pelvic floor muscle relaxation during voiding.
- Breathing and relaxation exercises to improve muscle control.
- Play‐based exercises to enhance engagement.
Medical Management:
- Anticholinergics to reduce bladder overactivity.
- Alpha‐blockers in selected cases under pediatric urologist supervision.
Enuresis and Constipation Management:
- Separate evaluation for nighttime incontinence.
- Constipation treatment to lower bladder pressure.
Advanced Interventions:
- Clean intermittent catheterization (CIC) for incomplete bladder emptying.
- Surgical options for refractory cases, coordinated by a multidisciplinary team.
