Hinman syndrome is a micturition disorder that causes patients to void their bladder much less frequently than healthy individuals. The cause is considered to be learned detrusor-sphincter dyssynergia based on an early neurodevelopmental or behavioral disorder. Treatment focuses on normalizing voiding behavior.
What is Hinman Syndrome?
The bladder corresponds to an expandable hollow organ in the area of the small pelvis. Their main job is to store urine. Together with the urethra, the bladder forms the lower urinary tract, which plays an active role in voiding urine. Physicians refer to the voiding of urine as voiding.
For a healthy person, voiding is not associated with pain or other discomfort. While the urge to urinate is involuntary, emptying of the bladder can be influenced voluntarily. In medical circles, there is always talk of a micturition or bladder emptying disorder when the micturition can no longer be voluntarily controlled. Complaints such as pain can also occur
characterize micturition disorders. The doctor distinguishes between different types of voiding disorders. Hinman syndrome is a special form of impaired bladder emptying. In professional circles, this symptom complex is better known as non-neurogenic neurogenic bladder ( NNNB ).
Analogous to this, in English there is talk of the lazy bladder syndrome or the infrequent voider syndrome. The associated symptom complex was first described in 1974 by Frank Hinman. The main symptom is an unusually rare emptying of the bladder with pathological bladder enlargement.
Causes
Hinman syndrome mainly affects children. Even the term “non-neurogenic neurogenic bladder” describes a causal relationship independent of the nervous system. Although the Hinman syndrome shows similar symptoms to the neurogenic bladder, the causes of the symptoms in Hinman syndrome do not lie in disturbances in the motor sensory nerve supply of the bladder or sphincter.
Instead of a neurological problem, Hinman syndrome is based on learned detrusor sphincter dyssynergia (DSD). In this bladder dysfunction, the interaction of the structures involved in emptying is disturbed. The result is an obstruction of the bladder outlet during micturition effort.
The musculus detrusor vesicae, which is involved in voiding, contracts even with small amounts of urine, which means that smaller amounts of urine are lost outside of active micturition. This form of incontinence results in a reduced residual urine volume. Patients with detrusor sphincter dyssynergia therefore experience active bladder emptying much less frequently than healthy people.
Those affected show a large bladder capacity with infrequent voiding frequency. Scientists assume that patients with Hinman syndrome have detrusor-sphincter dyssynergia learned in childhood, which is probably the result of a behavioral disorder or a delay in the maturation of pathways in the central nervous system.
Symptoms, Ailments & Signs
Patients with Hinmann syndrome empty their bladders significantly less often than their peers. In many cases, after emptying the bladder, residual urine remains in the bladder. This permanently increases the risk of inflammation of the lower urinary tract structures for those affected.
As long as there is no inflammation, patients usually do not suffer from pain during micturition. Nevertheless, some of those affected report persistent feelings of pressure in the bladder area. Due to the causative detrusor-sphincter dyssynergia, slight incontinence can occur in individual cases.
If Hinman syndrome is associated with chronic bladder or urinary tract inflammation, typical symptoms such as dysuria or alguria are present. This is a painful burning sensation during the micturition process. Pollakiuria in the sense of a frequent urge to urinate with small amounts of urine or bladder tenesma in the sense of bladder spasms can also accompany cystitis.
In extreme cases, patients observe hematuria, i.e. blood in the urine. Some of those affected also suffer from a strong urge to urinate with loss of urine ( urge incontinence ) and complain of persistent abdominal pain.
Diagnosis & disease progression
The clinical picture of Hinman syndrome resembles that of neurogenic bladder. It is therefore important to rule out neurogenic causes for the symptoms in the first step of the diagnosis. If, despite neurological clarification, no neurogenic changes are detectable, the diagnosis of Hinman syndrome is obvious.
To confirm the diagnosis, the doctor carries out urodynamic tests that confirm the suspicion of a pathologically high bladder capacity. Ultrasound examinations form the focus of diagnostics.
Complications
In most cases, patients with Hinman syndrome suffer from very restricted emptying of the bladder. This can not only lead to physical, but also to severe psychological problems and thus have a very negative effect on the quality of life of those affected. In addition, there is a high residue of urine in the bladder after emptying.
This residue increases the risk of various inflammations and infections that can affect the kidneys, bladder and urinary tract. Severe pain is not uncommon. This can occur in the form of pain at rest or directly when urinating. As a result, those affected often suffer from depression and other psychological complaints and deliberately drink less liquid to avoid this pain.
This leads to dehydration and a very unhealthy condition for the patient’s body. Without treatment, Hinman syndrome reduces life expectancy. Treatment takes place with the help of medication and behavioral therapy and, as a rule, does not lead to any special complications. With early treatment, behavior can already be influenced in childhood, so that there are no longer any symptoms in adulthood.
When should you go to the doctor?
If there is residual urine in the bladder after emptying the bladder, Hinman syndrome may be the cause. A doctor’s visit is indicated if the symptoms persist over a longer period of time or worsen quickly. If other symptoms occur, such as a feeling of pressure in the bladder area, incontinence or a painful burning sensation when urinating, you should consult your family doctor or a urologist. Hinman syndrome primarily affects infants and young children.
Parents should speak to the pediatrician immediately if any of the above symptoms appear or if the child suffers from any other condition that cannot be traced back to a specific cause. During drug therapy, regular check-ups by the doctor in charge are required. If complications arise, the doctor must be informed. In the case of urinary retention and severe pain, it is best to call the emergency services or take the child to a hospital immediately. In case of doubt, the medical emergency service should be contacted first.
Treatment & Therapy
Healthy people empty their bladder every two to three hours on average. On average, they urinate at least three and a maximum of eight times a day, depending on the amount of fluid they consume. In patients with Hinman syndrome, the average number of voids is well below the values mentioned.
Since the causal detrusor sphincter dyssynergia is obviously a learned disorder, the focus of therapy is initially on voluntary behavioral adjustment. The first goal of therapy is to get the patient to urinate every two to three hours. The regular effort to urinate must gradually become part of the everyday behavior of those affected.
Repeated emptying of the bladder should be avoided, especially at the beginning. In addition, hardly any residual urine should remain in the body during the individual micturition processes in order to remove the basis for accompanying bladder infections. According to recent studies, biofeedback sessions have also proven to be a successful treatment option in the therapy of patients with Hinman syndrome.
Many of those affected suffer from frequent inflammation of the urinary tract. Those affected with this concomitant symptom receive infection prophylaxis. From a pharmacological point of view, treatment with drugs such as alpha-receptor blockers can also be considered.
Outlook & Forecast
Hinman syndrome often occurs chronically and is associated with various restrictions in everyday life for those affected. This can lead to urinary incontinence, pain and sensory disturbances in the bladder and urinary tract. Even with early treatment, late effects usually remain and various inflammations and infections of the kidneys, bladder and urinary tract occur again and again over the course of life.
The persistent pain and the usually accompanying urinary incontinence can also lead to depression, inferiority complexes and other psychological problems. The prognosis of Hinman syndrome is therefore rather poor. Early behavioral training can only lead to a positive outcome if the diagnosis is made in early childhood. If the parents have the child treated closely by a pediatrician, there is a good chance of a symptom-free life.
Accompanying functional disorders of the bladder and malformations worsen the prognosis. In the case of Hinman syndrome, no clear prognosis can be given due to the different degrees of severity of the symptoms. Life expectancy is generally not reduced by the condition. However, the quality of life of those affected suffers greatly in the case of pronounced diseases.
Prevention
Hinman syndrome is rooted in a learned behavioral disorder. Concentrating on normal micturition behavior as early as childhood can be an important step in preventing the symptom complex later in life.
Aftercare
Since Hinman syndrome is a hereditary disease, it cannot be completely cured. The measures and the options for aftercare are therefore very limited in most cases. The affected person is primarily dependent on a quick and early diagnosis and treatment, so that there are no further complications. Self-healing cannot occur in this case.
In most cases, Hinman syndrome is treated with therapy. Above all, relatives, friends and parents must find out about this disease and understand it correctly. In many cases, psychological treatment is also necessary, which must be carried out especially in children.
Parents must properly explain the disease to the affected children so that there is no bullying or teasing. Regular examination of the internal organs is also very important in Hinman syndrome to prevent damage to the organs. In general, the loving care and support of one’s own family has a very positive effect on the further course of this disease. The life expectancy of the affected person is not reduced by this syndrome.
You can do that yourself
Therapy for Hinman syndrome aims to increase the frequency of voiding. This is primarily achieved through regular reminders, for example through an alarm clock or with the help of relatives. The doctor will also recommend strict personal hygiene to the person concerned to avoid infection and the resulting complications. The biofeedback sessions can be supported at home with specific exercises. Exactly which measures are possible here depends on the individual complaints and must therefore always be worked out in consultation with the responsible doctor.
In addition to medical therapy, psychological treatment is sometimes useful. This is especially true when those affected suffer greatly from Hinman syndrome and psychological problems are already developing. Behavioral therapy can support treatment and help prevent relapses into old behavior patterns in the long term. If the measures mentioned are observed and combined with an individually tailored drug treatment, Hinman syndrome can usually be treated well. Nevertheless, regular visits to the family doctor or a urologist are indicated in order to be able to identify any complications at an early stage.
