Hinman syndrome is a micturition disorder that causes patients to void their bladder much less frequently than healthy individuals. The cause is thought to be learned detrusor-sphincter dyssynergia based on an early neurodevelopmental or behavioral disorder. Treatment focuses on normalizing micturition behavior.
What is Hinman syndrome?
The bladder corresponds to an expandable hollow organ in the area of the lesser pelvis. Its main function is to store urine. Together with the urethra, the bladder forms the lower urinary tract, which plays an active role in urination. Physicians refer to urination as micturition. For a healthy person, micturition is not associated with pain or other discomfort. While the urge to urinate is involuntary, the emptying of the bladder can be influenced voluntarily. In medical circles, a micturition or bladder emptying disorder is always referred to when micturition can no longer be controlled voluntarily. Complaints such as pain can also
also characterize micturition disorders. Doctors distinguish between different types of micturition disorders. Hinman syndrome is a special form of impaired bladder emptying. Among experts, this symptom complex is better known as non-neurogenic neurogenic bladder (NNNB). Analogously, it is referred to in English as lazy bladder syndrome or infrequent voider syndrome. The first description of the associated symptom complex was made in 1974 by Frank Hinman. The main symptom is considered to be an unusually infrequent voiding of the bladder with pathological bladder enlargement.
Causes
Hinman syndrome predominantly affects children. The very term “non-neurogenic neurogenic bladder” describes a nervous system-independent causative relationship. Although Hinman syndrome presents with similar clinical features to neurogenic bladder, the causes of the symptoms in Hinman syndrome are not due to disturbances in the motor sensory nerve supply to the bladder or sphincter. Instead of a neurologic problem, Hinman syndrome is based on learned detrusor sphincter dyssynergia (DSD). In this bladder dysfunction, the interaction of the structures involved in voiding is disturbed. The result is obstruction of the bladder outlet during micturition effort. The detrusor vesicae muscle, which is involved in voiding, contracts even with a small amount of urine, causing smaller amounts of urine to be lost outside of active micturition. This form of incontinence results in reduced residual urine volume. Patients with detrusor-sphincter dyssynergia are therefore much less likely to experience active voiding than healthy individuals. Affected individuals exhibit a large bladder capacity with infrequent micturition frequency. Scientists hypothesize that patients with Hinman syndrome have detrusor-sphincter dyssynergia learned in childhood, which is thought to be the result of a behavioral disorder or maturational delay in pathways of the central nervous system.
Symptoms, complaints, and signs
Patients with Hinmann syndrome empty their bladders much less frequently compared with their peers. After emptying the bladder, residual urine remains in the bladder in many cases. This permanently increases the risk of inflammation of the lower urinary tract structures for those affected. As long as there is no inflammation, patients do not usually experience pain during micturition. Nevertheless, some of those affected report persistent feelings of pressure in the bladder area. Due to the causative detrusor-sphincter dyssynergia, mild incontinence may occur in isolated cases. If Hinman’s syndrome is associated with chronic cystitis or urinary tract infection, typical symptoms such as dysuria or alguria are present. This is a painful burning sensation during micturition. Pollakisuria in the sense of frequent urination with small amounts of urine or bladder tenesmus in the sense of bladder cramps can also accompany cystitis. In extreme cases, patients observe hematuria, i.e. blood admixture 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 and course of the disease
The clinical picture of Hinman syndrome is similar to that of neurogenic bladder. Therefore, the first step in diagnosis is to rule out neurogenic causes for the symptoms. If no neurogenic changes are palpable despite neurologic workup, the diagnosis of Hinman syndrome is obvious.To confirm the diagnosis, the physician performs urodynamic examinations, which confirm the suspicion of a pathologically high bladder capacity. Ultrasound examinations form the focus of diagnostics.
Complications
Due to Hinman syndrome, patients suffer from very limited bladder emptying in most cases. This can lead not only to physical, but also to severe psychological discomfort and thus have a very negative impact on the quality of life of the affected person. 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. It is not uncommon for severe pain to occur. These can occur in the form of pain at rest or, however, also directly during urination. Those affected not infrequently suffer from depression and other psychological complaints as a result and deliberately consume less fluid in order to avoid this pain. This leads to dehydration and thus to a very unhealthy condition for the patient’s body. Without treatment, Hinman syndrome will reduce life expectancy. Treatment takes place with the help of medication and behavioral therapy and usually does not lead to any particular complications. With early treatment, behavior can be influenced in childhood, preventing symptoms in adulthood.
When should you see a doctor?
If residual urine repeatedly remains in the bladder after voiding, Hinman syndrome may be the underlying cause. A visit to the doctor is indicated if the symptoms persist over a long period of time or intensify rapidly. If other symptoms occur, such as a feeling of pressure in the bladder area, incontinence or a painful burning sensation during urination, the family doctor or a urologist must be consulted. Hinman syndrome predominantly affects infants and young children. Parents should talk to the pediatrician immediately if any of the above symptoms occur or if the child suffers from other symptoms that are not due to any specific cause. During drug therapy, regular monitoring by the responsible physician is required. If complications arise, the medical professional must be informed. In case of urinary retention and severe pain, it is best to call the ambulance or the child should be taken to a hospital immediately. If in doubt, first contact the emergency medical services.
Treatment and therapy
Healthy people empty their bladder on average every two to three hours. On average, this means they micturate at least three and no more than eight times a day, depending on the amount of fluid they take in. In patients with Hinman syndrome, the average number of micturitions is significantly lower than the above-mentioned values. Since the causative detrusor-sphincter dyssynergia is apparently a learned disorder, the initial focus of therapy is on voluntary behavioral adaptation. The first therapeutic goal is to get patients to void every two to three hours. The regular micturition effort must gradually become part of the patient’s everyday behavior. Multiple 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 prevent 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. Sufferers with this accompanying symptom receive infection prophylaxis. From a pharmacologic perspective, additional treatment with medications such as alpha receptor blockers may be considered.
Outlook and prognosis
Hinman syndrome often occurs chronically and is associated with various limitations in daily life for those affected. Thus, urinary incontinence, pain, and sensory disturbances in the area of the urinary bladder and urinary tract may occur. Even with early treatment, late effects usually remain and various inflammations and infections in the area of the kidneys, bladder and urinary tract occur repeatedly in the course of life.Due to the persistent pain and the usually accompanying urinary incontinence, depression, inferiority complexes and other psychological complaints may also develop. The prognosis of Hinman syndrome is accordingly rather poor. Only if diagnosed in early childhood can a positive course be made possible by early behavioral training. If the parents have the child treated closely by a pediatrician, the prospect of a symptom-free life is given. Concomitant functional disorders of the bladder as well as malformations again worsen the prognosis. In Hinman syndrome, no clear prognosis can be given due to the varying severity of the symptoms. Life expectancy is basically not limited by the condition. However, the quality of life of those affected suffers greatly in cases of pronounced disease.
Prevention
Hinman syndrome is rooted in a learned behavioral disorder. Even in childhood, focusing on normal micturition behavior can be an important step in preventing the symptom complex for later life.
Follow-up
Because Hinman syndrome is a hereditary condition, it cannot be completely cured. Therefore, the measures and options for aftercare are very limited in most cases. The affected person is primarily dependent on a quick and early diagnosis and treatment, so that no further complications occur. Self-healing cannot occur in this case. In most cases, Hinman syndrome is treated with the help of therapy. Especially the relatives, the friends and also the parents have to be informed about this disease and have to understand it correctly. In many cases, psychological treatment is also necessary, especially for children. Parents need to explain the disease properly to the affected children so that there is no bullying or teasing. Regular examination of internal organs is also very important in Hinman syndrome to prevent damage to the organs. In general, loving care and support from one’s family also 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.
This is what you can do yourself
The therapy of Hinman syndrome aims to promote the frequency of bladder emptying. This is accomplished primarily by regular reminders, such as an alarm clock or help from family members. The physician will also recommend strict intimate hygiene to the affected person to avoid infection and resulting complications. The biofeedback sessions can be supported at home by specific exercises. Exactly which measures come into question here depends on the individual complaints and must therefore always be worked out in consultation with the doctor in charge. Psychological treatment is sometimes useful to accompany medical therapy. This is especially true if the affected person suffers greatly from Hinman syndrome and psychological complaints have already developed. Behavioral therapy can support the treatment and helps in the long term to avoid relapses into old behavioral patterns. If the aforementioned measures are adhered to and combined with individually tailored drug treatment, Hinman syndrome can usually be treated well. Nevertheless, regular visits to the family doctor or a urologist are indicated to detect any complications at an early stage.
