We review the clinical problem of idiopathic non-obstructive urinary retention and voiding difficulty in young women, thought by Fowler and associates to be due to urinary sphincter spasm. We conclude that this voiding disorder in Fowler’s syndrome (FS) is not due to sphincter spasm associated with a so-called characteristic electromyography pattern in the urinary rhabdosphincter, since the latter has been shown to occur in normal young women. We point out that non-obstructive urinary retention and voiding difficulty is also a feature of the posterior fornix syndrome (PFS) and we suggest that these two syndromes are one and the same. In idiopathic non-obstructive urinary retention, as described in PFS and in FS, the voiding disorder is usually associated with laxity of the uterosacral ligament (USL)with resultant loss of balance in the pelvic floor muscular vectors, causing impaired opening of the urethra for voiding. The various associated features of these two syndromes, especially enlarged bladder, urgency and frequency, chronic pelvic pain, and secondary psychological symptoms are all relieved when voiding difficulty is resolved by successful management strategies, including physiotherapy, tape-based reinforcement of the USL, and neuromodulatory management. We suggest that, given its simplicity and long-term effectiveness, surgical reinforcement of the USL, by plication in younger women or tape reinforcement after the menopause, is the optimal first line treatment for posterior fornix syndrome (PFS). Nonetheless, we caution that our conclusions described here do not exclude other, central neurological causations for this voiding disorder in some patients.
Corresponding Author: SWASH M.|