Case Presentation: Two months after chronic use of an abdominal binder made for weight loss and waist shaping, a 38 year-old woman presented with anuria and amenorrhea. The patient also reported nausea, bilious vomiting, extreme sensitivity to smell, and a chronic penny-like taste in the mouth. She was found to have end-stage renal disease. Workup for reversible causes was negative per chart review and the patient was started on peritoneal dialysis. Due to the patient’s BMI of 55, she was ineligible for kidney transplant. We hypothesize that abdominal binder used (girdle) caused ACS due to increased pressure exacerbated by her morbid obesity. Chronic elevated intra-abdominal pressure (IAP) has been reported to lead to end-organ failure. We assume that the patient continued use of the abdominal binder despite recognizing dramatic physical findings of disease.
Discussion: The popularity of waist cinchers, shapewear, abdominal binders, corsets, and waist trainers has increased in the female population. Sales for shapewear world-wide were estimated at 2.26 billion USD in 2018. Despite this, providers are often unaware their patients are using binders. Both patients and providers may not be aware of the health consequences of long-term use of these binders. Well-known side effects include skin irritation and breathing restriction, however, more permanent consequences can arise that are less common but potentially fatal. Additionally, the psychiatric element to what drives individuals to these garments is not well studied. We describe a patient who was admitted after wearing a girdle for weight loss and shaping purposes for 2 months which led to chronic abdominal compartment syndrome (ACS). On presentation, the patient was found to have end-stage renal disease requiring dialysis. We hypothesize that due to chronic abdominal compression, the patient developed ACS that lead to acute renal failure. This may be partially due to the patient prioritizing her mental health by wearing shapewear despite physical health consequences.
Conclusions: Abdominal compartment syndrome is defined as constant intra-abdominal pressure (IAP) of >20 mmHg associated with organ dysfunction. ACS is a known factor of increased mortality in patients in the ICU but is not a common finding in non-post-surgical patients. People that associate happiness with a smaller BMI or waist size may use abdominal compressing garments to modify body shape or attempt under-researched weight loss techniques. To maintain mental well-being, patients are willing to endure physical symptoms. Physiologically, abdominal girth plays a factor in ACS; increased abdominal girth decreases compliance of the abdominal wall, leading to increased IAP. Compression of the abdominal wall also causes an increase in IAP, to which the kidney is particularly sensitive. An increase in IAP can potentially result in renal injury or failure, which result in life-long dialysis in patients for whom transplant is not an option such as our patient. Physicians should be aware of these lasting effects and ask patients about their use of binders. Currently there are no recommendations regarding binders. We recommend physicians advise patients to limit the duration and use of very compressive binders and immediately seek medical care for abdominal pain, changes in urine output, or changes in menstruation. We also recommend that physicians engage with patients about self-image and encourage healthy weight loss techniques.