From the Guidelines
Abdominal binders are recommended for managing orthostatic hypotension (OH) and can be helpful for patients with autonomic dysfunction (including autonomic ataxia or AA). These elastic compression garments are worn around the abdomen and work by increasing peripheral vascular resistance and reducing venous pooling in the splanchnic circulation when a person stands up. For optimal effectiveness, the binder should be applied while lying down before getting up and should provide firm compression across the entire abdomen from the lower ribs to the pubic area. Patients should aim to wear the binder during daytime hours, especially when symptoms are most problematic or during periods of increased activity. The compression level should be comfortable but firm (typically 10-20 mmHg pressure).
Key Points to Consider
- Abdominal binders are particularly useful because they target the splanchnic circulation where significant blood pooling occurs during standing, making them more effective than lower extremity compression alone.
- They're generally well-tolerated, though some patients may experience discomfort, difficulty breathing, or digestive issues.
- Before starting, patients should consult their healthcare provider, especially those with gastrointestinal disorders, respiratory conditions, or recent abdominal surgery.
- Abdominal binders should be used as part of a comprehensive management approach that may include hydration, salt intake, medication adjustments, and gradual positional changes, as suggested by recent guidelines 1.
- The most recent and highest quality study 1 supports the use of abdominal binders as a nonpharmacologic measure to manage orthostatic hypotension, in conjunction with other treatments such as ensuring adequate salt intake and avoiding medications that aggravate hypotension.
From the Research
Abdominal Binder for Orthostatic Hypotension
- The use of an abdominal binder as a treatment for orthostatic hypotension has been studied, with one study finding that servo-controlled abdominal venous compression with an automated inflatable binder is as effective as midodrine in managing orthostatic hypotension 2.
- The study found that the combination of midodrine and the abdominal binder produced a greater increase in orthostatic tolerance and decreased orthostatic symptoms compared to midodrine alone 2.
- Another study discussed the use of pressure support garments, including abdominal binders, as a non-pharmacological treatment option for orthostatic hypotension, highlighting their potential benefit in managing the condition 3.
Comparison with Other Treatments
- Fludrocortisone, a mineralocorticoid, is considered a first- or second-line pharmacological therapy for orthostatic hypotension, and its effects have been compared to those of the abdominal binder 4.
- The evidence suggests that fludrocortisone may be effective in reducing orthostatic symptoms, but the certainty of the evidence is very low due to the limited number of studies and their small sample sizes 4.
- Midodrine, a pressor agent, has also been studied as a treatment for orthostatic hypotension, and its effects have been compared to those of the abdominal binder, with the combination of the two showing greater improvement in orthostatic tolerance 2.
Management of Orthostatic Hypotension
- Orthostatic hypotension is a complex condition that requires a multidisciplinary, patient-centered approach to management, including individually tailored pharmacological and non-pharmacological treatment 5.
- The treatment of orthostatic hypotension aims to improve standing blood pressure, minimize symptoms, and improve standing time, without generating excessive supine hypertension 6.
- A combination of treatments, including fludrocortisone, pressor agents, and procedures to improve orthostatic defenses, such as water bolus treatment and physical countermaneuvers, may be used to achieve these goals 6.