Urinary syncope is a type of situational fainting that occurs more frequently in males. Straining to urinate stimulates a circulatory reflex of the vagus nerve, resulting in a decrease in blood flow and oxygenation in the brain. Symptoms include dizziness, sweating, nausea, stomach pain, and vision fading. The biggest health risks are lacerations or bruises sustained during a fall. Treatment may include beta-blocker drugs, antidepressants, or a cardiac pacemaker.
Urinary syncope is one of several varieties of situational fainting, during which the victim temporarily loses consciousness during or immediately after urinating. The condition occurs more frequently in males than females, with a peak of onset between the ages of 30 and 50. Doctors believe that the process of straining to urinate stimulates a circulatory reflex of the vagus nerve, producing a substantial slowing of the heart rate and a rapid drop in blood pressure associated with blood pooling in the lower extremities. This results in a decrease in blood flow and oxygenation in the brain, which produces a loss of consciousness. Symptoms associated with micturition syncope include previous dizziness, sweating, nausea, stomach pain, and vision fading.
Episodes of this type of faint usually occur when the patient has just risen from a lying position for an extended period, such as in the morning or late evening. Drinking too much alcohol, having a fever, or being too hot also increases the frequency of urination syncope. Other factors that contribute to situational fainting include emotional stress or shock, pain, anemia or mild blood loss, poor physical condition, and low blood sugar levels. Voiding syncope accounts for about four to eight percent of all cases of syncope or fainting. It is not life threatening and occurs only intermittently.
Some cases of micturition syncope may be accompanied by some jerking of the limbs, similar to those seen with seizures. There is usually no tongue biting, incontinence, or post-episode confusion, however. The biggest health risks from this condition are lacerations or bruises sustained during a fall, which can include serious head injuries. Once discovered, the patient should be allowed to rest on the floor until consciousness returns, and no ammonia inhalants and cold water should be used to resuscitate the patient. Full recovery occurs within seconds to minutes of micturition syncope, with the patient recalling the events just prior to the episode.
Urination, defecation, vomiting, swallowing cold drinks, and severe coughing can cause situational syncope. All of these activities activate mechanisms in the body that lower blood pressure. Although most cases of situational syncope are harmless and self-limiting, medical evaluation for associated illnesses is essential, especially in elderly patients. For example, some cases of syncope during urination may be associated with prostate enlargement due to prostatic hypertrophy or prostate cancer.
After evaluation for the underlying disease, most cases of mild voiding syncope do not require treatment. Patients should sit on the side of the bed for several minutes before getting up to go to the bathroom if possible. Also, the patient can avoid the fainting attack if he sits down while urinating. If episodes are severe, doctors may treat patients with beta-blocker drugs or some form of antidepressant medication. Also, patients with a pre-existing abnormally slow heartbeat, called bradycardia, may benefit from the placement of a cardiac pacemaker.
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