- A Y Kim. How to interpret a functional or motility test – defecography. J Neurogastroenterol Motil. 2011 Oct;17(4):416-20. doi: 10.5056/jnm.2011.17.4.416.
Arch Intern Med. 1986 Dec;146(12):2377-9.
Defecation syncope. A symptom with multiple etiologies.
To our knowledge, there is no previous clinical description in the literature of patients with defecation syncope. We evaluated 20 patients with this disorder who were a subgroup of a larger, prospective study of syncope, 13 women and seven men, with a mean age of 59 years. Eleven patients had had one episode and nine had experienced multiple episodes. Fourteen patients were recumbent before the urge to defecate, nine of these asleep. The diagnostic evaluation disclosed that two patients had gastrointestinal tract problems, three had cardiac diseases, and one had transient ischemic attacks. Three additional patients had marked orthostatic hypotension. No identifiable cause for defecation syncope was found in 11 patients, but new medical problems were noted in four of those patients. In follow-up at two years, syncope had recurred in ten patients, but the majority of recurrences were unassociated with defecation. Seven patients died during the follow-up period of underlying chronic diseases. We conclude that defecation syncope is not a single distinct clinical entity. Multiple pathologic abnormalities in association with physiologic changes during sleep and defecation may contribute to syncope. Patients with defecation syncope should undergo a careful evaluation for diagnosis of underlying illness causing syncope.
[Indexed for MEDLINE]
- W N Kapoor, J Peterson, M Karpf. Defecation syncope. A symptom with multiple etiologies. Arch Intern Med. 1986 Dec;146(12):2377-9.
Defecation syncope: The temporary loss of consciousness (syncope) upon defecating (having a bowel movement). Syncope is the temporary loss of consciousness or, in plain English, fainting. The situations that trigger this reaction are diverse and include having blood drawn, straining while urinating (micturition syncope) or defecating, coughing or swallowing. The reaction also can be due to the emotional stress of fear or pain.
Under these conditions, people often become pale and feel nauseated, sweaty, and weak just before they lose consciousness.
Situational syncope is caused by a reflex of the involuntary nervous system called the vasovagal reaction. The vasovagal reaction leads the heart to slow down (bradycardia) and, at the same time, it leads the nerves to the blood vessels in the legs to permit those vessels to dilate (widen). The result is that the heart puts out less blood, the blood pressure drops, and what blood is circulating tends to go into the legs rather than to the head. The brain is then deprived of oxygen, and the fainting episode occurs.
The vasovagal reaction is also called a vasovagal attack. And situational syncope is also called vasovagal syncope, vasodepressor syncope, and Gower syndrome after Sir William Richard Gower (1845-1915), a famous English neurologist whose name is also associated with a sign, a solution, another syndrome, and a tract in the central nervous system.
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Micturition syncope or post-micturition syncope is the name given to the human phenomenon of fainting shortly after or during urination. The underlying cause is not fully understood but it may be a result of vasovagal response, postural hypotension, or a combination thereof.
When one strains to increase the flow of urine, it stimulates the vagus nerve (usually more pronounced in elderly men with large prostates). The vagus nerve stimulus causes slowing down of the heart (bradycardia) and a drop in blood pressure. The heart cannot perform effectively as a pump because insufficient blood comes to it. It can be associated with a very rare tumor known as a paraprostatic pheochromocytoma within the urinary bladder.
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There is no specific treatment for micturition syncope. General advice to men with micturition syncope includes:
- to sit while urinating
- to sit on the edge of the bed for a while before getting up and going to the toilet
- to avoid urinating while sleepy
- to urinate before sleep
- to stop urination, cross the legs, and flex them immediately upon feeling faintness
- ^ Padevit C.; John H.; Gunz A.; Wiesli P.; Hauri D.; Schmid C. (2005). “Micturition Syncope due to Paraprostatic Pheochromocytoma”. Urol Int. 74: 276–277. doi:10.1159/000083563.
- ^ “Fainting during urination (micturition syncope): What causes it? – Mayo Clinic”.