Sometimes a patient temporarily loses consciousness during or shortly after urination. This is called micturition syncope or micturition collapse. This fairly common condition occurs due to a severe drop in blood pressure that causes the brain to not receive enough oxygen. Micturition syncope is most common in men and usually occurs at night after a deep sleep. This type of fainting also occurs sporadically when defecating, vomiting or coughing. The treatment is mainly preventive, and attention must also be paid to the medical situation and history of a patient.
- Epidemiology of micturition syncope
- Causes of the condition: Drop in blood pressure
- Risk factors: fainting during or after urination
- Diseases
- Environmental factors
- Symptoms: Fainting during or after urination (especially at night)
- Diagnosis and examinations
- Treatment of micturition collapse
- Prevention disease
- Help after fainting
- Complications
- Prognosis
Epidemiology of micturition syncope
The prevalence of voiding syncope is 2.4 to 8.4% of all fainting cases in adults. In addition, 61% of patients with micturition syncope also experience other forms of syncope. The medical problem often presents itself between the ages of 30 and 49 years, but patients of younger and older ages have also been reported in the medical literature. The condition has a predilection for men. Finally, micturition syncope mainly occurs at night or after waking.
Causes of the condition: Drop in blood pressure
The precise cause of micturition syncope is unclear. Vasodilation (widening of the blood vessels) may occur when the patient gets up, goes to the toilet and quickly empties a full bladder. A quick stream of urine stimulates the vagus nerve. This causes a slowed heart rate (bradycardia) because the heart cannot pump enough blood, and a sudden drop in blood pressure (hypotension).
Risk factors: fainting during or after urination
Micturition syncope has various triggering factors, which focus on disorders and environmental factors. However, in a number of patients with voiding collapse, no risk factors or causes are known. All these factors activate mechanisms in the body that lower blood pressure.
Diseases
The following conditions lead more quickly to voiding collapse:
- akinetic seizures
- anemia or mild blood loss
- vomit
- a respiratory infection
- hysterical reactions
- fever
- low blood sugar levels (hypoglycemia)
- pain
- prostatic pheochromocytoma (rare tumor in the urinary bladder)
Fainting while urinating is more likely to occur due to alcohol abuse / Source: Jarmoluk, Pixabay
Environmental factors
Micturition syncope is also caused more often by a number of environmental factors:
- alcohol abuse
- poor physical condition
- emotional stress or shock
- swallowing cold drinks
- cough
- hungry
- feces
- to pee
- exhaustion
- dehydration
- fatigue
- medicines:
- alpha blockers (ensure better urine production in men with prostate problems)
- antidepressants
Symptoms: Fainting during or after urination (especially at night)
Attacks of this type of fainting usually occur when the patient has just gotten up after lying down for a long time, for example in the morning or late at night. Before losing consciousness (loss of consciousness), the patient often looks pale, has poor vision, feels nauseous, is sweaty, has stomach pain, and feels weak. In some patients, voiding syncope is accompanied by jerky limbs. These jerking movements are reminiscent of those that occur during convulsions (convulsions: uncontrollable physical movements and changes in consciousness), but voiding syncope usually does not involve tongue biting, incontinence or confusion after a seizure. The symptoms do not all have to be present, but often a patient can just feel the syncope coming. Syncope does not only occur during or after every episode of urination. This often happens when other factors are present in the patient, such as drowsiness, alcohol or dehydration (symptoms of dehydration).
Electrocardiography (ECG) / Source: CardioNetworks, Wikimedia Commons (CC BY-SA-3.0)
Diagnosis and examinations
Physical and diagnostic examination
The doctor first questions the patient thoroughly through an anamnesis (interview with the patient). The patient also receives a physical examination. The doctor then performs an electrocardiography (ECG: measurement of the electrical activity of the heart), which produces normal results. A blood test is also required. These tests are important to rule out other conditions. In addition, Holter monitoring (24-hour monitoring of the heart with a portable device) and a supine and standing blood pressure examination are required. In addition, the doctor tests the patient’s autonomic instability.
Differential diagnosis
The following conditions are very similar in symptoms to voiding collapse, and are therefore known as the differential diagnosis for this disease:
- heart rhythm disorders (arrhythmias)
- orthostatic tachycardia syndrome (POTS) (accelerated heart rate when standing up)
- hypovolemia (insufficient blood in the body)
- orthostatic hypotension (suddenly dizzy after standing up)
- structural cardiovascular diseases such as aortic stenosis (narrowing of the aortic valve in the heart) or hypertrophic cardiomyopathy (heart muscle disease)
Treatment of micturition collapse
Treating the underlying condition
There is no proven effective treatment available for micturition syncope. However, a doctor will thoroughly investigate the symptoms of micturition syncope because this sometimes indicates an underlying medical condition for which he or she will provide treatment. For example, the doctor injects botulinum A toxin injections (botox) into the detrusor muscle of the bladder in patients with spinal cord injuries. By addressing the underlying disease, the symptoms of fainting during or after urination disappear or decrease.
Avoiding triggering factor
Moreover, the side effect of certain medications may cause this condition. Sometimes it is possible to reduce or eliminate this medication so that the problem disappears. Avoiding some other triggering factors such as alcohol, exhaustion and dehydration is also a possible treatment option.
Prevention disease
Some preventive tips are available to reduce the risk of serious injuries due to micturition collapse. It is best to leave the bathroom door open and it is recommended that all sharp, dangerous and moving objects be placed elsewhere. It is best that the patient does not drink excessive amounts of alcohol during the day. The patient should always urinate before going to sleep to avoid having to get up during the night. If the patient does feel the urge to go to the toilet at night, it is best to first sit at the edge of the bed for a while and then move his legs. The patient should be sure that he does not feel dizzy or light-headed. Only then can he get up to go to the toilet. It is desirable that the patient is sufficiently awake before urinating. The patient should urinate while sitting down.
Help after fainting
If the patient has fainted on the floor, he should rest on the floor until consciousness returns. Cold water or products containing ammonia to revive the patient are strongly discouraged. Complete recovery always occurs within seconds to minutes after micturition syncope. The patient then only remembers the events just before the syncope.
Complications
The biggest risk of this condition is cuts, bruises or a serious head injury during a fall. This is often the result of sharp objects near the patient. Although most cases of situational syncope are harmless and resolve on their own, a medical examination is essential, especially in older patients. For example, some patients with voiding syncope suffer from prostate enlargement, either due to prostate hypertrophy or prostate cancer.
Prognosis
Micturition syncope is not life-threatening and only occurs occasionally. Patients recover completely within seconds to minutes after the attack. The patient then remembers the events just before the attack.
read more
- Fainting (syncope): Temporary loss of consciousness
- Loss of consciousness (unconsciousness): Causes & treatment
- Dizziness and vertigo: Causes of dizzy feeling
- Presyncope: Almost fainting (light-headedness)
- Vasovagal syncope: Fainting after trigger
