Micturition syncope is a brief fainting during or after urination. This phenomenon usually presents in the setting of prostatic hyperplasia. Treatment of syncope includes medication administration, as well as circulatory training and blood pressure-regulating treatments.
What is micturition syncope?
In micturition syncope, unconsciousness occurs during or shortly after urination. The unconsciousness is only short-lived but can result in serious fall injuries. On average, sufferers are unconscious for only one or two minutes. Women are comparatively less likely to be affected by the phenomenon than men. As a rule, patients are younger persons of the male sex. About five percent of all syncopes are micturition syncopes. Fainting during or immediately after defecation is also broadly understood as micturition syncope. About a quarter of all syncope occurring at night is micturition syncope. Nevertheless, micturition syncope is a rather rare occurrence. Unconsciousness shortly after or even during urination is included in vasovagal syncope, which overall encompasses most forms of syncope.
Causes
When urination is made difficult by conditions such as prostatic hyperplasia, an enlarged prostate, excessive vagotonus sets in as a reflex. This tone causes fainting. Vagotonus is the state of excitation of the parasympathetic nervous system. As a rule, micturition syncope mainly affects drowsy individuals with overfull bladder. Especially often, unconsciousness during urination occurs after alcohol consumption. Moreover, since the phenomenon typically occurs at night, it is related to vasodilation as caused by bed warmth. The orthostatic effects that occur when changing from a lying to a standing position are probably also important. In addition, during micturition, blood pressure is no longer supported by the full bladder. This fact can also cause circulatory collapse.
Symptoms, complaints and signs
Before fainting, diffuse dizziness with disorientation and sweating presents as part of micturition syncope. Sometimes they also have ringing in their ears. The onset is abrupt and unsystematic. The duration of the dizziness is limited and thus does not signal to the affected person in time that they are about to lose consciousness. Therefore, micturition syncope often results in a severe fall, which in the worst case results in broken bones. Usually, after changing from a lying or sitting position to a standing position, those affected suffer from generally poor circulation. A heartbeat of less than 60 beats per minute can be considered symptomatic in micturition syncope. The same is true for pale skin and clonic twitching. Sufferers do not remember the time of unconsciousness. After fainting, they reorient quickly and their values normalize within a short time.
Diagnosis and course of the disease
The physician makes the diagnosis of micturition syncope by taking the patient’s history. If necessary, he will arrange for neurological examinations to rule out a neurological disease as the cause. When investigating the cause, the physician will also order a prostate examination to detect hyperplasia if necessary. These hyperplasias are usually benign, but cause increased bladder outlet resistance and should be corrected. The examination is usually equivalent to a rectal digital examination or palpation. If prostatic hyperplasia is not the cause of the fainting episodes, the physician will initiate further investigation. The course of micturition syncope is determined by the severity of the resulting fall. In individual cases, micturition syncope has already led to death, such as in sailors on the open sea who went overboard due to unconsciousness.
Complications
Primarily, micturition syncope leads to severe dizziness in the patient. Affected individuals themselves feel disoriented and confused, and further not infrequently lose consciousness. Likewise, the loss of consciousness due to a fall can result in various injuries. It is not uncommon for the fainting spells to occur very spontaneously and without any particular symptoms, so that they cannot usually be avoided.Sufferers can also sustain serious injuries or even fractures. Due to these complaints, micturition syncope significantly limits the quality of life of the affected person. Furthermore, patients suffer from a decreased pulse and pale skin. Twitching occurs and patients feel tired and fatigued. The patient’s ability to cope with stress also decreases considerably as a result of micturition syncope, so that strenuous activities are usually no longer possible for the affected person. Treatment of micturition syncope can be carried out with the aid of compression stockings, which keep the blood pressure high and thus reduce or completely prevent the fainting spells. Complications do not occur with this treatment. However, causative treatment is also necessary if micturition syncope does not resolve on its own.
When should you see a doctor?
Since micturition syncope does not resolve on its own, the condition should always be evaluated by a physician. The condition may indicate other diseases or medical conditions and should not be ignored. A doctor should be consulted for micturition syncope if the affected person suffers from dizziness or fainting spells, which occur mainly after urination. These symptoms are characteristic of micturition syncope and directly indicate the condition. The severity of the dizziness can vary greatly. However, if the symptoms occur over a long period of time and do not disappear on their own, a doctor should be consulted. In case of loss of consciousness, the emergency physician should be called. In the first instance, micturition syncope can be diagnosed by a general practitioner. Further treatment depends on the exact causes of the condition and is carried out by the respective specialist. In addition to dizziness, twitching or pale skin may also indicate the complaint.
Treatment and therapy
Various treatment options are available for micturition syncope. Among the therapeutic options, for example, is the avoidance strategy. As a rule, syncope always occurs in the same situations. Thus, those who can avoid the triggering situation will no longer suffer from micturition syncope. An even more helpful strategy is circuit training. In this training, sufferers learn to avoid the fainting episodes through conscious breathing and other means. The use of compression stockings can also minimize venous pooling, helping to maintain normal blood pressure. When blood pressure no longer drops to a threatening level, fainting will not occur. Medication administration may also be considered in the treatment of micturition syncope. For example, increased NaCl intake can serve well. The same applies to treatment with propranolol or circulatory stabilizing drugs such as fludrocortisone. If the syncope is in fact related to the orthostatic effects of moving from a recumbent position, perhaps even slowly standing up can prevent the fainting episodes. If the patient moves his or her legs before standing up, first straightening up and remaining in a seated position for some time, then his or her cardiovascular system will find it easier to adjust.
Outlook and prognosis
In general, the prognosis is favorable. This is because micturition syncope occurs suddenly and then resolves spontaneously. Medical management is not mandatory. Risks exist mainly after alcohol consumption. According to expert estimates, young men are among the most frequently affected. On ships, cases are conceivable in which men urinate into the sea from the deck. Then micturition syncope can even take a fatal course. They fall unconscious into the water and drown. Injuries and discomfort result from the fall that takes place. Depending on the local conditions, this results in the greatest risk. The scientific situation regarding micturition syncope is poor. A temporary drop in blood pressure ensures that the brain is inadequately supplied with oxygen. A resulting fall is usually attributed to alcohol or other accompanying circumstances. As a result, the condition is less well known to physicians. Patients almost never present at all. Some scientists therefore assume that the prevalence and number of unreported cases should not be underestimated. Incidentally, women are less susceptible to fainting during urination.They urinate while sitting, which can also prevent negative consequences in men.
Prevention
To prevent micturition syncope, targeted circulatory training can help. By reacting quickly to the abrupt onset of dizziness and sitting or lying down in a timely manner, the affected person can also reduce the risk of fall injuries.
Follow-up care
Loss of consciousness requires a rapid response, and it is sometimes possible to precede another fainting episode. In this respect, aftercare can only build on prevention. If there are clear signs of circulatory weakness, those affected should try to lie down or at least find a place to sit. When doing so, the legs should be placed as high as possible. For one thing, this will prevent you from falling and sustaining more serious injuries in the event of unconsciousness. Do not try to ignore the symptoms out of shame in public situations and do not act directly. Approaching unconsciousness is too dangerous behind the wheel of a car or while driving large machinery such as at work. Since the fainting spells sometimes occur unpredictably, it is advisable to inform the close social environment about them so that they can intervene in an emergency. Contact with other sufferers of micturition syncope can help to learn how to deal with the condition confidently and improve quality of life. In this respect, follow-up care also focuses on improving psychological stability.
Here’s what you can do yourself
When micturition syncope is present, the most important action is to avoid triggering situations. Strengthening the cardiovascular system, such as through exercise or a change in diet, can help reduce fainting episodes. Conscious breathing, relaxation techniques and other remedies can also reliably help against sudden syncope. However, sufferers should always talk to a doctor as well. The physician will first examine the symptoms and clarify the causative condition. Depending on the underlying condition, further measures can then be taken. If blood pressure fluctuations are the cause, the use of compression stockings can be useful, as these stabilize the blood flow and thus prevent fainting. In addition, patients should take their time getting up in the morning so that the cardiovascular system can adjust to the change in position. It is advisable to first move the legs, then slowly straighten the upper body and move to a sitting position before standing up after a few minutes of remaining there. In the case of chronic discomfort, appropriate holding devices should be installed in the bathroom. Mats may also be installed in some circumstances to prevent serious injury after a fall.
