Voiding syncope is a brief period of fainting during or after urination. This phenomenon usually occurs in the context of prostate hyperplasia. Medication can be used to treat syncope, as can cardiovascular training and blood pressure-regulating applications.
What is voiding syncope?
Loss of consciousness occurs during or shortly after urination as part of voiding syncope. Unconsciousness is short-lived but can result in serious fall injuries. On average, people are unconscious for only a minute or two. Women are comparatively less likely to be affected than men. As a rule, the patients are young males. See AbbreviationFinder for abbreviations related to Voiding Syncope.
About five percent of all syncopes are voiding syncopes. Fainting during or immediately after defecation is also understood in the broadest sense as voiding syncope. About a quarter of all syncopes that occur at night are voiding syncopes. Nevertheless, voiding syncope is a rather rare occurrence. Loss of consciousness shortly after or even during urination is considered part of vasovagal syncope, which encompasses most forms of syncope.
Causes
If urination is made more difficult by diseases such as prostate hyperplasia, i.e. an enlarged prostate, an excessive vagal tone occurs as a reflex. This tone causes fainting. The vagal tone is the state of excitation of the parasympathetic nervous system. As a rule, micturition syncope mainly affects people who are sleepy and have an overfull bladder.
Unconsciousness occurs particularly often when urinating after drinking alcohol. In addition, since the phenomenon typically occurs at night, it is associated with the vasodilation caused by the warmth of bed. The orthostatic effects that occur when changing from a lying to a standing position are probably also important. When urinating, the blood pressure is no longer supported by the full bladder. This fact can also cause circulatory collapse.
Symptoms, Ailments & Signs
Before fainting, diffuse dizziness with disorientation and sweating occurs as part of voiding syncope. Sometimes their ears are also ringing. The phenomenon comes on abruptly and occurs unsystematically. The duration of the dizziness is limited and therefore does not signal to those affected in time that they are about to lose consciousness. This is why voiding syncope often leads to a serious fall, which in the worst case can result in broken bones.
Those affected usually suffer from a generally poor circulation after changing from a lying or sitting position to a standing position. A heartbeat below 60 beats per minute can be considered symptomatic in voiding syncope. The same goes for pale skin and clonic jerks. Those affected do not remember the time they were unconscious. After fainting, they reorient themselves quickly and their values return to normal within a short time.
Diagnosis & disease progression
The doctor makes the diagnosis of voiding syncope based on the medical history. If necessary, he will arrange for neurological examinations to rule out a neurological disease as the cause. When investigating the cause, the doctor will also order a prostate examination to detect any hyperplasia. These hyperplasias are usually benign, but cause increased bladder outlet resistance and should therefore be corrected.
The examination usually corresponds to a rectal digital examination or palpation. If the prostatic hyperplasia is not the cause of the fainting spells, the doctor will arrange for further investigations. The course of voiding syncope is determined by the severity of the fall it causes. In individual cases, micturition syncope has already led to death, for example in sailors on the open sea who fell overboard due to unconsciousness.
Complications
First and foremost, voiding syncope leads to severe dizziness in the patient. Those affected feel disoriented and confused and often lose consciousness. Loss of consciousness from a fall can also result in various injuries.
It is not uncommon for fainting spells to occur very spontaneously and without any particular symptoms, so that they usually cannot be avoided. Those affected can also suffer serious injuries or even broken bones. Due to these symptoms, voiding syncope significantly reduces the quality of life of those affected.
Furthermore, the patients suffer from a reduced heart rate and pale skin. Twitches occur and the patients feel tired and exhausted. The patient’s resilience also decreases significantly as a result of voiding syncope, so that strenuous activities are usually no longer possible for the affected person.
Treatment of voiding syncope can be done with the use of compression stockings, which keep blood pressure high and thereby reduce or completely prevent fainting. There are no complications. However, causal treatment is also necessary if the voiding syncope does not go away on its own.
When should you go to the doctor?
Since voiding syncope does not heal on its own, the condition should always be examined by a doctor. The disease can indicate other illnesses or ailments and should therefore not be ignored. A doctor should be consulted for voiding syncope if the person affected suffers from dizziness or fainting spells, which occur primarily after urinating. These symptoms are characteristic of voiding syncope and point directly to the disease.
The severity of the dizziness can vary greatly. However, if the symptoms occur over a longer period of time and do not go away on their own, a doctor should be consulted. In the event of a loss of consciousness, an ambulance should be called. Primarily, voiding syncope can be diagnosed by a general practitioner. Further treatment depends on the exact causes of the disease and is carried out by the respective specialist. In addition to dizziness, twitching or pale skin can also indicate the complaint.
Treatment & Therapy
There are various treatment options for voiding syncope. The avoidance strategy, for example, is one of the therapeutic options. As a rule, the syncopes always occur in the same situations. Those who can avoid the triggering situation will no longer suffer from voiding syncope. Cardiovascular training is an even more helpful strategy. In this training, those affected learn to avoid fainting attacks through conscious breathing and other means.
The use of compression stockings can also minimize venous pooling, helping to maintain normal blood pressure. If the blood pressure no longer drops dangerously far, there will be no more fainting. Medication can also be used to treat voiding syncope. For example, the increased supply of NaCl can be of good service. The same applies to treatment with propranolol or circulatory stabilizing drugs such as fludrocortisone.
If the syncope is actually related to the orthostatic effects of moving from the prone position, then slowly standing up may prevent fainting attacks. If the patient moves his legs before getting up, first sits up and remains in a sitting position for some time, then his cardiovascular system will find it easier to adapt.
Outlook & Forecast
In general, the prognosis is favorable. This is because voiding syncope comes on suddenly and then resolves spontaneously. Medical care is not absolutely necessary. The main risks are after alcohol consumption. According to expert estimates, young men are among the most frequently affected. On ships, cases are conceivable in which men urinate from the deck into the sea. Then voiding syncope can even be fatal. They fall unconscious into the water and drown. Injuries and discomfort result from the fall taking place. Depending on the local situation, this results in the greatest risk.
The scientific evidence regarding voiding syncope is tenuous. A temporary drop in blood pressure ensures that the brain is insufficiently supplied with oxygen. A resulting fall is usually attributed to alcohol or other accompanying circumstances. Therefore, the disease is less known to doctors. Patients hardly ever present themselves. Some scientists therefore assume that the spread and number of unreported cases should not be underestimated. Incidentally, women are less prone to fainting when urinating. They urinate while sitting, which can also prevent negative consequences for men.
Prevention
Targeted cardiovascular training can help to avoid micturition syncope. By reacting quickly to the abrupt onset of dizziness and by sitting down or lying down in good time, the affected person can also reduce the risk of falling injuries.
Aftercare
Loss of consciousness requires a quick reaction, and it is sometimes possible to faint again. In this respect, aftercare can only be based on prevention. If there are clear signs of circulatory weakness, those affected should try to lie down or at least find a seat. The legs should be placed as high as possible. On the one hand, this prevents you from falling and incurring serious injuries if you lose consciousness.
Do not try to ignore the symptoms and not act directly out of shame in public situations. Approaching unconsciousness at the wheel of a car or when operating large machines, such as at work, is too dangerous.
Since the fainting spells sometimes occur in an unpredictable manner, it is advisable to inform the immediate social environment so that they can intervene in an emergency. Socializing with other people who have urinary syncope can help them learn to deal with the condition with confidence and improve their quality of life. In this respect, aftercare also focuses on improving psychological stability.
You can do that yourself
When voiding syncope is present, the most important response is to avoid triggering situations. Strengthening the cardiovascular system, for example through exercise or a change in diet, can help reduce fainting attacks. Conscious breathing, relaxation techniques and other means can also reliably help against sudden syncope.
However, those affected should always speak to a doctor. The doctor will first examine the symptoms and clarify the causative disease. Depending on the underlying condition, further measures can then be taken. If blood pressure fluctuations are the cause, it can make sense to use compression stockings, because they stabilize the blood flow and thus prevent fainting. In addition, the patient should take his time getting up in the morning so that the cardiovascular system can adapt to the change in position. It is advisable to move your legs first, then slowly straighten your upper body and go into a sitting position before standing up after a few minutes of rest.
In the case of chronic complaints, appropriate holding devices should be installed in the bathroom. Under certain circumstances, mats can also be laid to prevent serious injuries after a fall.
