Micturition syncope and defecation syncope

Douglas J Lanska MD FAAN MS MSPH (Dr. Lanska of the Great Lakes VA Healthcare System and the University of Wisconsin School of Medicine and Public Health has no relevant financial relationships to disclose.)
Originally released January 27, 2004; last updated January 29, 2017; expires January 29, 2020

This article includes discussion of micturition syncope and defecation syncope, bed pan syncope, post-micturition syncope, defecation syncope, and micturition syncope. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

The author explains the clinical presentation, pathophysiology, diagnostic work-up, and management of micturition and defecation syncopes. Micturition syncope is a fairly common disorder that generally occurs in men. Younger men with micturition syncope typically have a benign self-limited condition, whereas older male patients and female patients of any age typically have significant medical comorbidities and orthostatic hypotension. In contrast, defecation syncope is a relatively rare disorder that typically occurs in middle-aged or older individuals and affects women more often than men. More than one third of patients with defecation syncope die within 2 years of complications of their underlying diseases. Alcohol intake is an important precipitating factor for micturition syncope in younger patients (less than 55 years of age), but it is rarely a factor associated with defecation syncope.

Key points

 

• Micturition syncope is a fairly common disorder that generally occurs in men.

 

• Younger men with micturition syncope typically have a benign self-limited condition, whereas older male patients and female patients of any age typically have significant medical comorbidities and orthostatic hypotension.

 

• Particularly among older patients (over 55 years of age), micturition syncope typically occurs only when patients void immediately after arising from the supine position after prolonged recumbency. Thus, micturition syncope is most common in the evening or early morning, especially in older patients (over 55 years of age).

 

• Micturition syncope in younger patients (less than 55 years of age) tends to occur in the evening or nighttime before midnight, whereas in older patients, it tends to occur after midnight or early in the morning.

 

• Micturition syncope most often occurs at the termination of or just after urination.

 

• Defecation syncope is a relatively rare disorder that occurs typically in middle-aged or older individuals and affects women more often than men.

 

• More than one third of patients with defecation syncope die within 2 years of complications of their underlying diseases.

Historical note and terminology

Micturition syncope was first described by Rugg-Gunn in 1946 (Rugg-Gunn 1946) and Proudfit and Forteza in 1959. Micturition syncope is defined as syncope occurring during or immediately after urination.

Defecation syncope was first described by Pathy in 1978, and later studied in detail by Kapoor and colleagues (Kapoor et al 1986). Defecation syncope is defined as syncope occurring during or immediately after defecation.

Defecation and micturition syncopes are forms of the so-called situational syncopes, which occur immediately after precipitating situations, such as urination, defecation, cough, swallowing, or rarely laughing (Brignole 2005; Gaitatzis and Petzold 2012). Generally such situational syncopes are considered forms of neurally mediated syncope with reflex-mediated vasodilation and bradycardia (Brignole 2005; Grubb 2005), but other mechanisms can also be involved.

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