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  • Updated 10.21.2020
  • Released 01.27.2004
  • Expires For CME 10.21.2023

Micturition syncope and defecation syncope

Introduction

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 (67) 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 (35). 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 (07; 20). Generally such situational syncopes are considered forms of neurally mediated syncope with reflex-mediated vasodilation and bradycardia (07; 22), but other mechanisms can also be involved.

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