Micturition Syncope

“Micturition” (pronounced “mick chure ISH un”) syncope is the medical term for passing out during or right after urinating (peeing). It’s a situational type of reflex syncope. Standing up while peeing leads to hypotension (low blood pressure) and less blood flow.

Normally, your blood pressure is higher with a full bladder because its blood vessels are constricting. (This is why you should empty your bladder before checking your blood pressure.) When you stand up and empty your bladder, your blood pressure falls. This can make you faint.

After you wake up from passing out, you may feel tired afterward. But people with micturition syncope (fainting urination) recover quickly and usually don’t have any long-term issues.

Micturition syncope can happen more than once in your life. But you can make adjustments to manage it. It’s common in childhood and around age 40 to 50, especially in people who pee while standing.

Symptoms of micturition syncope

Micturition syncope symptoms that may happen before fainting (even while peeing) may include:

• Sweatiness
• Warmth
• Loss of color in your skin
• Dizziness
• Phosphenes (lights with flickering colors you see when your eyes are closed)

What is the cause of micturition syncope?

You can faint if your brain doesn’t get enough blood after your blood pressure drops. Micturition syncope causes include:

• Decreasing blood pressure from emptying your bladder
• Standing up quickly to get to the bathroom after lying in bed
• Standing still while peeing

Risk factors for micturition syncope

Anyone can have micturition syncope. But it’s more likely to happen when a person with a penis gets out of bed in the morning and stands up to pee.

You’re more at risk for micturition syncope if you:

• Are very tired
• Have an airway infection
• Have alcohol use disorder
• Just delivered a baby

How doctors diagnose this condition

To diagnose micturition syncope, a healthcare provider will do a physical exam. They’ll ask questions about what was going on when you fainted. There are many reasons why people faint. Your provider will want to rule out another condition (like a heart issue) that could make you faint.

Tests for micturition syncope may include:

• Blood tests
• Urinalysis
• Electrocardiogram (EKG)
• Echocardiogram
• Exercise stress test
• Electrophysiology study
• Tilt table test
• Neurological exam

How to treat micturition syncope

For micturition syncope treatment, your healthcare provider may tell you to:

• Consume more fluid and salt.
• Cut back or stop taking diuretics and other medicines that lower your blood pressure.
• Take medication like midodrine, fludrocortisone or beta-blockers.

It’s important that you only do these under a provider’s direction.

For some types of situational syncope, providers recommend avoiding the situations that made you faint. Clearly, this isn’t an option for people with syncope during micturition. Everyone needs to pee.

When should I see my healthcare provider?

With a micturition syncope diagnosis, you may need follow-up visits if the problem continues. But knowing the cause of your syncope can go a long way toward being able to manage it.

You may want to ask your provider:

• Which treatments do you recommend?
• Do I need to take medication?
• How long before bed should I stop drinking fluids?

What is the prognosis for micturition syncope?

This type of syncope usually doesn’t carry a risk of serious problems. Unlike some other types of syncope, micturition syncope isn’t related to heart disease or heart rhythm issues. Micturition syncope is usually harmless, but you may get hurt when you faint.

Treatments can help you manage this condition and possibly prevent future episodes.

Can this be prevented?

You may be able to prevent an episode of micturition syncope by:

• Getting out of bed slowly after waking up
• Sitting down to pee instead of standing
• Emptying your bladder every three hours and before going to sleep
• Limiting how much you drink in the evening
• Quickly tensing your arms or legs without holding your breath