Vasovagal Syncope and Incontinence

Yes, vasovagal syncope can cause urinary incontinence during episodes of loss of consciousness. 1

Mechanism and Clinical Features

Vasovagal syncope (VVS) is characterized by transient loss of consciousness due to cerebral hypoperfusion, typically lasting less than a minute 1
During a vasovagal episode, there is a reflex-mediated drop in blood pressure and often heart rate, leading to reduced cerebral blood flow 1
Urinary incontinence can occur during syncope episodes and does not differentiate between epileptic seizures and syncope 1
The European Society of Cardiology guidelines specifically note that incontinence may occur during vasovagal syncope episodes 1

Typical triggers include pain, emotional stress, seeing blood, having blood drawn, or prolonged standing 1
Prodromal symptoms often include feeling nauseous, sweating, or turning pale before losing consciousness 1
The unconsciousness typically lasts less than a minute with quick return to full consciousness 1
During attacks, patients may fall and potentially injure themselves if upright 1, 2
A few movements of the face and limbs can occur during the episode 1

Incontinence alone cannot be used to differentiate between epileptic seizures and syncope 1
Other clinical features must be considered for proper diagnosis:
- Duration of loss of consciousness (typically <30 seconds in syncope vs. longer in seizures) 1
- Presence of prodromal symptoms (more common in vasovagal syncope) 1
- Pattern of movements (limited in syncope vs. more pronounced in seizures) 1
- Recovery pattern (typically rapid in syncope) 1

Incontinence during syncope should not be mistaken as a sign of epilepsy 1
Proper diagnosis is crucial as management strategies differ significantly between vasovagal syncope and epilepsy 3
Injuries can occur during syncope episodes due to falls, making prevention strategies important 2
Patient education about recognizing prodromal symptoms and using countermeasures is essential 1, 4

Physical counterpressure maneuvers (PCMs) can help prevent syncope when prodromal symptoms occur 1, 4
Lying down or sitting with legs crossed and muscles tensed can abort an impending episode 1
Adequate hydration (around 2L of fluid daily) and sufficient salt intake are recommended as first-line measures 1, 3
Pharmacological treatments may be considered in refractory cases 3

While incontinence can occur during vasovagal syncope, its presence alone should not guide diagnosis 1
A comprehensive clinical evaluation is necessary to distinguish vasovagal syncope from other causes of transient loss of consciousness 1
Recurrent episodes of syncope with incontinence may significantly impact quality of life and require more aggressive management 3