From the Research
Urinary incontinence in syncope is not a reliable diagnostic indicator, as it can occur in both syncope and seizures, and its presence does not necessarily distinguish between the two conditions. According to a systematic review and pooled analysis of data from the literature 1, urinary incontinence has no value in the differential diagnosis between epileptic seizures and syncope. The study found that the pooled accuracy measures of urinary incontinence showed a statistically not significant positive likelihood ratio (pLR) for differentiating between epileptic seizures and syncope.
When evaluating a patient with syncope and urinary incontinence, a comprehensive assessment including cardiac evaluation, orthostatic vital signs, and sometimes neurological workup is still necessary regardless of the presence of incontinence. Other clinical features such as duration of unconsciousness, presence of aura, post-event confusion, and tongue biting are more helpful in differentiating between syncope and seizure activity. Patients should be reassured that incontinence during syncope is not uncommon and does not by itself indicate a more serious underlying condition.
The exact prevalence of urinary incontinence in syncope is not well-established, but it is considered to be relatively common, occurring in a significant proportion of syncope cases. However, the available evidence does not provide a clear estimate of the prevalence of urinary incontinence in syncope.
It is essential to note that the provided evidence 2, 3, 4, 5 is not directly related to the question of urinary incontinence in syncope, as it primarily focuses on the treatment of urge and mixed urinary incontinence with oxybutynin and tolterodine. Therefore, these studies do not influence the answer to the question.
In clinical practice, the presence of urinary incontinence during a syncopal episode should not be relied upon as a diagnostic indicator, and a comprehensive evaluation should be performed to determine the underlying cause of the syncope. A thorough assessment, including cardiac and neurological evaluations, is necessary to determine the cause of syncope and to develop an appropriate treatment plan.