Sunday, 17 July 2022 | Kishan Kalra | in Guest Column
Kishan Kalra
Anyone can have a fall at any time. It could be slipping in the bathroom, a missed step or an unintended push by someone or various other reasons. A fall can result in all kinds of injuries – even life threatening and fatal ones, or if one is lucky just a minor bruise or soft tissue damage. However old people are more prone to falls and injuries in their case are often more serious. Having suffered serious falls twice – both in the bathroom due to micturition syncope I want to share details about this phenomenon that might save some other old people like me.
First, let me explain what this term means. According to Google, “Micturition syncope or post-micturition syncope is the name given to the human phenomenon of fainting shortly after or during urination. The underlying cause is not fully understood but it may be a result of vasovagal response, postural hypotension, or a combination thereof.” In simpler terms, this is caused by the sudden drop in a person’s blood pressure which can happen after passing urine – particularly when waking up from sleep to use the toilet. Neurologists would explain that urine is a stress on the body and when one is released from that and, having got up from deep sleep when blood circulation is already very low, there are chances of fainting. The situation gets worse if one is on medicines – especially for prostate – that tend to lower the BP.
My first unfortunate episode happened in 1999, when I was 59. I had started taking Hytrin, my first medicine for a mildly enlarged prostate, prescribed by a dear friend and well known urologist. I had taken it barely for a month when, one fine morning I got up to visit the loo. I finished my job, tied my pajamas and then I have no clue about what happened. Luckily my wife came into the bathroom and found me prostrate on the floor. She asked why I was lying on the floor. I was instantly back to my senses and equally surprised to see myself in that position. We used to live in a joint family so she called my brother and then we noticed that there was some blood on the floor near where my head must’ve hit. I was rushed to a nearby clinic where they had to put 8 or 10 sutures to stop the blood flow. The doctor’s prognosis “drug induced micturition syncope”; they felt that everything was fine but I was advised to get a thorough investigation done. Some x-rays, a CT Scan, an MRIand EEG confirmed that I was lucky and all was indeed well. Back to my urologist next day, I sought an explanation. He was quite casual and told me that this medicine can lower the BP and I should’ve been careful. How was I supposed to know about the side effects of the blasted medicine remains a mystery to date. Anyway I discontinued that medicine, tried several homoeopathic ones, got an ultrasound done every year to make sure the prostate enlargement was only mild and residual urine barely negligible and didn’t do much more about the matter. Around 2008 when I consulted another urologist I was advised to start taking Veltam 0.4 every night. This medicine served me well and kept the BPH (Benign Prostatic Hyperplasia) in check. Once again, around 2014 by when it had become necessary for me to get up once every night to pass urine, another urologist advised me to switch to Silodal 8. Everything worked well till late February 2021 when one morning I passed urine involuntarily in bed. My urologist wasn’t worried about a single episode, prescribed a mild antibiotic for five days and asked me to get an ultrasound and uroflowmetry done. Whereas the ultrasound showed pretty much the same position, the flow test indicated an obstructive stream and he added a medicine to be taken in the mornings. I took this for 20 days – it helped – but as soon as it was discontinued, I started dribbling one or two drops of urine during the day. The doctor changed some medicines but the annoying dribbling continued. Quite frustrated at the turn of events, I went and met another experienced urologist – coincidentally the same who had started me on Veltam.My good man told me not to worry about a few drops of dribbling, said I could use a diaper if it bothered me and changed the morning medicine to Duloxetine 30mg. Three days of this new drug – some respite from dribbling and peaceful sleep at night but started feeling very drowsy on the third evening. Once I went to bed early, got up at 5:30 AM to pass urine, finished the job, tied my pajamas and then found myself lying on the floor after perhaps a minute or two. I have no clue about what happened and how I fainted. Now, as I am not used to sitting on the floor, it was quite difficult for me to get up but somehow I managed to do so by holding the wash basin counter top; did see a couple of drops of blood but didn’t realise what all injuries I had sustained; so I just walked back to my bed and went to sleep. It was only three hours later that I woke up and told my wife about the fall. Luckily our son was visiting so she called him and they could see some more blood on the upper lip as well as an injury very close to the right eye. Few calls to the hospital and we landed up there for a fuller investigation. Our first meeting was with a neurologist friend and his verdict – after I had explained the sequence of events – micturition syncope. He also told us that the medicine Duloxetine is essentially a neurological medicine and if at all it has to be given for prostate, it should be a smaller dose (not 30 mg) and the patient must be forewarned that it can cause fainting. Anyway I was advised to get an MRI and an EEG done, meet the plastic surgeon for stitching up the lip injury and the ENT specialist, for examining what looked like nose bone damage, and the dentist too. We spent pretty much all day at the hospital and the final verdict – with God’s grace no head or spine or hip injury. I had a nose bone fracture that would heal by itself, two front upper teeth fractured and a third one also damaged but no dental job for at least a month or till the nose bone heals, seventeen stitches on the upper lip outside and inside, and minor cut above the right eye and bruises below the eye as well as on the left flank at waist. I was told I was lucky to get away without anything life threatening! So grateful to the almighty for his grace. So the dreaded micturition syncope had got me once again after 22 years.
There are many lessons I have learnt, that I want to mention here just in case these can help save some other old people like me. If you have to get up in the middle of the night to pass urine, never get up suddenly. First take a few deep breaths, sit on the edge of the bed, tap your feet a few time, take a sip of water, massage your calves – do at least some of these activities, so that blood circulation improves, then get up and do the job sitting. After the bladder is evacuated fully, it is advisable to keep sitting on the WC seat for a minute or two before getting up, because this is precisely when the syncope is most likely to happen. You can also do the foot tapping routine a few times. Of course, if there is someone to help it would be ideal to take support. Preferably install some grab rails near the WC so you can get support while sitting down and getting up. Whenever any of your medicines is changed, try to get a second opinion about the possible side effects. Even Google search can also help in this – even if may not always accurate, it will give a broad idea. Sadly micturition syncope does not give you even a moment’s warning, it happens all too suddenly – no feeling of dizziness or any weakness in the legs or any other sign of what is coming.
(A veteran of the corporate world, the author now does only voluntary work in various spheres. Views expressed are personal)
