Defecation Syncope; Digging Deep: A Case Report

Abstract

Defecation syncope explains the exaggerated vasovagal response while defecating, which may result in unconsciousness and rarely cardiac arrest. It is underreported, mainly because of the patient's hesitation and inability to correlate the two, unless specifically probed by meticulous history taking; the importance of which cannot be over-emphasized. A 28- year old fieldworker with two episodes of syncope, the last of which culminated in a cardiac arrest requiring resuscitation by a bystander. Upon further questioning, it was revealed that both times, the patient had the urge to defecate followed by dizziness and warmth preceding the loss of consciousness. A head-up tilt table test was planned as a means to reenact the symptoms. Upon confirmation of diagnosis, the patient was counselled for lifestyle changes only. Defecation syncope leading to cardiac arrest is a rare entity but with high mortality ratio. Since vagal tone increases during straining effort, reducing physiological response may be helpful to avoid lethal results. Hydration, avoidance of constipation, and squatting position are among the important key risk-reducing factors.