Abnormalities of sympathetic and parasympathetic autonomic function in subjects with defaecation syncope
Open accessAbstract
UNLABELLED: Defaecation syncope is defined as blacking out at, or around, the time of defaecation. It is associated with increased mortality; however, patients rarely voluntarily report symptoms. We have examined autonomic function in a cohort of patients with defaecation syncope. METHODS: We prospectively identified all subjects referred to our unit with symptoms of defaecation syncope or presyncope on direct questioning. All subjects had autonomic function tests using beat to beat blood pressure measurement synchronized with R-R interval allowing real time assessment of autonomic function. RESULTS: Seven patients were identified who presented with defaecation syncope. Compared with age and sex matched controls, subjects had abnormalities of both sympathetic and parasympathetic autonomic function consistent with mild-moderate autonomic failure. On specific intervention syncope stopped in all subjects: 3 had culprit medication withdrawn, 3 received medication to increase blood pressure and 1 in whom cardioinhibition was demonstrated improved with permanent pacemaker insertion. Two subjects who had colonoscopy had profound haemodynamic changes during the procedure associated with syncope. CONCLUSIONS: Symptoms of syncope on defaecation are associated with autonomic failure. With appropriate therapeutic intervention our subjects all improved.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Evidence for treatment of situational syncope is limited mainly to case reports, small case series, and small observational studies.
“Evidence for treatment is limited mainly to case reports, small case series, and small observational studies (431,433–436).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [431]
Evidence for treatment of situational syncope is limited mainly to case reports, small case series, and small observational studies.
“Evidence for treatment is limited mainly to case reports, small case series, and small observational studies (280,282–285).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary (2017) · cites this paper as [280]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Diagnosis and management of diabetic autonomic neuropathy.
Ewing, D. J., & Clarke, B. F. (1982) · BMJ · doi:10.1136/bmj.285.6346.916 · Cited by 1,239 · see citing works
Composite Autonomic Scoring Scale for Laboratory Quantification of Generalized Autonomic Failure
Low, P. A. (1993) · Mayo Clinic Proceedings · doi:10.1016/s0025-6196(12)60631-4 · Cited by 466 · see citing works
Autonomic Nervous System Function
Low, P. A. (1993) · Journal of Clinical Neurophysiology · doi:10.1097/00004691-199301000-00003 · Cited by 217 · see citing works
Pharmacological dissection of components of the Valsalva maneuver in adrenergic failure
Sandroni, P., Benarroch, E. E., & Low, P. A. (1991) · Journal of Applied Physiology · doi:10.1152/jappl.1991.71.4.1563 · Cited by 189 · see citing works
Defecation syncope. A symptom with multiple etiologies
Kapoor, W. N. (1986) · Archives of Internal Medicine · doi:10.1001/archinte.146.12.2377 · Cited by 50 · see citing works
Part 1. The initial evaluation of patients with syncope
Brignole, M. (2001) · EP Europace · doi:10.1053/eupc.2001.0190 · Cited by 40 · see citing works
Brophy, C. M., Evans, L. V., & Sumpio, B. E. (1993) · Annals of Vascular Surgery · doi:10.1007/bf02002893 · Cited by 7 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- Pathy MS. Defaecation syncope. Age Ageing 1978;7:233e6.
- Ewing DJ, Clarke BF. Diagnosis and management of auto- nomic neuropathy. Br Med J 1982;285:916e8.
- Brignole M, Alboni P, Benditt D, et al. Task force on syncope: parts 1 and 2. Europace 2001;3:253e68.
Cited by
Sorted by citations
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.004 · Cited by 484 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000499 · Cited by 453 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Circulation · doi:10.1161/cir.0000000000000498 · Cited by 408 · see citing works
2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.003 · Cited by 327 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.03.002 · Cited by 155 · see citing works
Bae, M. H., Kang, J. K., Kim, N. Y., Choi, W. S., KIM, K. H., Park, S. H., Lee, J. H., Yang, D. H., Park, H. S., Cho, Y., et al. (2011) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2011.03290.x · Cited by 38 · see citing works
Shen, W.-K., Sheldon, R. S., Benditt, D. G., Cohen, M. I., Forman, D. E., Goldberger, Z. D., Grubb, B. P., Hamdan, M. H., Krahn, A. D., Link, M. S., et al. (2017) · Heart Rhythm · doi:10.1016/j.hrthm.2017.03.005 · Cited by 34 · see citing works
Clinical Characteristics of Defecation Syncope Compared With Micturition Syncope
Komatsu, K., Sumiyoshi, M., Abe, H., Kohno, R., Hayashi, H., Sekita, G., Tokano, T., Nakazato, Y., & Daida, H. (2010) · Circulation Journal · doi:10.1253/circj.cj-09-0421 · Cited by 30 · see citing works
Pathophysiology of syncope: current concepts and their development
Benditt, D. G., Fedorowski, A., Sutton, R., & van Dijk, J. G. (2024) · Physiological Reviews · doi:10.1152/physrev.00007.2024 · Cited by 23 · see citing works
Cardiac arrest in the toilet: clinical characteristics and resuscitation profiles
Inamasu, J., & Miyatake, S. (2012) · Environmental Health and Preventive Medicine · doi:10.1007/s12199-012-0301-y · Cited by 20 · see citing works
Characteristics of Syncope in Japan and the Pacific Rim
Abe, H., Kohno, R., & Oginosawa, Y. (2013) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2012.11.008 · Cited by 9 · see citing works
Out‐of‐hospital cardiac arrests in the toilet in Japan: a population‐based descriptive study
Kiyohara, K., Nishiyama, C., Kiguchi, T., Kobayashi, D., Iwami, T., & Kitamura, T. (2018) · Acute Medicine & Surgery · doi:10.1002/ams2.349 · Cited by 8 · see citing works
Clinical characteristics of stroke occurring in the toilet: Are older adults more vulnerable?
Inamasu, J., Tomiyasu, K., Miyatake, S., Mayanagi, K., Yoshii, M., & Nakatsukasa, M. (2017) · Geriatrics and gerontology international/Geriatrics & gerontology international · doi:10.1111/ggi.13168 · Cited by 8 · see citing works
Assessment of Constipation in Children With Tracheostomy
Simons, J. P., Mehta, D., & Mandell, D. L. (2010) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archoto.2009.207 · Cited by 5 · see citing works
Unusual Cause of Cardiac Arrest
Tsushima, T., Patel, T. R., & Sahadevan, J. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.8370 · Cited by 4 · see citing works
Tester, M. A., Hockin, B. C. D., David, T., Franciosi, S., Harris, K. C., Claydon, V. E., & Sanatani, S. (2018) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2018.07.013 · Cited by 3 · see citing works
Defaecation syncope: new light on an old problem
Grubb, B. P. (2004) · EP Europace · doi:10.1016/j.eupc.2004.01.008 · Cited by 3 · see citing works
Buchanan, E. B., Suresh, S. P., & Yoo, D. (2024) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2024.09.018 · Cited by 2 · see citing works
Hertz, P., & Gin, K. G. (2013) · International Journal of Internal Medicine · Cited by 2 · see citing works
Evaluation and Management of Reflex Vasovagal Syncope—A Review
Udyavar, A. R., & Deshpande, S. A. (2021) · Indian Journal of Clinical Cardiology · doi:10.1177/26324636211050154 · Cited by 2 · see citing works
Diaphragmatic Cardiac Compression Mimicking Defecation Syncope: A Case Report
Velibey, Y., Güvenç, T. S., Uğur, M., Güzelburç, Ö., & Eren, M. (2016) · Annals of Internal Medicine · doi:10.7326/l15-0594 · Cited by 1 · see citing works
Research Progress on Situational Syncope
Deng, Q., Wang, Y., Li, F., Hong, C., Liu, L., Liu, L., Zou, R., Wang, S., & Wang, C. (2025) · Journal of Child Neurology · doi:10.1177/08830738251392434
- Authors
- Allan, L.
- Affiliations
- Royal Victoria Infirmary (GB)
- Corresponding author
- Allan, L
- ORCID
- Allan, L
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2004-05
- Volume
- 6
- Issue
- 3
- Pages
- 192-198
- ISSN
- 1099-5129 (ISSN-L)
- OpenAlex
- W2108988936
- Cited by
- 22
- References
- 7
- Citations by year
- 2025: 1 · 2024: 2 · 2021: 2 · 2018: 2 · 2017: 7 · 2016: 1 · 2013: 2 · 2012: 1
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- EP Europace (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- Guts UK
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- autonomic failure, sympathetic dysfunction, parasympathetic dysfunction, beat-to-beat blood pressure, presyncope, cardioinhibition, permanent pacemaker, drug withdrawal
- MeSH terms
- Adult, Aged, Aged, 80 and over, Blood Pressure, Defecation, Female, Heart Rate, Humans, Male, Middle Aged, Parasympathetic Nervous System, Prospective Studies, Sympathetic Nervous System, Case-Control Studies, Syncope, Vasovagal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
