Hi!
I’m Tori, and I’m a doctor of physical therapy who specializes in pelvic dysfunction
and I think that pelvic health and pelvic issues should both be more openly discussed
and widely understood because everyone has a pelvis!
So, today we are going to talk about defecation syncope—aka fainting during or soon after
a bowel movement!
Now I do think this is more common than is reported in the literature so, if this happens
to you, know that you are NOT alone and I also think that this may be more treatable
than we realize so, let’s make sense of it and talk about potential interventions.
Fist of all, fainting, or syncope, is caused by any phenomenon that results in decreased
blood flow, or decreased oxygen delivery, to the brain.
That’s why some people faint after locking their knees and standing for a while.
You only have so much blood in your body at any given time and it’s constantly circulating
and delivering oxygen to your body.
Locking your knees can constrict the veins in your legs, causing your blood to pool or
collect in those veins, which decreases your blood pressure and eventually restricts circulation
and oxygenation to the brain—and then you pass out!
But what mechanism causes you to faint, exactly?
What connects your nervous system and your circulatory system in this way?
Something called the vagal response, which happens when your vagus nerve, the part of
your parasympathetic nervous system that regulates your heart and blood vessels, responds to
a trigger by slowing down your heart rate and widening the veins in your legs.
Now, you can physically trigger this response via the circulatory system by doing something
that promotes that pooling of blood in the legs—as we see in our knee lock example,
but this response can also be triggered via the nervous system—by intense emotional
or physical stress—think fear, or shock, or trauma, or pain—this is why some people
pass out at the sight of blood.
So why would a bowel movement cause someone to faint?
Well, straining or bearing down—like this—can physically trigger the vagal response, just
like locking your legs can.
So improving stool consistency, avoiding straining, and sitting properly on the toilet to poop
can mitigate this, but what if you aren’t straining?
Well, it’s important to consider someone’s history!
Why couldn’t the vagal response be caused by fear or other emotional stress in this
scenario?
What if someone has a history of trauma related to their bowels or their pelvis, could we
treat the trauma and improve these symptoms?
The connection between the parasympathetic nervous system and the intestines is undeniable—if
intestinal dysfunction lends itself to vagus nerve hypersensitivity, could we treat the
intestinal dysfunction?
What if we’re wrong about the vagus nerve ending in the abdomen just like we were wrong
about it ending in the chest, what if it extends into the pelvis for some of us—which might
explain certain kinds of untraditional orgasms—could you then improve these sorts of symptoms by
improving impairments in the pelvis?
These are hypotheses but, in the same way that we constantly learn that the body is
much more interconnected than we previously believed, perhaps the body is much more capable
of healing itself than we currently believe, and the pathway to that healing hinges on
first accepting the body’s interconnectedness, so that we can intervene in different ways!
After watching this, if you have a gut feeling—pun intended—about something a little more “out
of the box” that may be related to your defecation syncope, pursue it!
No one knows a body like the person living it and, in the interim, if you start to feel
faint during a bowel movement, either spread you legs and put your head in between your
knees or, better yet if you can, lay down on your back and rest your ankles on the toilet.
Both of these improve blood flow to the brain and can prevent fainting.
Even though it can be embarrassing to clean up a mess, that’s so much better than potentially
hitting your head or another part of your body on the bathroom floor.
On that note, thank you so much for watching!
Be sure to join me on the 10th and 20th of every month for future pelvic PSAs, with surprise
PSAs on the 30th, where I attempt to cover an interesting pelvic health or pelvic issue
topic in 5 minutes or less!
See you next time!