Code Orange: Defecation Syncope -An Undignified Way to End Up in the ER
Full Disclosure - I am the co-chair of the Palliser chapter of Friends of Medicare. I have been involved with them since 2021.
Disclaimer: I write about healthcare, but I don't practice it. This column is not medical advice. If you faint, fall, or hit your head, call a professional. Don't rely on a journalist with a lopsided brain and five stitches to diagnose you.
Monday night I fell down and went boom. Did I fall down some stairs? Nope. I fainted while sitting on the toilet.
(I am fine, details for the non squeamish at the bottom of the page.)
I had taken my low dose sleep aid a few hours before. I was sound asleep when I woke with an urgent need for the bathroom. My toilet is literally steps away from my bed.
Next thing I know, I'm waking up in a pool of cold liquid on the bathroom floor.
How long was I out? No idea.
The cause? Most likely a classic case of defecation syncope.
Yup, that is exactly like it sounds. It is a well known medical phenomenon which very few people talk about.
What Happens to Your Body
Defecation syncope is a fancy medical term for fainting while - or shortly after - you're on the toilet. It's a form of vasovagal syncope, which just means your vagus nerve (the one that runs from your brain to your gut) overreacted to something. When you strain during a bowel movement - that bearing-down action is called the Valsalva maneuver. It's a normal physical response, but in some people, it can trigger a sudden drop in blood pressure and, well, you wake up on the floor.
Here's the chain reaction:
You strain during a bowel movement (the Valsalva maneuver, if you want to sound smart about it)
This increases pressure in your chest and abdomen
That pressure reduces the amount of blood returning to your heart
Your heart rate slows and your blood vessels widen
Blood pools in your legs
Your brain doesn't get enough oxygen
You wake up on the floor wondering what just happened
The whole process takes seconds. One moment you're minding your own business, the next you're starring in your own medical drama.
Why Sleep Medications Can Be a Factor
I take a small dose of medication to help me stay asleep. I'd taken it a couple hours before this happened. Sleep medications, even at low doses, can lower your blood pressure and slow your heart rate. Also, your blood pressure typically decreases when you sleep. Combine that with the sudden wake-up, the urgency, and the straining, and you've got a perfect storm for a vasovagal episode.
If you're on sleep aids, sedatives, or anything that affects your blood pressure, be aware that middle-of-the-night bathroom trips come with extra risk. Talk to your doctor about whether your medications might be contributing. Your pharmacist is also a great resource, they are experts in medication.
Why People Over 60 Are at Higher Risk
Medicine Hat has a senior population of over 30%. I'm knocking on that door myself, and defecation syncope becomes more common as we age.
Why? Several reasons :
Constipation becomes more common, which means more straining
Medications like blood pressure pills and diuretics can lower blood pressure
Blood vessels stiffen with age, making it harder for your body to compensate
The body's blood pressure monitoring system becomes less sensitive
Heart conditions like atrial fibrillation become more prevalent
The Unspoken Embarrassment
Fainting on the toilet is embarrassing. It's undignified. It's the kind of thing you don't bring up in casual conversation - unless you're a journalist who writes about healthcare and has no shame when it comes to bodily functions.
It's also something that happens more often than people admit. Patients don't volunteer this information unless specifically asked.
Warning Signs to Watch For
Lightheadedness or dizziness
Cold sweat or clammy skin
Nausea
Blurred or tunnel vision
Ringing in your ears
A sudden feeling of warmth
If you feel any of these while on the toilet, stop straining immediately. Lean forward, put your head between your knees, breathe slowly, and call for help .
What To Do If It Happens To You (Or Someone You Love)
If you're the one who fell:
Don't rush to stand up. Stay where you are until you're sure you're stable. Getting up too quickly can cause another faint or a fall.
If you hit your head, get it checked. Even if you feel fine. Head injuries can be deceptive.
If you're on blood thinners, call 911 immediately. Head injuries bleed - A LOT. Blood thinners magnify this.
Don't drive yourself to the hospital, your pride is not worth a car accident which may injure others.
Tell your doctor the whole story. They need to know. They've seen it all and they are not allowed to talk about it.
If it happens more than once, push for answers. Don't let it slide.
If you find someone on the floor:
Don't rush in blindly. Your first instinct will be to help, but take a breath. Don't get up too quickly yourself - especially if you've just woken up or have your own mobility or health issues. The last thing anyone needs is a second person falling while trying to help the first.
Check if they're conscious. If they're not, call 911 immediately.
Don't move them unless they're in immediate danger. They may have a fracture, a spinal injury, or other damage that could be made worse by being moved. Wait for paramedics to assess them.
If they're conscious, ask what happened and how they're feeling. Pain in the hip, back, or neck are red flags - keep them still and call for help.
If they're bleeding from the head, apply firm pressure with a clean cloth - but don't move them to do it.
If they're on blood thinners, call 911 right away.
If you're unsure at all, call 911. For seniors, even a fall that seems minor can turn into something serious.
A note about ambulances in Alberta:
Seniors, age 65 and over, enrolled in the Coverage for Seniors program do not receive a bill for ambulance services. The Alberta government pays the complete cost of ambulance services. Other groups may also qualify for free ambulance services. More info here.
If you're unsure, call anyway. Paramedics can assess the situation on the spot and may prevent a longer hospital stay by catching something early. A quick check by professionals is never a waste of time.
Reducing Your Risk
A few simple changes can lower your chances of a repeat performance :
Stay hydrated.
Eat more fiber.
Don't strain.
Get up slowly from bed.
Review your medications with your doctor, some of them might be contributing. Pay special attention to sleep aids, blood pressure meds, and sedatives. Your pharmacist is a good resource too.
Regular exercise. Even gentle walks help with bowel function.
The author is a 63-year-old journalist with a lopsided brain, five stitches, and a capability for making stupid decisions about her own injuries. This column is for informational purposes and does not constitute medical advice. If you faint, see a doctor. If you want to know what happened with me, you can find it under the Resources section.
Resources
Alberta Health Services
Health Advice Line: 811 (toll-free, 24/7) - speak to a registered nurse
MyHealth Alberta: myhealth.alberta.ca - reliable health information and after-care instructions
Medicine Hat Regional Hospital
Geriatric Assessment Team: 403-528-5609. Provides assessments for adults 65+ with health problems related to aging.
Saskatchewan Readers
Saskatchewan Health Authority: saskhealthauthority.ca
HealthLine: 811 - free, confidential health advice from registered nurses
General
If you faint and hit your head: Call 911 or go to the nearest emergency department. Don't wait.
If you have chest pain, shortness of breath, or confusion: Call 911 immediately.
My Experience
TL:DR
Yup, I promised my results after this section but the detail are rather graphic. This is a trigger warning - no graphic pictures will be shown but the written description might be a bit much. It is written with a bit of dark humour.
In the meantime, here’s the short, not graphic version.
I went to the ER. They did bloodwork and hooked me up to a heart monitor, a blood pressure cuff and an O2 sensor. I was screened for neurological issues to rule out a brain injury. I got 5 stitches in my scalp, the doc who stitched me up hardly cut any hair. I had actually expected them to shave the area but I guess it has been a long time since they did that. I also ran into Parksy, aka Dr Paul Parks, who is a delightful person (unless you belong to the UCP government…). I only saw him in passing and we exchanged cordial greetings.
Everything is all good. My family doc is going to schedule a 24 Holter Monitor to rule out A-Fib (atrial fibrillation) as 10-20% of people over 60 have it.
If you see me in public, you will not see my stitches, they are under my hair. I do have some bruising under one eye.
July 15, about 40 hours after my undignified fall from my toilet - the swelling on my nose has gone down a bit. I will be wearing braids for a while. It hides the stitches but also helps keep my hair and thereby my stitches from getting pulled - the advantage of having such a long, luxurious silver mane.
Last chance to not read this part
Okay, here goes!
Monday night I fell down and went boom. Did I fall down some stairs? Nope. I fainted while sitting on the toilet. Not my finest moment, laying on the floor with my pants literally down.
I had taken my low dose sleep aid a few hours before. I was sound asleep when I woke with an urgent need for the bathroom. My toilet is literally steps away from my bed.
Next thing I know, I'm waking up in a pool of cold liquid on the bathroom floor. I did not know what happened. It was dark because I did not bother to turn on the light to use the toilet. I sat up, still not sure what happened or what the cold liquid was. When I was able to, I stood up and I turned on the light.
It looked like a crime scene or the set of a Tarantino movie.
I knew that head wounds bleed a lot but the amount was still quite impressive. I sat on the toilet and I fainted again. I think I fell on my face that time, my nose was pretty swollen and sore. I should have stayed on the floor but there was so much blood on it…
When I finally got up (again) and looked in the mirror, the first thing that came to mind was the movie Carrie. I could see a good sized gash in my scalp, that explained the blood dripping from my long hair on that side.
How long was I out? No idea.
By the time I was able to keep my feet under me without falling down, I noticed that some of the blood had already coagulated. The immediate issue was the bleeding - I put pressure on the wound and it stopped.
I did think about calling an ambulance but then I did not want to have to come home and clean up the dried blood. It was a hell of a mess. Priorities…
I sat for a while and decided that I could not continue to sit there while blood dripped from my silver locks. By midnight, I had showered, mopped up what looked like a crime scene, and started a load of laundry, cold water of course. I may have a large gash in my hair but at least my towels were clean. Once again, priorities…
ER wait times showed a 3 hour wait so I decided if I was going to have to wait, I would be more comfortable at home. I was obviously well enough to shower, clean up the blood that looked like I lost a knife fight and do a load of laundry. The bleeding was stopped so after the washer started, I laid on my bed and watched TV; I kept the light on all night. Not because I was scared of the dark - I just wanted to make sure I didn't miss any blood I'd have to explain to my kids in the morning. I am still finding the odd spot.
The ER Visit
I messaged my kids around 6 am asking for a ride to the ER; I did not want to drive myself until I got checked out. The wait times now said 30 minutes to see a doctor. I was thinking more clearly and I knew that I would not have to wait long - head trauma with loss of consciousness is one of the things that is prioritized in triage (unless someone with a life threatening issue comes in). I was right - I hardly had a chance to sit down after completing the registration process. Mind you, there was hardly anybody there.
I was taken right back and they hooked me up to a heart monitor, a blood pressure cuff and an O2 sensor. I was screened for neurological issues to rule out a brain injury. Someone came to collect blood. I could have brought some from off my bathroom floor, and the toilet, and the sink and the walls…
The ER doc said the scalp laceration was about 13 centimeters (five inches). He ordered a head CT scan. I had to wait, the technician was not at work yet. It was obviously not life threatening or they would have called someone in early. I got the CT just before 8 am. The results were good - no fracture, no hematoma, nothing to worry about.
The CT scan confirmed what I already suspected: my brain is structurally sound, even if my life choices are occasionally questionable.
I got 5 stitches, the doc very kindly took before and after pics for me for posterity; I was sent home.
I had told my daughter to go to work, she did not need to stick around as Tom (Fougere), my fellow Owl News journalist, had offered to come get me. I knew he would worry when he heard what happened which is why I took him up on the offer. I knew once he saw that I was still me, his fears would be eased.
I made the Wrong Call
I waited until morning to go to the ER, but that was the wrong call. I made that choice because I believed I have a lot of experience navigating the healthcare system. I do - I was the primary caregiver for my late husband, who was a frequent flyer at the hospital. I know what an emergency looks like and what can wait.
Even so, I should have gone to the ER right away. I had a head injury and I was obviously not thinking straight. In my defence, I was operating on about three brain cells.
The smartest choice is to call 911 or go to the ER immediately. Head injuries are unpredictable, and they bleed a lot.
So here's the takeaway from someone who learned it the hard way: if you faint and hit your head, don't wait.
Call someone.
Call 911.
Call your ex if you have to.
Just don't sit there mopping up blood and wondering if you should finish the laundry first. When you do clean up the blood, remember, cold water only!
