Much attention has been paid to concussions in the past several years, and it has cast a rather dark shadow, especially on athletes and athletics.

There is nothing quite as valuable as a completely functioning brain, and a damaged one is far worse than a limp, an ACL tear or a host of other disorders. Concussions, however, are just one item on the list of head injuries collectively termed traumatic brain injury.

Our faithful Centers for Disease Control and Prevention are ever diligent in their collection and dissemination of disease and accident statistics. Based on emergency department numbers from 2006 to 2010, falls are the cause of the majority of TBIs in two age groups: the very young (0-4 years old) and the elderly (65 and older) – 73 percent and 82 percent respectively.

For ages 5 to 14, falls caused 35 percent of traumatic brain injuries while being struck by or against an object also caused about 35 percent of TBIs. For ages 15 to 44, the distribution evens out with TBI occurring in near-even proportions for assaults, falls and motor-vehicle “events.” In the 45-to-60 age group, falls increase to nearly half that of the older-than-65 group, or about 40 percent.

A college roommate of mine experienced a bizarre TBI. On a protracted ride home, his requests to pull over to relieve himself were ignored, and he experienced urinary bladder over-pressure.

After threats to flood the rear floor of the vehicle, the driver swung off to a bowling alley. In midstream (so to speak), my friend passed out, falling backward from the porcelain, like a falling tree, to a one-point landing on the back of his head. It wasn’t pretty: He was unconscious with the fountain still running, liberally hosing him down. The scene was amusing, with guys running out to the car and back into the restroom with dry clothes.

He had experienced micturition syncope – micturition is urinating or peeing, syncope is fainting. A sudden decrease of bladder pressure can initiate a nerve reflex, causing a drop in blood pressure, reduced circulation to the brain and loss of consciousness – the faint. It is a condition much more prevalent in males and worse with age and straining to pee.

In a 1961 letter to the British Medical Journal, a British physician summarized: “... the sex difference is not (just) due to the short wide urethra of the female preventing the need to strain, but to the difference in posture of the two sexes while micturating and, of course, to the quantity of beer each is prepared to consume.” Yes, alcohol can be a factor.

My friend, though otherwise fully recovered, had lost his sense of smell (anosmia) and was unable to appreciate perfume, other fine aromas and even some unmentionable odors. The nerves for smell pass from the upper nasal passages through bone, in sieve-like openings, to the brain. When the brain is accelerated (or decelerated) because of impact, it slides and can severe the nerves of smell. There is no treatment, and the loss is usually permanent. Pee with caution!

www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.