Rope and POTS

Considerations to make when the person in rope has Postural Orthostatic Tachycardia Syndrome (POTS).

February 10, 2026

Disclaimer, this is not medical advice, I speak from a collection of experiences, what I have learned, and some research, but I’m not an expert. I myself have POTS (diagnosed in 2023), I acknowledge it has minor effects on my life these days, and I tie people who have POTS or have a fainting risk that’s not POTS.

I invite anyone to share their own experiences, knowledge and resources. If you see anything that is wrong/incorrect drop a comment or DM me, I love corrections and learning! This is written in the context for someone who is in rope, bottom or self tier/suspender, who has POTS.

What is POTS?

[The following is summarised from Australian POTS Foundation, (Australian POTS Foundation, 2025a), (Australian POTS Foundation, 2025b).]

Postural Orthostatic Tachycardia Syndrome (POTS) is an autonomic dysfunction. A bodies autonomic nervous system doesn’t correctly signal/manage involuntary functions like heart rate and blood pressure when changing positions (like laying to standing). This results in blood pooling since blood vessels do not constrict properly, allowing for blood to pool in the abdomen and lower body, to compensate this a body’s heart rate increases to maintain circulation (to the brain). Body may release excessive norepinephrine, contributing to palpitations, shakiness and chest pain. It can cause pre-syncope, or symptoms before someone faints, and syncope, fainting.

Layman’s terms: The body doesn’t appropriately regulate circulation and increases heart rate to keep blood in the brain. Someone with POTS may experience a high spike in heart rate from sitting to standing causing pre-syncope. There are a number of other bodily effects of POTS as well. The ways to manage it are increase water and salt intake, compression socks or stockings, increase physical exercise if possible to help increase tolerance, and medications.

What triggers a POTS flare/ pre-syncope?

It depends on the person, but can include and not limited too…

Standing up, standing for long periods, waking up (blood pooling when sleeping), hot temperatures (heat dilates blood vessels, makes it harder to get blood to brain), anxiety/dysregulated nervous system, caffeine, sudden movement, dehydration, sitting for too long then moving, eating a big meal, using the bathroom (both urine/poop), arms above your head, bending over, laughing/coughing, etc.

POTS in rope

In application of Shibari/rope there’s a few things to think about. What’s important I think is understanding blood pooling and position changes in relation to rope. I’m yet to have an answer to blood pooling from rope versus blood pooling from a bodies own positions, I’ll crowd source input and edit when I’m informed. I have noticed for some that POTS doesn’t affect them as much in rope because of the effect it can have on nervous system, but in the same breath I know some who don’t experience that. I’ll run through considerations below.

Pre tie considerations and preparation

• Bring the supplies you need (see below)
• Check in with your body. For me if I’m sleep deprived like I often am then I need to factor that in when I self tie, it affects my POTS.
• Eat throughout the day! Body needs food to function. I tend to work better on an emptier stomach, like ate a few hours ago because oh boy body needs a sec to process foods so it doesn’t spike heart rate. But if it’s been too long I’ll be shaky and POTise.
• Drink lots of water on the day, use the bathroom beforehand (unless you’re someone who gets pre-syncope from using the bathroom. Yep it’s a thing, navigate it however you need)
• Electrolytes! My go to is the hydralyte sachets, they’re cheaper in per salt content in comparison to the hydralyte dissolvable tablets. My favourite flavour is blackcurrant and raspberry. Some folks love Sodii too. Otherwise Gatorade or Powerade work too.
• In general it’s recommended to maintain some level of physical exercise to manage POTS if feasible, I see an exercise physiologist and that’s helped me so much in managing symptoms.
• Compression socks if they work for you, optional to wear during a tie. Some use the calf sleeves from a chemist to give some compression but leave the feet free. Personally I own toe less compression socks. Socks will factor in to a low body tie for circulation and blood pooling, work with your rigger.
• Have you just woken up? For some it takes some time for their body to regulate post sleep. My POTS spikes a lot more in the morning if I’m doing high level of physical activity versus in the evening when I have a gym session.
• How hot is it today? Have you been sweating and having more floor time than usual? Or does the space you’ll be tied in have poor circulation? Factor that in as much as you for pre tie body care. A body struggles to circulate blood appropriately because heat dilates blood vessels, causing more pooling.
• What is the tie you’re doing? Do you know if it’s a position or sequence that could cause some issues? If not is your rigger informed on how you’d like them to respond?
• Edit addition: Menstrual cycle might affect your POTS, consider where you are in your cycle and if that might contribute to what’s going on in your body.

Tools to bring with you that could help

For nausea/ weak tummy/ motion sickness

• Ginger lollies
• peppermint lollies
• Alcohol swabs to smell (supposedly it helps with nausea)
• Anti nausea medication

For a vasovagal responses separate from POTS*

• Ice pack to the back of the neck (get an instant ice pack from a pharmacy and put it in your rope kit)

For POTS management

• Hydralyte or electrolytes
• Full water bottle
• Salty snacks
• Sugary snacks
• Water
• Compression socks
  • Bonus points for the ones that don’t cover your toes, seeing toe circulation is great. Use your own judgment about how it affects circulation for lower body ties, especially behind the knees if the socks cut in.
• Instant ice pack (for when it’s hot or for pre-syncope, trial this outside of rope first)
• Portable fan/fan that can be worn around neck
• Heart rate monitor with alerts
  • Apple Watch/garmin. If I can work around a skirt I’ll work around a watch on the wrist pending the type of tie.
  • TachyMon and Beat Watcher are my favourite heart monitoring apps on an Apple Watch
• An optional third person you trust to watch your tie. A spotter for partnered ties might be helpful if you need to be lifted in a suspension and brought down at the same time. They could also get items for you like a fan, ice pack, water, a pillow for when you need to lay down. If you are a higher fainting risk then a third person that you consent to touch you and knows how to respond with the rigger may be helpful.

Considerations for shapes/positions/placements

• Caesar position when sitting (heels under bottom, knelling) can contribute to blood pooling and trigger pre-syncope when someone moves out of the position or while in it. Try alternatives like sitting on a floor pillow, standing with unlocked knees and shifting weight for a short period, a chair.
• Standing works for you? Wiggle your feet, your toes, unlock your knees, shift your weight from one leg to another, get that circulation moving.
• Standing doesn’t work for you? Sweet then sit. If you and your rigger want to get into the air then work together to help each other out. It might be tying the core ties and then using what remaining legs you have free to push yourself up, or simply carabiners on top and bottom to reduce friction on the uplines.
• Bending over ties where head is below heart might make things harder for you.
• Arms above head in ties might cause pre-syncope.
• Sudden position changes such as laying to sitting/standing, sitting to standing etc. could cause pre-syncope.
• Someone might find inversions more comfortable than vertical ties because body doesn’t need to work as hard to bring blood to brain. This comes with a caveat that going from inversion to upright could cause pre-syncope, a solution is to lower to the ground without coming back up or bring person up to horizontal.
• Rope, such as predicament, is strenuous on the body and can cause pre-syncope. But on the flip side, some self suspenders use it as a way to condition body, or others find the endorphins/affect of rope lowers their heart rate after. I have a little thought about how rope can regulate a nervous system that then helps with POTS (an autonomic nervous system disorder) * .

Considerations for those who experience syncope/nausea/motion sickness

That aren’t necessarily POTS related

• It’s been reported that some experience nausea/vertigo/pre-syncope/fainting responses when their diaphragm is restricted. Especially for ties around the waist, ribcage, underbust, and for shapes/positions that are vertical (hashira, standing predicaments). For some this might be blood pressure, for others it might be the big arteries are constricted and trigger a vasovagal response (they faint). I have seen reports of people experiencing a vasovagal fainting response to upright vertical ties due to a waist rope (see resources below for mentions)
  • https://fetlife.com/groups/51/posts/30812059](https://fetlife.com/groups/51/posts/30812059)
• Some might find it best to avoid being suspended on a swivel, full inversions (or on the other end of things upright standing if blood pooling is working against you, drops or rapid transitions.
• Rope being rapidly removed from a body can also trigger pre-syncope * . From what I gather there can be a lot of reasons for why this can happen, body went through something strenuous and now it’s suddenly out of it. This is not a topic I am well informed on, it could be bullshit.

So you’re experiencing pre-syncope in rope? What now?

Depends! Have you experienced it before in rope? What level of symptoms are you experiencing? Is it ’need to lay down and I’m good’ or ‘I’m going to faint get me out immediately’? Do you know your warning signs and how urgent your situation is?

General strategy: Tell your rigger/spotter and lay down.  Other options include: Ice pack on neck or face for some help (suggestion to try this outside of rope first), have rigger/spotter lift your lower body so you can have a break from the position, if it’s hot get a fan on you, wiggle toes/feet if standing.

For myself pre-syncope is like the low iron feeling when you stand up. My vision blacks out briefly, I see stars, my hearing might very briefly dampened and there’s a ringing sound in my ears. I’ll need to hold onto something when I stand up and then it goes away. Other times I stand up from laying down for a while, I make it about twelve steps then my legs stop working and I flop to the ground until my body regulates. For others this is not the case, their heart rate continues to increase and it may not be immediate either, causing more pre-syncope symptoms or syncope (fainting).

I have tied folks with POTS before, mostly those who are versed with their own POTS and warning signs. I’m glad that I’ve been able to communicate with them in the moment about what they need, often it was to sit, lay down, have a chair put under them, or ice pack on a neck while I take them out of the suspension. Other adjustments were untying their wrists from a TK, lifting a body to offload some pressure, or making the tie more sustainable so the person could have a moment to breathe.

As a self suspender my own adjustments include having my spotter untie my uplines, untie my chest harness because reaching behind me can be exhausting for my POTS, have my spotter lift me up so I can take a break, pull myself up to bamboo/carabiner to take load off, find ‘breaks’ or comfortable positions (for me that’s face down on a chest harness or using my chest harness and a lower body tie as a hammock to breathe). I have also learned to be cautious about self suspension when it’s hot and humid.

An aside on communication - Keep it simple

Tops

• How long do we have?
• Give me a number?
• Talk to me.
• Come down or lift you?
• Lay down?
• Thank you, I’m going to…

Bottoms

• Need to sit
• Need to lay down
• POTSie, I can’t sustain this for long
• 2 minutes, time to come down
• I’m feeling faint
• I’m at a 7 (1 being sustainable, 10 being cut me out immediately)
• I’m going to faint
• Waist line. I’m going to faint.

Reminder for tops and bottoms, coming down or bailing on a tie does not mean stop. It might mean come out, take a break, reassess and return.  Top’s pretty please consider how much it sucks to have your body nope out in a potentially scary or anxiety inducing way. Bottom’s, the best advice I got when I got into rope was rope is all about failure, we just don’t see it in the Instagram posts or hear it when we watch scenes.

And self tiers/suspenders, please have a spotter you trust to touch you and will help with post tie care if you need, get some salt in you and trust what you know about your body.

Resources

These are posts I referred to while putting this together and resources I suggest you read

• A discussion on wether or not to cut rope when the bottom faints. https://fetlife.com/groups/51/posts/3983925
• A discussion about having a ‘weak tummy’ and easily experiencing vertigo and nausea in rope. https://fetlife.com/groups/51/posts/30812059
• Information about POTS - https://POTSfoundation.org.au
• Communication in Rope. (I especially appreciate this post because it offers a frame work that isn’t time based for those that can’t conceptualise time in rope). Author: Nix_ Link: https://fetlife.com/users/1404759/posts/2114327
• Purple limbs and rope bondage- when should you worry? Author: MissDoctorLink: https://fetlife.com/users/2791897/posts/5341280
• The whole ‘Bottoming’ index in the Rope Writing Library is worth a read. It covers things like breathing in rope, active bottoming, communication, being suspended, etc. https://fetlife.com/groups/95555/posts/10827393
• In the Rope Incident Reports group index go read the posts about people’s experiences in fainting in rope. The comments of those posts are also great in how to approach the situation and others experiences. https://fetlife.com/groups/47741/posts/9155202
• InFLUX wrote a post on first aid in rope, go read it! https://fetlife.com/InFLUX/posts/9072914
• Rope365 has a safety and risks page, special mention for the YouTube playlist they have put together that includes things from a range of rope educators. https://rope365.com/safety/ & https://youtube.com/playlist?list=PLkrdRffh_Gg2mh6eSyj_tbPSJRSbirB-k&si=FkYUhYWGaZHN51S0

*-Knowledge gaps

Topics I have mentioned that I acknowledge I need to research more

• Differences between blood pooling caused by rope and blood pooling from POTS, how do those intersect?
• Vasovagal response in rope caused by diaphragm constriction/tight rope around the waist
• Management of POTS
• The effect rope can have on someone psychologically and on their nervous system (positive and negative)

The topics I am not knowledgeable enough to cover in this writing and have avoided to reduce misinformation

• Panicking in rope
• To cut or not to cut rope
• First aid response
• Actual fainting in rope

Please see first aid instructions on fainting. I can’t definitively tell you to cut rope or not, it’s situation dependent and I’m not qualified, but the most you can do is stay calm and remember that their safety matters more than the rope kit.  https://www.stjohnvic.com.au/news/fainting-first-aid/

References

1. Australian POTS Foundation. (2025a, October 16). Living with POTS - Australian POTS Foundation. https://POTSfoundation.org.au/living-with-POTS/
2. Australian POTS Foundation. (2025b, October 16). What is POTS? - Australian POTS Foundation. https://POTSfoundation.org.au/POTS-for-practitioners/