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Eating Disorders and Pelvic Floor Dysfunction | Image Courtesy of Niklas Hamann via Unsplash
Eating Disorders and Pelvic Floor Dysfunction | Image Courtesy of Niklas Hamann via Unsplash

What's the Connection Bewteen Eating Disorders and Pelvic Floor Dysfunction?

Read on for some answers.

Eating disorders are unfortunately common, with at least 9% of people worldwide suffering from an eating disorder. This translates to 28.8 million Americans will have an eating disorder in their lifetime. There are different types of eating disorders (ED) including anorexia nervosa, bulimia nervosa, and binge eating disorder. Other than the typical psychological and social implications that these eating disorders may cause, they also can affect our pelvic health and lead to pelvic floor dysfunction. It can lead to incontinence (either urine or feces), prolapse, increased urinary urge, pelvic pain (possibly associated with polycystic ovarian syndrome or PCOS), constipation, and sexual dysfunction. 

Sometimes suffering from anorexia nervosa can affect hormone levels and in this case, it often decreases estrogen levels. In addition, because of the food restrictions, many people may also suffer from low protein. Both the low estrogen and protein levels can contribute to structural changes in the puborectalis muscle negatively. The puborectalis acts as a sling around your rectum and is crucial in our ability to defecate as well as keep us from leaking. As a result of the structural changes that occur in the puborectalis muscle, this may lead to fecal incontinence. 

Urinary Incontinence & Eating Disorders 

Hextall, et al. also found that 40% of women with anorexia nervosa experienced stress and urge urinary incontinence compared with their healthy matched controls. Stress urinary

incontinence is related to urine leakage during activities such as exercising, laughing, coughing, and sneezing. Urge incontinence is associated with a strong urge that leads to leakage before reaching the toilet. Eating disorders are also more commonly seen in athletes. Athletes that also suffer from eating disorders are almost 50% more likely to have urinary incontinence, and more likely to experience increased urinary urgency than athletes with no signs of eating disorders. 

Constipation and Pelvic Organ Prolapse

In addition, due to dietary restrictions, excessive intake, or purging, it is common to experience chronic constipation in those with eating disorders. Unfortunately, this can lead to habitual straining while defecating, painful bowel movements, hemorrhoids, and/or abdominal discomfort!  Check out the blog: "Chronic Constipation: The Basics" for more information. Over time, continued habitual straining can lead to prolapse of pelvic organs (a downward shift in pelvic organs due to poor support) which can lead to pelvic heaviness or feelings of something is coming out vaginally. Check out this blog for more information on pelvic organ prolapse

Bulimia Nervosa & Polycystic Ovarian Syndrome

A common comorbidity that we see specifically in those who suffer from bulimia nervosa is polycystic ovarian syndrome or PCOS. Kimmel, et al. who wrote a summary on the literature found that 75% of women with bulimia nervosa also had polycystic ovaries. On the other hand, about 33% of women with polycystic ovaries admitted to bulimic eating patterns. Females with PCOS, although sometimes asymptomatic, often experience cramping pain (not necessarily associated with menses), bloating, bodily pain, among other symptoms. 

Sexual Dysfunction & Eating Disorders Eating Disorders and Sexual Dysfunction | Image Courtesy of Maru Lombardo via Unsplash

Last, but not least, we often find sexual dysfunction in in those with eating disorders. Very often, women with eating disorders experience decreased libido, lower sexual functioning, and increased sexual anxiety. Clinically we find that those with increased anxiety in general, especially as it relates to sexuality, can lead to pain with sexual intercourse. Sexuality involves an integration of biological, social, and psychological systems, and can be further impacted if suffering from any type of eating disorder. This can easily manifest physically in the pelvic floor muscles, and make orgasms as well as sexual penetrative intercourse painful. 

Help with Eating Disorders and Pelvic Floor Dysfunction

Luckily, there is help! If you are suffering from any of the symptoms aforementioned, regardless of whether you have an eating disorder or not, there are manual techniques, exercises, stretches, and education that can help improve your symptoms. Most pelvic floor physical therapists are trained to help improve incontinence, work on abdominal viscera manually to help relieve any abdominal discomfort/bloating symptoms, educate on toileting strategies to minimize constipation, educate on strategies to decrease prolapse discomfort, and improve overall sexual functioning. Along with the help and guidance of an eating disorder specialist, please know we are here, ready to help! Schedule your in-person or telehealth appointment at Femina

References:

  1. National Association of Anorexia Nervosa and Associated Disorders. Eating Disorder Statistics: General & Diversity Stats: ANAD. November, 3 2021. Accessed on Jan 20, 2022. https://anad.org/eating-disorders-statistics/ 
  2. Bo K, Borgen JS. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Medicine and Science in Sports and Exercise 2001; 33(11); 1797-1802.
  3. Cortes E, Singh K, Reid WMN. Anorexia nervosa and pelvic floor dysfunction. Int Urogynecol J 2003; 14: 254-255. Doi: 10.1007/s00192-003-1082-z.
  4. Hextall A, Majid S, Cardozo L, et al. A prospective controlled study of urinary incontinence symptoms in women with severe anorexia nervosa. Neurourol. Urodyn. 1999; 18:398-399.
  5. Kimmel MC, Ferguson EH, Zerwas S, et al. Obstetric and Gynecologic Problems Associated with Eating Disorders. Int J Eat Disord 2016 March; 49(3): 260-275. doi:10.1002/eat.22483
  6. Martin ML, Halling K, Eek D et al. Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study. Health and Quality of Life Outcomes 2017; 15:162. Doi: 10.1186/s12955-017-0736-3

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Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

Read more: Testimonial by Lauren B.

Testimonial by Y.L. (mom of 2)

After having my second baby via C-section I searched for months to try to find help for my lower back pain and separated abdominal muscles. I finally came across Heather Jeffcoat via a mommy blog. I reached out to her via email and set my first appointment. My first appointment went amazing … she listened to what my symptoms, check my separation and explained to me in detail what the next steps would be. Not only did my abdominal separation go from 3 to about 1 -1/2 but my back has pain has significantly reduced. I’m personally recommending all my mommy friends to Heather!

Y.L. (mom of 2)

Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

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