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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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I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

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Testimonial by Jamie M.

I have been going to see Heather for a while now, and I can't tell you enough how much she has improved my quality of life. Heather specializes in issues like pelvic floor, but I see her for other orthopedic issues.

I have a lot of chronic joint pain and dysfunction issues (back, hips, neck) that require that have ongoing physical therapy maintenance. The effects of my problem joints/areas overlap and interconnect with each other in complex ways, so helping me requires really having a complete understanding of the entire skeletal and muscular system. Pain does not always appear where the problem actually is, the human body is a twisty, many-layered puzzle. I have an exercise program I do at home and I am very functional, but there are just something things I need a PT to help me out with.

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Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

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Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

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Testimonial by Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

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