Pelvic Floor Dysfunction and Eating Disorders

How Eating Disorders Impact Pelvic Floor Health

The pelvic floor is a group of muscles and connective tissues that stretch from the pubic bone to the tailbone. These muscles support vital organs like the bladder, bowel, and reproductive organs, and they play a key role in core stability, continence, and sexual function. Pelvic floor dysfunction (PFD)  has traditionally been linked to factors like pregnancy, vaginal birth, obesity, and aging. However, research has also shown a significant number of pelvic floor symptoms in women who have never given birth (nulliparous women). PFD is also closely tied to gastrointestinal (GI) issues like gastroparesis (delayed stomach emptying) and the sensation of incomplete bowel emptying. 

Additionally, eating disorders can significantly disrupt the health and function of the pelvic floor. Disordered eating behaviors such as malnutrition, purging, and excessive exercise often take a toll on the body’s muscular systems—including the pelvic floor! 

While PFD is well-documented in the general population, it remains under-researched in individuals with eating disorders—despite their high rates of GI symptoms and medical complications. Eating disorders, such as anorexia nervosa, involve disrupted eating behaviors that impair nutritional intake and overall health. Anorexia, one of the most common types, includes a restrictive subtype and a binge/purge subtype, both of which can negatively impact pelvic floor health.

Here’s how different eating disorders can affect pelvic floor function:

Anorexia Nervosa

Chronic restriction of food intake and severe malnutrition lead to muscle wasting throughout the body, including the pelvic floor. Without adequate nutrients like protein, vitamins, and minerals, these muscles weaken over time. Constipation is also common due to slowed digestion, which adds further strain to already weakened pelvic muscles.

Bulimia Nervosa

Frequent bingeing and purging, especially through self-induced vomiting, increase intra-abdominal pressure. Repeated episodes can overstress the pelvic floor muscles, potentially resulting in issues like urinary incontinence, pelvic organ prolapse, and painful sex.

Binge Eating Disorder

Sudden or sustained weight gain places increased pressure on the pelvic floor. This added stress can lead to urinary incontinence and raise the risk of organ prolapse. Binge eating is also frequently associated with constipation, compounding strain on the pelvic muscles.
Excessive Exercise

Compulsive, high-intensity exercise—common in individuals with eating disorders—can lead to overuse of the pelvic floor. Activities like heavy lifting, running, or jumping may cause the muscles to become tight and overactive (hypertonic), which can result in pelvic pain, urinary urgency, and difficulty with bowel movements.

Common Pelvic Floor Symptoms Associated with Eating Disorders:

• Urinary incontinence: Difficulty controlling urine, often due to weakened or overstrained pelvic muscles.

• Pelvic pain: Ongoing discomfort in the pelvic region, which can stem from muscle tightness or organ displacement.

• Constipation or Bowel Dysfunction: Trouble passing stool, frequently due to malnutrition and pelvic muscle dysfunction.

• Painful intercourse or Chronic Pelvic Pain: Either tight or weak pelvic muscles can lead to discomfort or pain during sexual activity.

A retrospective study published in 2024 by the Journal of Clinical and Experimental Obstetrics and Gynecology found that individuals with severe eating disorders commonly experience symptoms of pelvic floor dysfunction (PFD). The study looked at treatments such as biofeedback, pelvic floor muscle assessments, and active muscle retraining in treatment of PFD and found improvements in key pelvic floor symptom scores.

Even the control group—who did not receive targeted pelvic floor interventions—showed some symptom improvement. Possible reasons include:

• Weight restoration, which may strengthen the pelvic floor by reversing muscle atrophy linked to malnutrition.

• Hormonal changes, such as improved estrogen and collagen levels, which support pelvic tissue health.

• Diaphragmatic breathing, taught to all patients, may help regulate the nervous system and enhance coordination between the diaphragm and pelvic floor muscles.

The study also suggests that psychological factors like anxiety and depression—common in people with eating disorders—can affect pelvic floor function by increasing muscle tension and altering posture. Improvements in mental health may have contributed to symptom relief in the control group.

Further research is needed to explore how weight loss, posture, and psychological well-being influence pelvic floor health in this population.