Eating disorders and the pelvic floor

Eating disorders and the pelvic floor

When it comes to disordered eating and body image, the experience is physical as well as emotional.

In treatment, one explores and works to change one’s relationship with food, self, others, and beyond. Treatments often utilize a team approach and can include a psychologist, social worker, dietician nutritionist, and medical doctors. What may not be known, however, is the relationship between eating disorders and pelvic floor dysfunction and how a pelvic floor physical therapist can help.

We know that trauma is stored in the physical body and that the way we move and interact with the physical world hinges on how we feel. Our nervous system tells us whether we are safe or in danger and the body acts accordingly. But what happens when the danger is emotional? What happens when the danger and distress are our own internal dialogue? The body responds to this too. We get small. We hunch over and curl in a ball. On a subconscious level, our jaw grips, the belly tightens, and the pelvic floor contracts. Our body is preparing for impact, preparing to protect our most vital parts by bracing itself. Unfortunately, we easily get stuck in this loop and the body remains in protection mode even when painful thoughts and dialogue aren’t actively happening. The result: our digestion suffers, we experience pain, and we start to have trouble using those deep muscles responsible for stabilizing us. If those muscles are in protection mode, they are not able to as readily move with and stabilize us in day-to-day life. However, we often don’t recognize this until there is a problem such as pelvic pain, urinary leakage, constipation, bloating, etc.

Pelvic floor issues are not specific to any one diagnosis and I would argue that they have the potential to show up in any diagnosis associated with one’s relationship to eating and body image. Binging, purging, restrictive eating, and corseting/binding/body modification all have the potential to cause issues such as leakage, prolapse, and weakness given the influence of these diagnoses on the nervous and gastrointestinal symptoms. 

Digestion begins at the level of the glottis and ends at the level of the pelvic floor musculature. Any disruption on this path follows the butterfly effect where one small change can have large consequences. To illustrate this, let’s think about the role of body image. If a person does not feel comfortable in their body, they may wear baggy clothes, make themselves small, or on the flip side, wear size-altering garments and limit their food consumption in hopes of achieving an idealized image. In both cases, the nervous system is on edge and the abdomen and pelvic floor are likely gripping to brace oneself or trying to ‘suck in’ to change one’s appearance. That sucking it will eventually create a restriction in the connective tissue and limit movement. Anything from joint movement to muscle and organ movement can be affected. As a result, we can start to see changes in the GI system and even issues involving bladder and sexual health. 

Pelvic physical therapy should be a regular part of intervention planning in the treatment of eating disorders. Health is collaborative. No one practitioner knows everything and that knowledge is ever-evolving – that is why it is called a practice. Be an advocate for your own body and do not be afraid to ask for help. We are here for you. <3


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