5 Things You Should Know About Eating Disorders, Incontinence And Uterine Prolapse

One of the complications of eating disorders you don't generally hear about is organ prolapse, which can lead to bladder and bowel incontinence. Here are five things you need to know about this additional problem for people who live with eating disorders.

Bedwetting can be a symptom or a complication of anorexia

It's not unusual for teenagers who have anorexia nervosa to develop nocturnal enuresis, also known as bedwetting. Teens tend to be extremely reluctant to seek medical help with bedwetting. One survey found that just 30 percent let their doctors know about the issue; it is reasonable to assume that teens also seek to hide bedwetting from their parents and siblings.

The reasons for bedwetting may be related to anorexia itself. Anorexia changes the concentration of amino acids in the bloodstream and the kidneys may release fluid to keep amino acid concentrations higher. Another possible cause of bedwetting is the use of antidepressants, which interfere with sensation of the urge to urinate.

People who live with anorexia tend to have a number of issues with defecation

Researchers at the University Hospital Tor Vergata in Rome (Italy) surveyed 85 anorexia patients about their issues with bowel movement. Problems with defecation were very common:

• 93 percent of anorexia patients had at least one medical problem associated with defecation.
• 83 percent reported constipation.
• 84 percent were found to have obstructed defecation syndrome. (What is obstructed defecation syndrome? This is a condition that causes difficulty in emptying the rectum even after repeated visits to the bathroom and even when stools are soft. This syndrome can be due to tenesmus, muscle tension surrounding the rectum, or anismus, muscle tension that makes it difficult to open the anal sphincter. People who have this problem may try to "dig out" stool with their fingers, or they may become dependent on enemas.)

The Italian research team found obstructed defecation syndrome in 100 percent of patients who had a BMI of 18 or less. The researchers also found that the longer someone had had anorexia, the greater the likelihood of bowel problems. The percent of anorexia patients who had bowel issues was 60 percent among those who had had anorexia for less than five years, but nearly 100 percent in those who had had the condition with complications requiring hospitalization for more than five years.

Women who live with anorexia are especially at risk for pelvic floor dysfunction and vaginal and/or uterine prolapse

About half of women who have anorexia and who complain of constipation will have some degree of pelvic floor dysfunction — so they're not able to properly tighten and release pelvic muscles to facilitate a bowel movement. Symptoms of pelvic floor dysfunction include anal leakage, leakage of urine, and a frequent urge to urinate. This condition can also cause abdominal bloating with the formation of a "beer belly" even in people who have very low body fat. Bloating is more common than bloating plus abdominal distention (the appearance of a "belly").

Anorexia isn't the whole reason this problem occurs. The puborectalis muscle that makes bowel movement possible may be damaged by a low-protein diet, but it is also affected by estrogen levels. As women reach menopause, even if they don't have anorexia, it is not unusual for this muscle to atrophy so that bowel incontinence and urinary incontinence result. 

Women who live with anorexia are at higher risk of pelvic organ prolapse

The combination of a low-protein diet and estrogen deficiency can lead to several different kinds of organ prolapse, in which a pelvic organ shifts downward and bulges into or even out of the vaginal canal. Pelvic organ prolapse can involve the vagina, cervix, urethra, uterus, rectum, or bladder. Even in women who don't have eating disorders, pelvic organ prolapse is a very common problem. Experts estimate that between 11 and 19 percent of women in North America will have to have surgery for this condition before the age of 85, and 30 percent of those women will have to have surgery more than once.

The first line of treatment for pelvic floor prolapse is exercise, especially Kegel exercises. Pelvic floor muscle training sometimes reverses pelvic floor prolapse, and it almost always helps. But many women don't get complete relief without surgery.

Binge-eating disorder is associated with urination-related 'accidents'

People who live with binge-eating disorder tend to have more problems with not making it to the toilet in time to urinate. One problem is urinary incontinence. In the severely obese, another problem is the inability to walk fast enough to get to the bathroom. Weigh loss, however, eventually helps with both problems.