In this interview, Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, founder of the Fosnight Center for Sexual Health and medical advisor for Aeroflow Urology, discusses the strong connection between eating disorders and urinary incontinence in women. She highlights that disorders such as anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorders are particularly associated with bladder dysfunctions, especially among elite female athletes. Studies indicate that women with disordered eating have a significantly higher prevalence of both stress and urge urinary incontinence compared with those without such behaviors—approximately 50% for stress incontinence and 20% for urge incontinence.
Fosnight explains the physiological impact of long-term eating disorders, noting that chronic malnutrition leads to hormonal disturbances, particularly hypoestrogenism, which adversely affects the pelvic floor muscles and lower urinary tract tissues. This condition resembles the hormonal decline seen in perimenopause and menopause. Muscle wasting and reduced muscle mass further weaken pelvic floor support, increasing the likelihood of incontinence. Additionally, electrolyte imbalances and dehydration impair the detrusor muscle and neural control of the bladder, contributing to symptoms like urgency and frequency.
She also emphasizes the role of bowel health, stating that constipation—common in malnourished individuals—can increase pressure on the bladder and hinder normal voiding. Fluid intake patterns in eating disorders, such as restriction or excessive consumption, can worsen bladder irritation and symptoms. Lastly, Fosnight underscores the psychological dimensions, including a heightened need for control and anxiety, which can lead to dysfunctional voiding habits and high pelvic floor muscle tone. These psychological factors, particularly common among female athletes, further complicate bladder health. Her comprehensive analysis illustrates the deep interconnection between physical and psychological health in the context of eating disorders and urinary issues.