Pelvic Floor Dysfunction in People with Eating Disorders and the Acute Effect of Different Interventions – A Retrospective Cohort Study

Abstract

Background: Studies suggest that there is an association between eating disorders and pelvic floor dysfunction (PFD), although the contribution of PFD toward symptomatology and interventions to improve these symptoms in the eating disorder population is poorly understood. This study seeks to describe common symptoms of PFD in an eating disorder cohort, as well as the effect of interventions on pelvic floor symptomatology. Methods: In this retrospective case-control study, 193 patients who completed the Pelvic Floor Distress Inventory (PFDI-20) upon admission and discharge were included in the study. There were 84 subjects in the control group and 109 in the intervention group, with assignment based on the patient’s willingness to participate in additional interventions for PFD. Those subjects in the intervention group received one of several interventions aimed at improving functioning of the pelvic floor muscles (education, bladder retraining/pelvic floor stretches, internal assessment of the pelvic floor muscles with intervention aimed at improving coordination of these muscles, and biofeedback). Results: Participants at admission reported a mean pelvic organ prolapse distress inventory (POPDI-6) score of 24.44, a mean colorectal-anal distress inventory (CRAD-8) score of 31.28, and a mean urinary distress inventory (UDI-6) score of 23.03, for a total PFDI-20 score of 78.75. The control group saw improvement in the total PFDI-20 score as well as each of the subscales; however, bladder training and incorporation of pelvic floor stretches resulted in improvement above that seen in the control group for each of the subscales, biofeedback resulted in improvement above that seen solely in the control group in the POPDI-6 score, and internal assessment of the pelvic floor muscles with active intervention resulted in improvement in the UDI-6 score above that seen solely in the control group. Patients with anorexia nervosa binge-eating/purging subtype reported higher PFDI symptoms than patients with the restricting subtype of anorexia nervosa, as reflected by higher scores on the POPDI-6 and CRAD-8 subscales. Conclusions: Patients with eating disorders report an increased level of pelvic floor symptomatology. Studied interventions had a positive effect in reducing these symptoms. Future studies are warranted to better describe the etiology of the PFD in those with eating disorders and how PFD contributes to eating disorder behaviors and gastrointestinal symptoms.

Keywords

• eating disorders
• anorexia nervosa
• pelvic floor dysfunction
• pelvic floor interventions
• purging behaviors