Reprinted from Eating Disorders Review
July/August 2004 Volume 15, Number 4
©2004 Gürze Books
Q: A middle-aged woman with anorexia nervosa whom I’m treating was recently diagnosed with “pelvic floor dysfunction.” She’s developed anal incontinence and has had vaginal prolapse. She exercises a great deal, but has not been a laxative abuser. She’s never had children and has never had any gynecological surgery. Could this condition be a result of her anorexia nervosa? ( P.G., Miami)
A: Cases similar to the one you’ve described have been reported in connection with anorexia nervosa, even in the absence of laxative abuse. Pelvic floor problems are not uncommon in middle age, and may be particularly related to chronic constipation, a frequent symptom in anorexia nervosa. In one series, 5 of 12 women with anorexia nervosa who complained of chronic constipation were found to have some degree of pelvic floor dysfunction (Cortes E et al, Int Urogynecol J, 14: 254, 2003). Presumably, anal incontinence, one possible manifestation of pelvic floor dysfunction, might result from a combination of metabolic and physical damage to pelvic floor muscles, even in the absence of prior obstetrical or gynecological injury. Conceivably, the combination of hypoestrogenism, low-protein diet, and excessive exercise may result in structural damage and atrophy of the puborectalis muscle. Surgery may be necessary to repair the damage.