Aleece Fosnight, MSPAS, PA-C, on treating women with eating disorders and bladder dysfunction

In this video, 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, emphasizes a multidisciplinary, patient-centered approach as the optimal method for treating women with both eating disorders and bladder dysfunction. She highlights mental health care as the cornerstone of treatment, stressing that patients must first be in a psychologically safe space to engage in recovery. Cognitive behavioral therapy is the first-line treatment for bulimia, whereas other approaches may be more effective for anorexia. Fosnight also points out the importance of identifying psychological drivers that contribute to both disordered eating and urinary behaviors.

Nutritional support is another key component. Coordination with dietitians helps tailor hydration and nutrition plans while avoiding overly specific tracking behaviors that can trigger obsessive tendencies. Instead, patients are given general but flexible goals to reduce fixation on numbers.

On the urinary side, Fosnight prioritizes pelvic floor physical therapy as a first-line intervention for incontinence, citing evidence of significant symptom improvement. However, it’s crucial that therapists understand the unique physiology and challenges in patients with eating disorders. She also uses short-term medications like beta-adrenergics (eg, mirabegron [Myrbetriq] and vibegron [Gemtesa]) as a temporary "bridge," avoiding anticholinergics due to risks of constipation and dehydration.

Fosnight encourages integrated care, often involving joint sessions or real-time consults with nutritionists and therapists, fostering transparency and empowering the patient. Ongoing relapse monitoring through menstrual health and urinary symptoms helps identify early signs of setbacks.

Follow-ups every 3 to 6 months, alongside regular therapy (weekly or biweekly), support sustained recovery. Throughout the process, Fosnight stresses self-compassion, autonomy, and self-care, reinforcing that healing is not about bodily failure, but an adaptive journey supported by a compassionate care team.