Balancing nutrition and bladder health in eating disorder recovery

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, emphasizes a careful, individualized approach to managing bladder and bowel symptoms in women with a history of disordered eating. Dietary irritants for the bladder often mirror those that affect patients with interstitial cystitis or bladder pain syndrome—such as citrus, tomatoes, spicy foods, vitamin C, artificial sweeteners, caffeine, carbonated drinks, and alcohol. For bowel health, limiting FODMAPs (fermented foods, certain saccharides, lactose, gluten, dairy, sugar alcohols) can reduce irritation. She advises framing these changes as temporary “pauses” rather than restrictions to avoid triggering disordered eating behaviors. Reintroduction should progress from least to most irritating foods under the guidance of a nutritionist or dietitian, with attention to mental health. High-fat foods should be monitored for potential gastrointestinal effects, and supportive tools like non-calorie-counting diet apps can help patients follow plans without focusing on weight.

Fosnight notes that emerging research in this area is limited and often focuses on elite female athletes, though disordered eating affects people across body sizes. Current urology guidelines frequently center on weight loss, but she warns against weight-centric bias, which can perpetuate stigma. Instead, she stresses normalizing hydration, incorporating electrolytes, and tailoring voiding strategies.

She highlights “interoceptive dysregulation”—difficulty sensing internal bodily cues—as a common issue in this population, which can impair awareness of bladder fullness and contribute to retention, urgency, and incontinence. Interventions like mindfulness, mindful toileting, purposeful journaling, and nutritional rehabilitation can help restore bladder function.

Pelvic floor therapy is her first-line intervention, though access may be limited. She recommends leveraging online pelvic floor programs as a supplement and encourages medical providers to gain basic pelvic floor training themselves—such as trigger point release, biofeedback, and diaphragmatic breathing—to support patients until specialized care is available. This multifaceted, stigma-sensitive approach aims to improve urologic health while safeguarding mental well-being.