Eating disorders and pelvic health: What clinicians need to know

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 the importance of a trauma-informed, weight-inclusive, and multidisciplinary approach when assessing urinary symptoms in patients with known or suspected eating disorders. As a Health at Every Size (HAES) provider, Fosnight rejects weight-based assumptions, instead focusing on individualized care that fosters emotional safety and trust.

She highlights the unique challenges in discussing both urinary issues and disordered eating, stressing the need for non-judgmental, empathetic communication. Fosnight recommends clinicians normalize the conversation by asking open-ended questions about urinary habits, hydration, bowel movements, diet, caffeine use, and exercise patterns—all of which may be influenced by disordered eating behaviors.

A key diagnostic clue is that individuals with disordered eating often have unusually precise awareness of their food and fluid intake. Excessive water consumption, for example, may serve as an appetite suppressant, whereas caffeine is frequently used as a meal substitute, both of which can worsen urinary symptoms.

Fosnight also discusses the importance of assessing menstrual health, noting that irregular cycles due to malnutrition can affect urinary function. Recent guidelines from the American Urological Association have acknowledged hormonal deficiencies’ impact on the lower urinary tract—further validating the link between poor nutrition and urinary issues.

She underscores the role of a multidisciplinary team, including therapists, dietitians, and pelvic floor specialists, in managing these patients. As a urology PA, she often acts as a triage coordinator, ensuring comprehensive care.

Ultimately, Fosnight advocates for nutritional rehabilitation and weight restoration as foundational to improving both urinary symptoms and overall health. Improvement in menstrual and urinary function can serve as indicators of successful re-nourishment and recovery.