Pelvic floor therapy aids bladder recovery in patients with eating disorders

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, outlines how pelvic floor physical therapy plays a crucial yet underutilized role in supporting bladder function recovery in individuals recovering from eating disorders. Fosnight emphasizes that any patient presenting with urinary incontinence or related symptoms should be evaluated for pelvic floor dysfunction. However, it is essential to ensure that the pelvic floor therapist is appropriately trained, particularly in conducting internal examinations and hands-on muscle assessments. Therapists who only perform external work may offer limited support; comprehensive care typically requires internal evaluation, biofeedback, and possibly electrical stimulation.

Pelvic floor therapists also help patients modify toileting behaviors, manage fluid intake, and address habits like straining during defecation. Tools such as bladder diaries and devices like the Squatty Potty can assist in optimizing bathroom practices and reducing pelvic floor stress. They may also guide clients to better understand how daily routines, including hydration and nighttime behaviors, affect urinary health.

Regarding exercises, diaphragmatic breathing is highlighted as especially effective. This practice fosters relaxation of the diaphragm and pelvic floor, which often become tense due to anxiety—a common issue in individuals with eating disorders. Deep breathing activates the vagus nerve, promoting a calm parasympathetic state and reducing bladder overactivity.

Stretch-based exercises like deep squats (supported or unsupported), Child’s Pose, and Happy Baby are also beneficial. These help relax and stretch the pelvic floor muscles. Fosnight cautions against routine use of Kegels, as many patients may already have high-tone (overactive) pelvic floors. In such cases, Kegels can exacerbate muscle fatigue and tension rather than improve strength or coordination.

Ultimately, pelvic floor therapy should be personalized. Even 1 or 2 sessions with a trained therapist can help determine whether the pelvic floor is tight, weak, or poorly coordinated, which guides the most effective intervention strategy.