What Does Pelvic Health Have To Do With Eating Disorders?
I am an eating disorder-informed and sensitive pelvic health physical therapist – try saying that 10 times fast! When I first began working in the field of eating disorders, my value on the treatment team was scrutinized. I would often be asked, “Why do people with eating disorders need physical therapy anyway?” A physical therapist specializing in the eating disorder field is pretty uncommon – groundbreaking actually – and I am honored to be at the forefront of advancing my profession within this field. Regarding the original question, I typically answer it in several different ways, but today, my focus is on the pelvic health component. I am going to share with you how a pelvic health therapist (physical or occupational therapist) can be a valuable player on the recovery-focused treatment team.
The Basics on Pelvic Floor Therapy
Before we get too far into our discussion, pelvic health therapy is often referred to as pelvic floor therapy. So, where is the pelvis/pelvic floor located and what is it? The pelvis is in the center of your body – place your hands on your hips and you are touching the top of your pelvis. Both hips and the low back are closely connected to the pelvis, and hip and low back pain can often be related to pelvic floor dysfunction.
The pelvic floor is sometimes also called the pelvic bowl because it literally looks like a bowl! The “floor” is the bottom of the pelvis and consists of all kinds of muscles and ligaments – all supporting the internal organs that are nestled in the bowl. The pelvic floor additionally contains the urethra, or “pee hole”, and the anus, or “poop hole.” And, as you might imagine, our sexual organs are located here as well. Pelvic floor issues are often associated with vagina owners, but did you know that penis owners can also experience pelvic health dysfunction?
The pelvic floor is an amazing pressure management system that serves the following five functions: support, sphincteric, sexual, stability, and “sump pump.” Learning how to properly move our diaphragm and allow relaxation into our pelvic floor is my first line of defense for any and all of my clients. Before I get into the mechanics of breathwork, let’s expand our mind model of the pelvic floor and include several other key components. This will help us understand how the pelvic floor does not function in isolation – it is a part of a system!
I think of the pelvic floor as the bottom of a canister. This canister includes the abdominal wall, back (spine and including musculature), and the diaphragm. This is what I often refer to as the “core” canister. Can you see how it is more of a system now? Let's focus a bit on breathing mechanics for a moment in order to better understand how this all works. Your diaphragm, which is your large respiratory muscle, is located at the base of your ribs. I think it looks like a large open umbrella. When you inhale, your diaphragm drops down toward your pelvis. Ideally, as the diaphragm drops down, your belly will expand out with your breath and your saddle area (aka pelvic floor) will relax. Seems pretty simple, right? Yes and no.
The Connection to Eating Disorders
Now if we relate pelvic floor dysfunction to eating disorders, the correlations are quite evident. Recovery work with eating disorders typically involves weight restoration and/or nourishing the body appropriately. Often, this results in abdominal discomfort and bloating, gastroparesis or a slowing of the stomach emptying, and constipation or difficulty having a complete bowel movement. These are all “diagnoses” that a pelvic health therapist can provide treatment for – amazing!
If we circle back to the breathing component that we discussed, typically I find that my patients hold their midsections very tight and do not allow their breath to move their belly. This is common outside of eating disorders as well, due to the diet culture/thin ideal society that we are all trying to navigate. This manifests as abdominal wall muscle dysfunction – a condition where the abdominal muscles tend to reside in more of a contracted state and are uncoordinated.
Finally, if purging via vomiting and/or use of laxatives is a component of the eating disorder, then there can be concerns about decreased motility through the colon and prolapse. Prolapse, generally speaking, is when an organ is protruding through an opening in the pelvic floor. There are several different types of prolapse and details around this are outside the intent of this blog. The important thing to understand is that vomiting causes an extremely high increase in intra-abdominal pressure (remember the pressure system?) and this pressure needs to be diffused somewhere. In some cases, it is the pelvic floor that takes the brunt of this – but not always. Sometimes the pressure pushes through the abdominal wall and can increase/cause abdominal separation (abdominal separation is common in pregnancy).
Whew! That’s a lot of information to think about! Let’s face it, recovery work from an eating disorder can be really uncomfortable. Be curious about what your patients are experiencing and, if they share symptoms that seem pelvic health-related, make sure to connect them with a pelvic health therapist. It can be truly transformative for them in their recovery process!