When Eating Disorders Affect Bladder Health, with Aleece Fosnight, MSPAS, PA-C

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For individuals living with disordered eating, conversations about health often focus on nutrition, mental well-being and recovery — but bladder issues like leakage, urgency and frequent urination are common and often overlooked. According to Aleece Fosnight, MSPAS, PA-C, a board-certified physician assistant specializing in urology and sexual medicine and a medical adviser at Aeroflow Urology, disordered eating can significantly impact bladder function in complex ways. In this interview, she explains the physical connection between eating disorders and bladder control, how pelvic floor therapy and simple breathwork can help, and what steps patients can take toward whole-body recovery — without shame.

Can you explain how certain eating disorders might lead to bladder control issues or incontinence?

Aleece Fosnight, MSPAS, PA-C: Anorexia nervosa and other restrictive eating disorders often lead to muscle wasting, including the pelvic floor muscles. Inadequate intake of proteins, electrolytes and essential nutrients can impair neuromuscular function, leading to stress incontinence. Constipation is also common in people with disordered eating, which leads to increased pressure on the bladder, decreased ability to empty the bladder to completion and can lead to increased urinary urgency. Many individuals restrict fluid intake and can impact the bladder with concentrated urine, causing irritation to the bladder lining, leading to increased urinary frequency and urgency. Electrolyte imbalances (especially potassium and/or magnesium) can impair the detrusor or bladder muscle leading to bladder spasms, nocturia and incontinence. Severe disordered eating disrupts hormone balance (especially estradiol and cortisol), leading to decreased bladder mucosa integrity (think GSM, genitourinary syndrome of menopause), sensitivity to stretch of the bladder and increased urinary infections.

If someone is experiencing bladder leakage or urgency and also has a history of disordered eating, where should they start in getting help?

AF: Seeking assistance from your primary care provider is a good place to start. They will be able to support you with referrals, especially to a disordered eating specialist (which could include a nutritionist, therapist and/or medical provider such as a psychiatrist), which is crucial in navigating through this condition. Don’t be afraid to reach out to a mental health therapist on your own. Finding a trained therapist in disordered eating is essential — Psychology Today is a great resource to finding an appropriately trained provider that works within this specialty.

Can bladder problems improve with treatment for the eating disorder, or do they often need to be addressed separately as well?

AF: Yes, bladder symptoms can improve with disordered eating treatment as the root cause is the malnutrition, fluid restriction and/or constipation causing the bladder symptoms. However, do not shy away from focusing on bladder-specific treatment options as you are working with a trained professional addressing your disordered eating. Working with a pelvic floor therapist can improve muscle coordination, address constipation, improve abdominal tension and address behavioral patterns (like skipping bathroom breaks).

Can you share a few beginner pelvic floor exercises that might help patients improve bladder control gently and safely?

AF: One of my most favorite and underutilized exercises are diaphragmatic or belly breathing. This is great for calming the nervous system, reducing bladder urgency and connecting your breath to your pelvic floor. Here is a simple way to get started:

• Lie on your back or sit comfortably.
• Place one hand on your chest, one on your belly.
• Inhale slowly through your nose, letting your belly expand (feel your pelvic floor gently drop).
• Exhale slowly through your mouth, gently engaging your pelvic floor (as if lifting a blueberry with your vagina or anus — these are also known as gentle kegels).
• Repeat for five to 10 breaths, one to two times daily.

Other options include stretching the pelvic floor with deep squats, low back releases, child’s pose and happy baby stretches.

What lifestyle habits — like hydration, movement or toileting patterns — can support bladder health during eating disorder recovery?

AF: Start slow. Aim for 40 to 60 ounces of water daily, ensuring that the fluid is spread out throughout the day. Sip slowly and consider adding in electrolytes to a glass of water daily. Limit bladder irritant foods such as caffeine, carbonated drinks and alcohol. Timed voiding can ensure you are not delaying urination. Ideally you should be voiding every two to three hours. Avoid constipation with increased fiber intake, proper toileting and establishing a regular time to defecate. Gentle movements (yoga, walking, stretching) can also aid in digestion and regular bowel movements. Sleep is also very important. Prioritize a consistent bedtime routine and incorporate calming rituals. This can be a good time to incorporate the diaphragmatic breathing discussed earlier. Incorporating mindfulness into daily routine, especially during times of urination, increases the interoception awareness. Many individuals with disordered eating become disconnected from their body and body cues. A pelvic floor therapist and/or mental health therapist will be a great resource to incorporate mindfulness into daily practice.

What’s one piece of advice you’d offer to someone who feels embarrassed talking about both bladder leaks and food struggles?

AF: You are not alone, and you deserve care that honors your whole self. Starting with a brave sentence is a great first step. Consider the following: “I’ve been struggling with eating and having bladder concerns. I think they might be related and I’d like to talk about it.” Practice with a friend or practice in the mirror before your appointment. And if your provider dismisses your concerns or fails to offer meaningful support, know that you have the right to seek care elsewhere.