A 2011 study found that 40% of women with anorexia nervosa experienced urge and stress urinary incontinence compared with their healthy matched controls.
In starvation, the body needs to generates energy so it does this first by breaking down glycogen (form of glucose) from the liver and skeletal muscle. Once the body taps out glycogen stores it goes for the fat tissue and breaks it into fatty acids which coverts into glucose. When the body is chronically starving, the liver begins to make ketone bodies which decreases the body’s need for glucose to function. In the final stages of starvation protein in muscle is broken down into its small counterparts called amino acids. Attempting to survive the liver than uses amino acids to create glucose. Although our bodies are incredible at withstanding just about everything, its only a matter of time before the muscles begin to waste away becoming weak. Just like other body structures (e.g. organs) the pelvic floor, essentially a giant muscle, becomes weak and bladder incontinence occurs. Urinary incontinence also has a psychological component, according to a recent study in 2022 desire for control, perfectionism, as well as emotional or physical trauma in childhood contribute. Certain medications such as anti-depressants, can cause symptoms of urinary incontinence as well. Since other illness such as STIs and UTIs (just to name a few) can cause similar symptoms.. just another reason why its important to seek medical care.
There are a few different types of bladder
Overflow incontinence: the bladder fails to empty completely and urine involuntarily 'spills' out of the bladder. This can be due to constipation and/or detrusor under activity which can result from a low estrogen state, both common in Eds.
Stress incontinence (SUI): the bladder and urethra become weak resulting in the involuntary leakage of urine during activities that put pressure on the bladder (e.g. such as sneezing, coughing, athletics, lifting). This occurs from weak pelvic floor muscles, low estrogen state, and unhealthy vaginal connective tissue, common in malnutrition.
Urge incontinence: there is a sudden involuntary urge to urinate resulting in leakage of urine which occurs while awake and/or sleeping. This is often caused by an impaired nervous system which is common in EDs.
Urinary incontinence can be an embarrassing, shameful and confusing condition but it shouldn't have to be. Please confide in a trusted health care professional who can help. In the setting of malnutrition, treatment should first begin with nutritional rehabilitation. Once the body is healthy or on its way, pelvic floor muscle training with a certified physical therapist and Kegel exercises can strengthen pelvic floor muscles. Lifestyle interventions are often helpful and as a last resort medications and surgical interventions may be necessary.