Join me on April 22 to begin this quest to learn more about signs, symptoms, and the journey that individuals with eating disorders endure. We will also explore ways that we as Pelvic Health Professionals can assist them on this journey in Eating Disorders and Pelvic Health Rehabilitation. This course will not have all the answers; rather will be a step forward for clinicians to expand their understanding and to seek out additional resources to learn more and provide evidence-based treatment for these individuals.

We, as pelvic health practitioners are NOT going to treat eating disorders… we are NOT going to diagnose eating disorders… but we CAN and SHOULD be asking questions… encouraging patients to seek additional support… and helping them find appropriately trained providers. We can ALSO provide support and speak with words that promote validation, wellness, and healing rather than words that are unintentionally triggering, harmful or nonvalidating. IN ADDITION, we can provide these individuals with manual skills, activities, and educational “tools'' to assist in GI distress, constipation, abdominal bloating, urinary dysfunction, pelvic pain, sexual dysfunction, POP issues, postural / body mechanics, abdominal canister coordination/function, tightness in trunk, hips, shoulders, rib cage, etc. These individuals would benefit from pelvic health professionals being an additional part (not the lead) of their treatment team.

We, as pelvic health professionals, need to: know what eating disorders are and are not, understand how this mental illness creates issues in all body functions, and what we can do to provide relief or reduction in some of their symptoms.

These case scenarios may be familiar or may have occurred without our awareness. These scenarios are based on real lives…and we likely see similar situations like this almost every day…

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Hope

Hope is a 31-year-old woman with an eight-year-old daughter with special needs. She is in your office for the second episode of care as she had COVID and her grandmother became terminally ill. Hope had come to PT before for severe abdominal pain and bowel dysfunction after a perforated colon during an ovarian cyst removal which resulted in a perforation in her colon, hemicolectomy, sepsis, and traumatic ICU hospitalization. 

She had offered to you during her first episode of care that she had a history of anorexia. She was walking 7-9 miles a day, doing yoga 5 days a week, and seeing chiropractic care for fibromyalgia and chronic pain in the back/neck. She had been seeing an eating disorder mental wellness therapist and an eating disorder dietician for a while but had not seen them for some time. At the time of her first couple of visits, she was encouraged to make an appointment with both a mental wellness therapist and a dietician who both focused on eating disorders with who she was comfortable in the past. She agreed to do this but then stopped coming to therapy as mentioned above due to COVID and family emergencies.

When she came back to therapy, she looked much different. Her eyes were sunken, she had a thin layer of hair (lanugo) over her cheeks (what could be seen with the mask) and over her abdomen. Her fingernails were brittle and split.

She reported today that she has lost 25 more pounds because she thought that would help with the abdominal pain. Her new dietician (NOT an ED dietician) had her keeping a log of her food and has told her, according to Hope, that her body does not need more than 1500 calories a day and that she was eating “way too much”. She now logs everything she eats and counts calories.

Hope describes how she is now staying with her grandmother during the day in a skilled nursing facility and is supporting her grandfather.  She is also caring for her 8-year-old daughter with special needs who is now in school during the day. She continues to exercise every day no matter what and is now not only walking the 7-9 miles but she is now doing strength training 4 days a week and yoga about 3-5 days a week.  She seems to be almost superhuman as she juggles and manages all of these difficult situations.

After assessment of orthostatics, and standing blood pressure - her systolic BP dropped 25 mmHG and diastolic BP dropped 10 mmHg and her heart rate increased by 25 bpm after 5 minutes standing.

What might be some red flags here? What might your recommendations be? Who would you contact?

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Faith

Faith is a 24-year-old woman who came to pelvic floor physical therapy for urinary incontinence and dyspareunia which began after the cesarean section birth of her first child six months ago. She does not understand why she has all of the extensive "stretch marks" on her abdomen and why her cesarean section scar looks so large. She is very unhappy about how her body looks after giving birth.

Upon further conversation, she shares that she only eats a “super clean diet” and has cut out major food groups such as dairy, sugar, and meat because those foods are "high in calories" and "not healthy". She sparingly consumes any carbs and mainly eats vegetables and some fish sometimes.

She has experienced episodes of lightheadedness and near syncope for years. She reports that has been very “bendy” and was a cheerleader in high school. Faith has had painful joints and subluxations in her hips and knees for as long as she can remember.

Faith also shares that it is always so tiring. She also reports that she worries a lot about her newborn and is having a hard time juggling all of the demands of work, home, and caring for her baby. Her husband is helpful though has to work a lot.

After the assessment of orthostatics, Faith becomes lightheaded when standing. She was orthostatic for heart rate (>20 bpm) after 1, 3, and 5 minutes in standing.  Her blood pressure also drops a bit in standing (<10 mmHg systolic) though was not considered orthostatic. She also has a Beighton score of 7 out of 9, has piezogenic papules on both of her heels, and soft velvety skin which is easily stretched.

Faith is asked if she would consider trying some salty snacks and some Gatorade to see if this helps with her lightheadedness. She responds that she will not eat pretzels or salty snacks because they are too high in carbs and she will not consider Gatorade because she doesn't drink beverages that are high in calories.

She keeps touching her abdomen and is uncomfortable about the “stretch marks'' that she has. She also keeps looking at herself in the mirror that is in the treatment room pulling her baggy sweater over her body.

She shares that she has always had constipation and abdominal pain - however this has really worsened lately. Faith also reports pelvic pressure at times and hopes that she does not have to deal with a pelvic organ prolapse like her mother had a few years ago.

During her first visit, she speaks very quickly and appears quite anxious.

This is only part of the history…but what might be helpful to say, do, explore, and assess?

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Brian

Brian is a 17-year-old wrestler who is coming to pelvic floor physical therapy for abdominal and pelvic pain. He shares that when he has to make "weight" before each meeting he will restrict water, and food and will exercise with layers of clothing on. He will drink about a cup of water during the day on those days and sometimes will just eat some chocolate, such as a peppermint patty, for dinner. After the meeting, he will sometimes eat a lot. He will often have significant abdominal pain and it will make him double over sometimes. He went to the GI doctor and was told that he has gastroparesis. He does not not know what he is supposed to do. If he doesn't eat, his abdomen hurts, and if he does eat it hurts too.

He also shares that he doesn't like school so much anymore. There is a lot of pressure to get a college scholarship and he is waiting to hear from a couple of his top choices. He doesn't feel like hanging out with some of his friends so much anymore. They always want to go out to eat and he can't do that. He typically will spend time with other wrestlers or will just stay at home. He reports being exhausted and having a hard time concentrating on his schoolwork.

Brian shares with you that he has to strain so much to have a bowel movement that he sometimes feels a bulging from his anus. He has a bowel movement about once a week and it is painful.

He does have urinary urgency and reports urinating "a little bit" many times during the day. His urine is tan in color.

When further questioned about Brian's response on the male genitourinary pain index (GUPI), he reports that he does not have pain with sexual climax because he does not have any desire to be sexually active anymore.

This is just a glimpse of Brian's journey... What other questions might you have? What can we do to help? What else would you be assessing?

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Joy

Joy is a 34-year-old musician with a history of binge eating disorder, which has been well-controlled for over five years. She comes to you with pelvic pain, dyspareunia, abdominal pain, and a history of constipation and urinary incontinence.

Joy saw a pelvic pain specialist who recommended a tricyclic antidepressant for pelvic pain.  Joy also has bipolar disorder. She is in DBT treatment weekly (group and individual) and is well supported by her psychiatrist.

She is reporting new binge-related urges that are becoming hard to control since beginning the new medication. She is concerned about these new urges and this is causing additional anxiety. Her pelvic pain is actually worsening now with the additional anxiety and she is beginning to leak urine more frequently. Bowels are becoming firmer and harder to pass.

What are some next steps with Joy? What can we do to assist with her situation?

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Eating Disorders and Pelvic Health Rehabilitation: The Role of a Rehab Professional is a live remote course (including lab and lecture) with required seven-hour pre-course content accessible on Teachable. During the live course, there will be lectures, interactive discussions, and lab activities. We recommend, if possible, having another human available during the lab activities to practice the techniques discussed.

I look forward to seeing you on April 22!

Eating Disorders and Pelvic Health Rehabilitation

Course Dates: April 22

Price: $395
Experience Level: Beginner
Contact Hours: 13.25

Description: This course explores types of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, ARFID (Avoidant Restrictive Feeding Intake Disorder), and OSFED (Otherwise Specified Feeding and Eating Disorder). We will also discuss conditions that do not yet have formal diagnostic criteria such as orthorexia and diabulimia and we will touch on Pica and Rumination Disorders. Most healthcare professionals understand very little about eating disorders and disordered eating. There is a weight stigma with health care identifying “health” in terms of weight, BMI, body appearance, exercise, and activity. As rehabilitation professionals, it is our responsibility to understand that health looks and feels different for everyone. In addition, we may be able to identify signs and symptoms of eating disorders and be able to provide support for these individuals through proper referral and modification of our rehabilitation plan of care.