Interpretation
Disordered eating, characterized by maladaptive eating attitudes and
behaviours, seem to be common among middle-aged women in Western
societies.26 The causes might lie in the biological
(e.g. BMI and menopausal status), psychological (e.g. aging anxiety) and
sociocultural factors (e.g. perceived pressure to be
thin).26,27 It has been hypothesized that menopausal
transition increases vulnerability to eating-related conditions, such as
eating disorders and negative body image,28,29 and, in
contrary, that disordered eating or body image concerns do not differ
between menopausal phases.30,31 However, there is
substantial evidence that reproductive hormones play an important role
in eating behaviour:32,33,34,35,36 In women, the
control of food intake is largely regulated by oestradiol, which acts as
an inhibitor by decreasing meal size and advancing
satiety.32,33,34,37
Restrained eating or dieting refers to intentional and sustained
restriction of food intake for the purposes of weight loss or weight
maintenance.38,39 Restrained eating appears to be
relatively common behaviour among middle-aged women8.
In the study of Drobnjak et al.8 10.7% of
normal-weight women aged between 40 and 66 reported to engage in extreme
dietary restraint. The authors described that postmenopausal women
reported higher levels of restrained eating compared to premenopausal
women. Another study40 examined overweight middle-aged
women and showed also increased restrained eating after menopause. The
present study is in line with the previous, since postmenopausal women
reported to restrict their eating more than pre- and perimenopausal
women. Overall, 10.6% of the women reported to restrict their eating.
According to a previous large study in women aged 31 to 61 years, higher
dietary fibre intake is associated with a decreased prevalence of
constipation41. Restrictive eating style could
possibly result in lower fibre intake, which may partly explain our
results of its association with constipation or defecation difficulties.
Restrictive eating style may also lead to deficient caloric intake,
which has been shown to cause or exacerbate constipation both in older
community-dwelling population42 and in women aged 18
to 40 years with eating disorders.43
In general, negative snacking habits are known to have adverse health
effects.18,44 In our sample, women with different
types of pelvic floor disorders consistently reported negative snacking
behaviour compared to total sample. Evening-oriented eating was most
commonly reported. For instance, of the women with perceived urge
urinary incontinence, 26.2% reported to have highest food consumption
in the evening corresponding to the 17.5% of the women in total sample.
Furthermore, we found that this kind of eating style was associated with
urge urinary incontinence even after controlling for BMI and other
confounding factors. Keski-Rahkonen et al. have studied the association
of highest food consumption in the evening with overweight and
obesity23 as well as with intentional weight
loss12 in young adults. To our knowledge, there are no
previous studies investigating this eating style in middle-aged women
neither women with pelvic floor disorders. Therefore, further studies
are needed for learning more about this phenomenon.
In our study, health-conscious eating style, especially attempting to
maintain healthy eating was highly prevalent (in total sample
“usually” or “often” reported by 94.2%), however, it was little
less common among women with symptoms of urge urinary incontinence
(89.9%). Interestingly, women who attempted to maintain healthy eating
patterns had lower risk of urge urinary incontinence than women who had
not reported this eating style. Healthy eating patterns are likely to
provide macro- and micronutrients that are important for skeletal muscle
function, including proper function of pelvic floor muscles, as
suggested by Carvalhais et al.6 Previous studies have
also shown that carbonated drinks, artificial sweeteners, caffeine, and
alcohol are bladder irritants.45,46,47 In addition,
higher intake of total fat, saturated fat, cholesterol, vitamins B12 and
C as well as calcium are shown to associate with increased risk of
urinary incontinence onset.48,49 Some studies show
that higher intake of vitamin D is associated with decreased risk of
urinary incontinence,50,51 while others do not support
the finding.52,53 Women with lower risk for urge
urinary incontinence may have more favourable diet for supporting the
health of the pelvic floor muscles, however, we were not able to study
this with the data available.
Although the number of women having urinary incontinence and
constipation or defecation difficulties in our sample are in line with
previously reported population
frequencies54,55,56,57,58 our sample included a rather
small number of women experiencing low-frequency pelvic floor disorders,
such as faecal incontinence (34 cases) and pelvic floor prolapse (56
cases). Therefore, our results of not finding significant associations
cannot be considered conclusive. Although only few variables turned out
to be statistically significant, it is notable that variables assessing
the same sector of eating behaviour similarly either protected from the
pelvic floor disorders or increased their risk. It is likely that the
associations would get stronger with larger data. Emotional and
externally cued eating styles emerged rarely, and no significant
associations with the symptoms of pelvic floor disorders were found,
which may also be related in the small size of the data.