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.