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Bulimia nervosa (BN) is a serious eating disorder that can have numerous medical complications if left untreated. Perhaps one of the most alarming of these is the appearance of blood after self-induced vomiting.
If this has happened to you, you're probably concerned about where the blood is coming from and if this is something that can be treated quickly and effectively.
Bulimia nervosa is an eating disorder characterized most commonly by the purging behavior of self-induced vomiting, which usually occurs after an episode of binge eating. Repeated and recurring episodes of forced vomiting can be extremely harsh on the body, particularly the esophagus and the throat.1
The esophagus is the tube of muscle that connects the mouth to the stomach. The blood vessels in the esophagus are thinner than those in other parts of the body, so they are more prone to rupturing through excessive pressure.
Regularly forcing large amounts of food back up the esophagus increases the pressure on the blood vessels, causing them to swell and rupture, which can result in bleeding. This is what leads to the appearance of bright red blood in vomit, and it is known as esophageal varices or swollen veins.1
Frequent vomiting can also cause tears in the lining of the esophagus, known as Mallory-Weiss syndrome. This, too, results in bleeding, which can be severe and life-threatening.2
The symptoms of Mallory-Weiss syndrome are similar to those of esophageal varices, with the addition of diarrhea and vomit that is bright red or looks like coffee grounds.3
If you or someone you know has experienced blood in their vomit after a purging episode, it's important to seek immediate medical treatment.
Esophageal varices or Mallory-Weiss syndrome should never be taken lightly. Even just a small amount of blood in your vomit could be an indicator of more serious bleeding within the esophagus or other parts of the gastrointestinal system, which will need to be controlled as soon as possible to prevent further complications.
In these rare cases of severe internal bleeding, you may experience a drop in blood pressure, a rapid pulse, difficulty producing urine, and even shock.2
Once you've had one episode of bleeding while purging, your risk of bleeding greatly increases.4 If you have bulimia nervosa and don't give your body enough time to heal or treat the esophageal varices effectively, you're likely to experience recurrent bleeding.1
The best way to treat and prevent esophageal varices and Mallory-Wiess syndrome is to address the underlying cause. Early treatment and intervention in cases of bulimia nervosa can prevent further damage resulting from esophageal bleeding and other complications of the eating disorder. Additionally, professional help from a multidisciplinary team will help a person to heal mentally and medically.
It can be uncomfortable to seek help for bulimia, and binging and purging behaviors are often accompanied by feelings of shame and embarrassment. But there is no shame in having bulimia.
Many other people have struggled with this condition, and many more have successfully overcome their eating disorders. Taking that first step, by asking for help, is very important and takes courage.
Treatment for BN is multifaceted and depends on the behaviors involved and the underlying causes of the disorders. However, intervention typically involves the combination of psychotherapy, nutritional counseling, and, in some cases, antidepressants to treat co-occurring psychological disorders.5
If more structure and supervision is needed to engage in the treatment, inpatient or residential treatment may be required to provide you with round-the-clock support and care.
Other therapies may include interpersonal therapy, group therapy, and family therapy, which teaches loved ones and family members about BN and how best to support someone during treatment. If you have questions or would like to learn about our virtual care program for treating bulimia nervosa, call us today.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
It's hard to say how long it takes for self-induced vomiting to cause damage to the esophagus. The severity of symptoms and time of onset depends largely on the sensitivity of the individual rather than the duration or severity of their purging behavior.6
What's certain is that repeated vomiting can introduce stomach acid to the esophageal lining, leading to a hoarse voice, acid reflux, gastroesophageal reflux disease (GERD), thick mucous over the larynx, and, in severe cases, esophageal ruptures.
Other complications, such as achalasia, where the muscles of the lower esophagus cannot relax, and esophageal spasms are also possible. However, these, too, have been found to occur independently of the duration or severity of self-induced vomiting behaviors.6
