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Bulimia nervosa presenting as rectal purging and rectal prolapse: Case report and literature review


  • Note: Ms. D. signed a document allowing her treatment team to use her de-identified data to prepare this scientific report.

  • Sources of industry/commercial support and potential conflicts of interest for Susan L. McElroy, MD: Dr. McElroy is employed by the University of Cincinnati College of Medicine, University of Cincinnati Physicians, and the Lindner Center of HOPE. Dr. McElroy is a consultant to, or member of the scientific advisory boards of: Alkermes, Eli Lilly and Company, and Shire. Dr. McElroy is a principal or coinvestigator on research studies sponsored by: Agency for Healthcare Research and Quality (AHRQ), Alkermes, AstraZeneca, Bristol-Myers Squibb, Cephalon, Eli Lilly and Company, Forest Labs, GalaxoSmith Kline, Jazz Pharmaceuticals, Marriott Foundation, National Institute of Mental Health, Orexigen Therapeutics, Pfizer, Shire, and Takeda Pharmaceutical Company. Patents: Dr. Susan L. McElroy is also inventor on United States Patent No. 6,323,236 B2, Use of Sulfamate Derivatives for Treating Impulse Control Disorders, and, along with the patent's assignee, University of Cincinnati, Cincinnati, OH, has received payments from Johnson & Johnson Pharmaceutical Research & Development, L.L.C., which has exclusive rights under the patent. Drs. Guerdjikova, O'Melia, and Palumbo and Mr. Riffle have no industry/commercial support or conflicts of interest to disclose.


Rectal prolapse, but not rectal purging (excessive finger evacuation to induce defecation), has been formally associated with eating disorders in the medical literature. We describe a young woman with bulimia nervosa and irritable bowel syndrome who used rectal purging as a method of counteracting the effects of her binge eating and who underwent two corrective surgeries for rectal prolapse in a 15-month interval. Further research into the relationship between eating disorders, rectal purging, and gastrointestinal dysfunction is called for. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)