While many people are aware of common physical signs of eating disorders (such as extreme weight loss, fatigue, loss of hair, absence of menstruation, etc.), one little-known symptom frequently affecting patients with eating disorders is swelling of the salivary glands.
Most often found among people with anorexia nervosa binge-purge subtype (AN-BP) and bulimia nervosa (BN), swollen salivary glands (officially known as Sialadenitis) is estimated to affect between 10 and 50 percent of ED patients .
In fact, several studies attest that salivary gland swelling is often the first and only visible sign of an eating disorder such as bulimia , . As such, it is critical for health professionals like doctors, dentists, and ED specialists to be on the lookout for this common, yet often overlooked, ED warning sign.
What Causes Salivary Gland Swelling in Eating Disorders?
While the exact cause of salivary gland swelling among patients with eating disorders is not entirely known, most studies suggest that the condition is caused by one or more of the following: nutritional deficiency, use of appetite suppressants, unusually low body mass index, starvation, hormonal irregularities, and purging behaviors (e.g., self-induced vomiting) .
Of these possible causes, purge vomiting seems to be the likeliest candidate as salivary gland swelling often occurs between two and six days after a purging episode . If purging behaviors cease, the salivary glands should return to normal on their own, but if the ED behaviors persist, swollen salivary glands can develop into a more serious problem requiring professional attention.
Signs and Symptoms
The human body has three separate pairs of major salivary glands, known as the parotid glands, the submandibular glands, and the sublingual glands. The parotid glands, the largest of the salivary glands and the most common glands affected by swelling among individuals with EDs, sit in the upper portion of the mouth directly in front of the ears .
The parotid glands help you chew, swallow, and digest food by emptying saliva into your mouth. When swollen, saliva is trapped inside the parotid glands, causing them to become enlarged and obstructing the natural flow of saliva into the mouth.
This can potentially cause inflammation and discomfort. If the parotid glands are swollen for a lengthy period of time, they may become infected, causing the following problems:
- General discomfort and pain in the mouth
- Painful and tender lumps in the cheeks
- Putrid-tasting discharge from the gland into the mouth
- Facial swelling
- Difficulty chewing, swallowing, speaking
- Difficulty opening the mouth fully
Treating Salivary Gland Swelling in Eating Disorder Patients
Though Sialadenitis (salivary gland swelling) will often resolve itself when the eating disorder symptoms cease, it may become a more serious problem among long-term or chronic ED patients. In cases such as these, the individual may require special salivary gland treatment. One promising procedure used to treat swollen salivary glands in eating disorder patients is sialendoscopy.
Sialendoscopy is a minimally invasive procedure that examines the ducts of the salivary glands with a miniature telescope. This gives health professionals a visual of both the salivary glands and the glands’ ducts (openings), allowing them to diagnose and treat the impaired gland without the use of surgery or other invasive techniques.
A recent study conducted on six females, all of whom had an ED diagnosis (4 with AN-BP and 2 with BN) and were suffering from swollen salivary glands, sought to uncover the efficacy and viability of using sialendoscopy to treat swollen salivary glands in ED patients .
Through the use of sialendoscopy, the patient’s swollen glands were analyzed, and the duct strictures were treated with hydrostatic pressure application and an injection of steroid solution.
This safe and relatively non-invasive procedure successfully reduced salivary gland swelling and effectively decreased pain in 83 percent of the patients . Thanks to these encouraging results, the researchers concluded that “sialendoscopy is a safe and effective therapeutic method to treat EDs salivary symptoms” .
Resources: Colella, G., Lo Giudice, G., De Luca, R. et al. Interventional sialendoscopy in parotidomegaly related to eating disorders. J Eat Disord 9, 25 (2021). https://doi.org/10.1186/s40337-021-00378-9  Garcia Garcia, B., Dean Ferrer, A., Diaz Jimenez, N., & Alamillos Granados, F. J. (2018). Bilateral Parotid Sialadenosis Associated with Long-Standing Bulimia: A Case Report and Literature Review. Journal of maxillofacial and oral surgery, 17(2), 117–121. https://doi.org/10.1007/s12663-016-0913-7  Bozzato, A., Burger, P., Zenk, J., Uter, W., & Iro, H. (2008). Salivary gland biometry in female patients with eating disorders. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery, 265(9), 1095–1102. https://doi.org/10.1007/s00405-008-0598-8  Colella, G., Lo Giudice, G., De Luca, R. et al. Interventional sialendoscopy in parotidomegaly related to eating disorders. J Eat Disord 9, 25 (2021). https://doi.org/10.1186/s40337-021-00378-9  ibid.  ibid.  ibid.  ibid.  ibid.
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published April 14, 2021, on EatingDisorderHope.com
Reviewed & Approved on April 14, 2021, by Jacquelyn Ekern MS, LPC