Why Purging With Bulimia Causes Cheek & Face Swelling

Bulimia face and cheek swelling

As a physician who specializes in treating patients with eating disorders, I want to first offer my support to anyone reading this who has an eating disorder or has a loved one with an eating disorder. Eating disorders are complicated and oftentimes misunderstood. 

Bulimia nervosa (referred to here as bulimia) is a common eating disorder. There are many physical symptoms and medical issues that can be related to this condition. Thankfully, almost all medical complications from bulimia are fully reversible with treatment. For this article we will focus on talking about bulimia-related face swelling, sometimes referred to as “chipmunk cheeks.”

Bulimia symptoms: A quick overview

The symptoms of bulimia include:

• Binge eating (consuming a large amount of food in a short time)
  AND
• Compensatory behaviors (engaging in a behavior to rid the body of food, such as making yourself vomit, taking laxatives or water pills or medication not prescribed to you)

To be diagnosed with bulimia, people engage in these behaviors at least once a week for three months and feel a lack of control during these episodes. The most common compensatory behavior for patients with eating disorders is self-induced vomiting, which is also known as purging.

View more bulimia symptoms here.

Causes of bulimia face swelling

Each person has three sets of salivary glands. The parotid glands are the largest of these glands and are located just in front of the ears. When people vomit frequently and then abruptly stop vomiting, the parotid glands can swell up to five times their normal size.

• The amount of swelling varies from person to person.
• The swelling may be very noticeable and bothersome.
• The swelling is usually painless and bilateral (on both sides of the face).

A small percentage of people with bulimia (10%) will experience painful face swelling [1]. The medical term for this is sialadenosis.

Why do the cheeks swell after purging stops?

The salivary glands typically do not start swelling until a few days after purging stops. It can be frustrating for people to experience this side effect after they stop purging. The exact cause of face swelling in bulimia is unclear. However, several theories have been proposed including dysregulation of the autonomic nervous system [2]. The good news is that the swelling does eventually go down.

How to reduce cheek swelling with bulimia

Face swelling with bulimia almost always responds to treatment. Treatment remedies include:

• Sucking on sour candy (lemonhead or other tart hard candy)
• Applying a heating pad to the cheeks several times a day
• Taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or acetaminophen

Over time, the salivary glands will shrink back to their normal size. In severe cases, this condition can be treated with the medication pilocarpine. It is extremely rare that a patient has chronic symptoms that do not respond to treatment. In those cases, surgery (parotidectomy) could be considered.

Other symptoms of bulimia

Facial swelling is just one of many side effects that can occur when people purge through self-induced vomiting. Frequent purging can affect many areas within the head, eyes, ears, nose and throat, potentially causing:

• Gingivitis
• Erosion of enamel
• Irreversible tooth damage
• Cavities
• Bad breath
• Dry mouth
• Broken blood vessels in the whites of the eye (subconjunctival hemorrhage)
• Nosebleeds (epistaxis)
• Hair loss

Bulimia doesn’t just affect the head, neck and face. There are many complications associated with bulimia throughout the entire body. Bulimia symptoms can be both mental and physical, including:

• Depression and anxiety
• Heart palpitations
• Fatigue
• Dehydration
• Irregular periods
• Dry skin
• Russell’s sign – scarring or thick skin on the backs of the knuckles
• Chronic constipation (particularly worse in those who misuse laxatives)
• Electrolyte and lab abnormalities

The long-term effects of bulimia tend to be more severe for those who purge more frequently.

Bulimia treatment options

In order to resolve cheek swelling with bulimia, it is important to stop purging completely. This can be very hard to do without support. When it comes to professional treatment, a three-pronged approach can be very effective. This includes:

• Evidence-based therapies for eating disorders
• Medical management from physicians experienced in eating disorders
• Nutritional counseling and support from registered dietitians

Eating disorder support groups and support from loved ones can also be very helpful.

Recovering from bulimia

Eating Recovery Center offers a full continuum of care that’s designed to connect you with the right support at the right time, starting with the assessment and continuing all the way through to aftercare support. Find healing with one of our distinct programs:

• Virtual intensive outpatient program (Eating Recovery At Home)
• Intensive outpatient program (IOP, on-site)
• Partial hospitalization program (PHP)
• Residential program
• Inpatient program

Learn more about bulimia treatment at Eating Recovery Center.

Eating disorders can cause devastating health consequences, but help is available. Please reach out to us at (866) 622-5914 if you have any questions about bulimia treatment or complications. And remember that eating disorder recovery is possible.

Read These Next:

• Anorexia vs. Bulimia: What’s the Difference?
• See How Purging With Bulimia Affects Your Teeth, Smile and Dental Health
• Bulimia Warning Signs: Know What to Watch for
• Eating Disorder Facts and Myths: Get the Facts Here

Sources

1. Mehler, P.S., & Andersen, A.E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed.). Johns Hopkins University Press. 
 
2. Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. (2021). Medical complications of bulimia nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333-343. doi: https://doi.org/10.3949/ccjm.88a.20168.