Hypermobility Affects on Pelvic Floor Health

As a pelvic health physical therapist, I frequently work with individuals whose bodies move in ways that feel both extraordinary and frustrating. One group that often finds its way into our clinic is people living with hypermobility syndromes, including Ehlers-Danlos Syndrome (EDS). While many think of hypermobility mainly in terms of flexible joints or frequent sprains, what’s less often talked about is how it can affect the pelvic floor.

What is Hypermobility and Ehlers-Danlos Syndrome?

Hypermobility simply means that joints move beyond the typical range of motion. For some, it’s isolated and causes no major issues. For others, hypermobility is part of a broader connective tissue disorder, such as Hypermobile Ehlers-Danlos Syndrome (hEDS).

EDS is a group of genetic disorders that affect collagen — the building block of connective tissue throughout the body. This leads to joint instability, stretchy skin, delayed healing. 

Why the Pelvic Floor is Especially Vulnerable

The pelvic floor is a group of muscles, ligaments, and connective tissue that supports vital organs (bladder, uterus, rectum), prevents leaking, and contributes to core stability. In people with hypermobility or EDS, the connective tissues are more elastic and less supportive, which can lead to both weakness and dysfunction in these muscles. The muscles will need to be very strong to overcome the weakness and hypermobility in the ligaments in order to support pelvic health and provide core stability.

Common Pelvic Floor Symptoms in Hypermobility and EDS

If you are living with EDS or hypermobility, you might notice:

1. Pelvic Organ Prolapse You may feel a heaviness or pressure in the vaginal or rectal area, as if something is "falling out." This happens because the ligaments that normally hold up the pelvic organs are too lax.

2. Urinary Symptoms

• Stress urinary incontinence (leaking when coughing, laughing, or sneezing)

• Urge incontinence (feeling a sudden, uncontrollable need to urinate)

• Incomplete bladder emptying

• Frequent urinary tract infections (sometimes due to inefficient bladder emptying)

3. Bowel Dysfunction

• Constipation (often due to weakened support for the rectum)

• Difficulty fully emptying the bowels

• Fecal incontinence or leakage

4. Pain

• Pelvic pain (aching, sharp, or burning sensations)

• Painful intercourse (dyspareunia)

• Tailbone pain (coccygodynia)

5. Instability and Core Weakness The pelvis is part of your core system. When the pelvic floor isn't providing a strong foundation, you might feel "wobbly" or have trouble with balance and coordination. This can also contribute to low back pain, hip instability, and even knee or ankle injuries.

Why Symptoms Can Be So Varied

No two people with EDS or hypermobility present exactly the same. Some may experience mostly bladder symptoms, while others have more pain-related issues or prolapse. Symptoms can also fluctuate based on hormones, activity levels, fatigue, or injury.

This variability means that one-size-fits-all approaches simply don’t work. Your body deserves an individualized plan that accounts for your unique connective tissue challenges and your personal goals.

How Pelvic Physical Therapy Can Help

Pelvic health physical therapy plays a critical role in managing and improving quality of life for those with hypermobility or EDS. Here's how we approach it:

• Education: Understanding how your body works (and how it's different) is empowering.

• Gentle Strengthening: We focus on building strength around the pelvis, hips, and core without overloading fragile tissues.

• Pelvic Floor Training: Sometimes you need more tone; other times you need better coordination or endurance. We assess your individual needs carefully.

• Breath and Pressure Management: Helping you manage intra-abdominal pressure (especially with lifting or exercise) reduces strain on your pelvic floor.

• Pain Management: Techniques like manual therapy, dry needling (when appropriate), and desensitization strategies can relieve pain.

• Bladder and Bowel Retraining: Specific exercises and habits can greatly improve continence and emptying issues.

• Lifestyle and Activity Modification: Small changes can prevent symptoms from worsening — like learning how to lift, stretch, and exercise in ways that protect your joints.

Final Thoughts

If you have Ehlers-Danlos Syndrome or hypermobility and are struggling with pelvic floor issues, know this: you are not alone, and there is help available. Your body might be different, but it is strong and adaptable with the right support.

Seeking care from a pelvic health specialist who understands connective tissue disorders can be life-changing. With the right tools and team, you can feel stronger, more stable, and more confident in your daily life.

If you're curious whether pelvic floor therapy could help you, I encourage you to reach out. Your journey to better pelvic health is absolutely worth it.

Interested in learning more about how we support hypermobile bodies? Reach out to us at 214-600-8168 or contact us to schedule your evaluation today.