Hypermobility Spectrum Disorder and Your Pelvic Floor
*originally posted as a guest post on Pelvic Health Support
What is Hypermobility?
Are you exceptionally “bendy” or “double jointed”? Can you touch your toes with ease, or do a back bend in a yoga class without a thought? Maybe you grew up dancing, and achieving your splits was easier for you than for some of your less-flexible peers. People who have hypermobility spectrum disorder (HSD) tend to be exceptionally good at the physical arts (dance, acrobatics, gymnastics) and yoga, but perhaps less coordinated when it comes to contact sports and activities.
Hypermobility is defined as joints that have more range of motion than what is normal. A Spectrum Disorder is a condition that has a wide variation in symptoms, severity, and presentation related to a specific cause. Some with joint hypermobility may not experience any symptoms at all, while others may experience more frequent injury such as joint dislocation, subluxation, or pain. Other associated symptoms include mast cell activation syndrome, pain, fatigue, GI dysfunction, autonomic dysfunction such as difficulty regulating blood pressure or dizziness, headaches and migraines, thin or stretchy skin, and anxiety.
Diagnosis
There are few tests available to diagnose HSD, and HSD is often a condition that is ruled-in or out by diagnosis of other conditions. While testing may be lacking, we can rely on the Beighton Score to screen for joint hypermobility as a place to start. Beighton Score Testing uses a 9-point scoring system, which tests 5 physical maneuvers, including how far you can bend your thumb or knees backwards, and asks 5 questions regarding your medical history. The test is positive for joint hypermobility if you score 5 or more points in the physical portion, with a history of pain in at least 4 joints for the past 3 months, and if you meet at least 2 of the medical history criteria.
Joint hypermobility is a common symptom related to many autoimmune conditions, Ehlers Danlos Syndrome, other heritable connective tissue disorders, chromosomal conditions, and neuromuscular conditions. If you have symptomatic joint hypermobility it is recommended you find a rheumatologist who is familiar with connective tissue disorders and hypermobility who can perform and interpret appropriate lab tests.
What does this have to do with your pelvic floor?
Symptoms and issues that are common amongst people with HSD that can perpetuate pelvic floor dysfunction include joint or pelvic instability, constipation, pelvic organ prolapse, autonomic dysfunction, and anxiety.
Instability
- Our pelvic floor as a muscle group is one of our primary hip and core stabilizers. If our body senses instability of the hip or pelvis, the pelvic floor muscles may increase their activity to create a sense of joint stability, leading to a hypertonic and overactive pelvic floor
Constipation
- Hypermobility spectrum disorder is related to having looser connective tissue, including looser intestinal walls which can reduce intestinal contractility and can slow gastrointestinal motility. This can lead to stool remaining in the gut for longer periods and may cause gut dysbiosis
- Slower motility causes constipation and can lead to straining for bowel movements. Straining puts high levels of pressure through your pelvic floor and your pelvic organs, leading to pelvic floor dysfunction
- To have a healthy bowel movement, we need our pelvic floor to relax, which is the opposite of what our pelvic floor does when we strain
Pelvic Organ Prolapse
- Our pelvic organs include our uterus and vaginal wall (in cisgender women), prostate (in cisgender men), small intestine, rectum, bladder, and urethra
- With looser connective tissue, your pelvic organs are at a higher risk of sitting lower in the pelvis than those with normal connective tissue
- Those with HSD who have experienced childbirth, chronic straining due to constipation, or excessive gastrointestinal activity may have pelvic organ prolapse
- Common symptoms include a sense of pelvic heaviness that is worse with standing for longer periods and is relieved with lying down, lower back pain, incomplete bowel or bladder emptying, straining for bowel movements, feeling the need to “push” to urinate, or lower abdominal heaviness
Autonomic dysfunction
- The autonomic nervous system is responsible for heart rate and blood pressure regulation, as well as involuntary action of our organs such as digestion or kidney filtration
- The autonomic nervous system also partially controls our pelvic floor due to the pelvic floor’s role in visceral activity including bowel and bladder control
- Autonomic dysfunction is common in individuals with joint hypermobility, which can lead to increased autonomic nervous system activity resulting in a hypertonic pelvic floor, as well as symptoms such as increased urinary frequency or Irritable Bowel Syndrome (IBS)
Anxiety
- With increased autonomic nervous system activity, we also see increased anxiety
- People who are hypermobile also tend to have higher levels of dopamine, epinephrine, and norepinephrine, leading to increased nervous system reactivity
- Like autonomic dysfunction, anxiety can also lead to increased urinary frequency, urgency, bladder sensitivity, and IBS
If this feels like you, the best treatment is physical therapy. Any stability your joints are seeking can be provided by strengthening and utilizing the right muscles. The important thing is to build that strength in a strategic and meaningful way that doesn’t create pain or exacerbate other symptoms you may be experiencing. We recommend calling a few physical therapy offices around you and asking to speak with a physical therapist directly to confirm they are the right fit for you and your goals.
Claire Delcambre is a Doctor of Physical Therapy who specializes in pelvic floor dysfunction and sexual health. Claire helps people of all genders, ages, and lifestyles to navigate their sexual, bowel and bladder health while helping them optimize their pelvic floor function and, in many cases, get their lives back.
References:
https://www.ehlers-danlos.com/what-is-hsd/
https://www.ehlers-danlos.org/information/autonomic-dysfunction/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365276/
