Can Ehlers-Danlos and Hypermobility Cause Pelvic Floor Muscle Dysfunction?

Short answer: Yes!

Let’s dive into the long answer. Ehlers-Danlos Syndrome (EDS) is a group of inherited connective tissue disorders associated with abnormal collagen. There are currently 13 identified subtypes of EDS but most are generally characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. EDS is more prevalent in women and more likely to impact the pelvic floor of these women. These pelvic floor symptoms are likely to be more severe and more common than in the general population. Pelvic floor symptoms include stress urinary incontinence in 60%, urinary urge incontinence in 54%, fecal incontinence in 24%, and pelvic organ prolapse in 21%. Pelvic pain was reported in a whopping 71% (Kciuk).

Those with EDS are more likely to have health conditions that impact other systems in the body that include but not limited to conditions impacting autonomic, vascular, and immune function like POTS (Postural Orthostatic Tachycardia Syndrome, gastrointestinal dysfunction, and mast cell issues (dysfunction) and food allergies and sensitivities. Conditions impacting the musculoskeletal are common given the vast array of connective tissue across the body from joints and tendons to tissue that gives blood vessels elastic qualities to maintain blood pressure. . biomechanical issues like joint hypermobility, subluxation/ dislocations, muscle and tendon tears, and muscle spasms are typical.

EDS is a whole-body issue that affects every part of the body including the pelvic floor. As physical therapists, we typically see that those with EDS overuse their global or big moving muscles and develop trigger points and sore muscles and pain as well as underuse their supportive, stabilizing muscles, thus NEEDING to use their global muscles even more. It becomes a vicious cycle.

The pelvic floor is no different. It is a group of muscles that are the “floor of the core.” One of the pelvic floor’s main functions is stability. Clinically, we see that those with EDS have short, tight, and weak pelvic floor muscles leading to stress urinary incontinence and prolapse and painful trigger points leading to urinary urge incontinence, painful sex, and pelvic pain.

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Diagnostic Criteria

Regardless of an official EDS diagnosis or not, a great way to see if you are having issues with hypermobility is the Beighton Score: This is a 9-point scale that is easy and quick (but not perfect because it samples only a few joints).

1 point bending forward at the trunk with knees straight so the palms touch the floor

1 point: being able to touch the pinky finger past 90 degrees backward LEFT

1 point: being able to touch the pinky finger past 90 degrees backward RIGHT

1 point: being able to bring the thumb to the forearm LEFT

1 point: being able to bring the thumb to the forearm RIGHT

1 point: hyperextension of the elbow beyond 10 degrees LEFT

1 point: hyperextension of the elbow beyond 10 degrees RIGHT

1 point: being able to hyperextend the knees beyond 10 degrees LEFT

1 point: being able to hyperextend the knees beyond 10 degrees RIGHT

Total: __/9

The maximum score is 9 and several researchers appoint a score of 0-3 as normal and 4-9 representing ligamentous laxity.

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Physical Therapy Management

Our treatment philosophy involves hands-on physical therapy to align joints, and reduce painful trigger points in muscles to allow the body to heal while teaching good stabilizing muscle recruitment and progressive exercises to strengthen the whole body. Manual therapy use helps to reduce pain and exercise and strengthening are what provide long-lasting results.

Because SO MANY of our patients and clients with pelvic floor muscle dysfunction also have hypermobility in their joints, all of our therapists have training in this unique and special population.

Book in person or Virtual

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Kciuk O, Li Q, Huszti E, McDermott CD. Pelvic floor symptoms in cisgender women with Ehlers-Danlos syndrome: an international survey study. Int Urogynecol J. 2022 Jun 25. doi: 10.1007/s00192-022-05273-8. Epub ahead of print. PMID: 35751670.

Muldowney Protocol Book

In order to learn more about EDS visit the EDS Society Page at:

https://www.ehlers-danlos.com/what-is-eds/