Pelvic floor dysfunction is much more common than most realize. While not everyone with pelvic floor dysfunction has hypermobility, every hypermobile person has pelvic floor dysfunction. As bold as this statement may seem, in this blog, we will explore the following:

  • What pelvic floor dysfunction is
  • Why do all hypermobile individuals have pelvic floor dysfunction
  • How to address postural instability which is the common denominator between pelvic floor dysfunction
  • Hypermobility, who to seek treatment by, and where to start

What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction refers to a collection of symptoms ranging from incontinence and pelvic pain to chronic pain in the tailbone, sacroiliac joint, and lower back to poor posture. While the ‘stories’ as to why it is present in an individual may vary from a person to a person, the common theme is the presence of postural instability. You can read about the subtle and not-so-subtle signs and symptoms of pelvic floor dysfunction in a blog I have written.

While women who have gone through childbirth and individuals of advanced age are commonly associated with pelvic floor issues, it is essential to recognize that pelvic floor dysfunction can affect anyone, regardless of age or gender. Another fact to consider is that because hypermobile individuals lack stability in the transitional sections of their body with the connection of the lower back spine to the pelvis being one of those transitional areas, all bendy bodies have pelvic instability and therefore pelvic floor dysfunction.

How Are Posture, Pelvic Instability And HyperMobility Related?

If pelvic floor dysfunction was the name of a book, it would have many chapters with pelvic instability being one of them. The pelvis is the base and foundation of the torso with the legs connected to them. This base not only has to manage the ‘structures’ above but has to somehow do so while the legs do the ‘walking’ and with any limitations or dysfunctional movements in the lower extremities, this job of stabilization becomes even harder. With this lack of stability of the pelvis, the ‘house’ that the pelvic floor is the ‘floor’ of, it is hard to avoid pelvic floor dysfunction.

Hypermobility often affects multiple joints, including those in the pelvic region, making it difficult for individuals to maintain a stable and aligned posture.

What Is HyperMobility?

Hypermobility is a condition where joints move beyond the normal range of motion. It is a connective tissue disorder typically due to increased mast cells, the type of white blood cells that lead to histamine production. While those individuals with hypermobility have other non-musculoskeletal (muscles, joints, ligaments, and bones) symptoms, we will focus on the postural and movement presentations that typically exist with hypermobility.

There is a difference between flexibility and instability and hypermobility is instability that may appear as being flexible. Most hypermobile individuals at some point in their life, primarily younger years, shine in the field of gymnastics, acrobatics, ballet and dance, cheer, or sports excess movements put them at a higher level of notice.

This only becomes problematic because the structures that support the joint end up going beyond their roles to stabilize the joint and since the ‘job’ of these structures is to support the move and not necessarily become the main ‘stabilizers’, they get injured and damaged.

When it comes to the pelvis, it is a foundation for the spine and the entire musculoskeletal system. In hypermobile individuals, maintaining a stable pelvis becomes a significant challenge. As we move, stand, or sit, the pelvis may shift and tilt unpredictably; this instability can contribute to chronic pelvic pain, urinary and bowel issues, and a range of other symptoms associated with pelvic floor dysfunction that providers and people, in general, don’t necessarily associate with pelvic floor dysfunction.

How Are HyperMobility And Pelvic Floor Dysfunction Connected?

The instability in hypermobile individuals places strain on the pelvis, pelvic floor, pelvis wall, and whatever is connected to the pelvis. Simultaneously, the dysfunctional pelvis exacerbates pelvic instability, creating a feedback loop of discomfort and dysfunction on the hypermobile joints.

Poor posture, a common feature in hypermobility, feeds this cycle too. Slouched or misaligned postures can increase pressure on the pelvis and contribute to pelvic instability. As hypermobile individuals may struggle to maintain a consistently stable posture, the risk of pelvic floor dysfunction increases.

How Is Pelvic Floor Dysfunction Addressed In The Bendy Bodies?

Recognizing the connection between hypermobility, posture, and pelvic floor dysfunction is the first step toward effective management and prevention. A holistic approach that combines whole body exercises vs specific regional exercises, lifestyle modifications, and understanding the positions, movements, and activities that put the body in a more vulnerable state is crucial in the treatment of pelvic floor dysfunction in all populations, hypermobile or not.

I wrote a blog on a comprehensive treatment list for pelvic floor dysfunction and when it comes to the hypermobile, EDS, hEDS, HSD, and MCAS population, I STRONGLY suggest seeking clinicians that TREAT the same population. Being able to treat and knowing what these acronyms stand for are not the same.

In my practice, treating a high number of the hypermobile population I can assure you that the response, awareness, strengths, and weaknesses of the bendy bodies are unique and different from the non-bendy people and many subtle and non-subtle factors can easily be missed if the clinician is unaware.

As explained in my blog, the treatment length varies depending on the following factors:

  • “The extent of the instability of the pelvis
  • How dysfunctional your movement is [and bendy bodies have a higher than average number of dysfunctional patterns of movement]
  • How balanced you are with movement
  • What portions of your brain with regards to balance and coordination are weak
  • Are the muscles in your lower back, hips, and pelvis moving in coordination or skipping function
  • How strong is your cortical connection (the connection of the brain to the body part when it comes to following a command) is
  • How motivated you are in performing the exercises you are given
  • How compatible your work environment is
  • How weak the muscles of your lower back, hips, and pelvis (internal and external) are
  • If you have any comorbidity such as EDS, other hypermobility, nerve, or tissue association with your pelvic floor dysfunction
  • If you have had any surgeries or scar tissue”

Who Do I See If I am HyperMobile And Have Pelvic Floor Dysfunction?

Seek care only from clinicians who are familiar with the hypermobile population; consult the EDS society website for the clinicians near you, ask other bendy friends, your existing providers, and social media!

Make sure you have a short session with the provider you are considering to see how their method of treatment is different and how much of their practice is the hypermobile population. Finding a clinician that does functional movement and stability, pelvic floor dysfunction and treats hypermobility is not common but not unheard of.

My practice has a high majority of hypermobile patients because of the style of movement practices that I guide them through and because of my overall mission of teaching them how to be so they can live their lives the way they wish to live. A combination of functional movement, pelvic floor dysfunction, and hypermobility care and awareness has allowed me to help many, and am here to help you either myself or with a referral elsewhere if I know someone in your area. Do not hesitate to contact me.

Dr. Shakib