Why Should You See a Pelvic Floor PT if You Have Hypermobility?

First of all, addressing pelvic health is crucial for overall well-being. Our pelvises do so much for us, we need to make sure they are in good working order and getting the care that they need! I have had my own personal journey with pelvic floor dysfunction and as someone with HSD, I really understand the issues that can arise. 

Living with hypermobility spectrum disorders (HSD) or Ehlers-Danlos Syndrome (EDS) is a big deal. These conditions can affect your whole body—including your pelvic floor. The triad of EDS/HSD, mast cell activation syndrome (MCAS), and dysautonomia is known to significantly impact the pelvic floor, bladder, and sexual function. Which is why working with someone like me, a PT that specializes in pelvic floor dysfunction and HSD/hEDS, can make a huge difference in your overall health and well-being.

The Role of Pelvic Floor Physical Therapy for People With Hypermobility

Pelvic floor dysfunction is prevalent among individuals with connective tissue disorders as was highlighted in the most recent episode of Bendy Bodies Podcast featuring Dr. Kelly Casperson and Dr. Linda Bluestein.

And to quote Dr. Kelly Casperson, MD:
“I mean, I think everybody needs a good pelvic floor PT. Mm hmm. Like, have that person when you're doing well so you have that person when you're not doing well. Yeah, like they're just, you know, where, where are you weak? Where are you strong? Where are you guarding? We’re, you know, we're all these like imperfect off-balance people all the time until something breaks, you know, so the physical therapists, which are hard to come by. They're not everywhere, but they’re amazing!”

The Myth of Pelvic Floor Therapy - It's not just kegels!

One common misconception about pelvic floor physical therapy is that it revolves solely around Kegel exercises, but what even is a kegel (we'll get to this later)? And first of all, what even is a pelvic floor?

Well, The pelvic floor consists of the bony opening of the pelvis and includes muscles, fascia, ligaments, connective tissue, and nerves. It provides support for the abdominal and pelvic organs. The pelvic floor muscles extend from the tailbone/back of the pelvis to the pubic bone/front of the pelvis and spans the space between the sit bones. 

The pelvic floor has a number of functions: 

• Organ support

• Postural support

• Sexual function

• Sphincter support and mobility for the urethra and the anus - both conscious and unconscious

• Breathing and abdominal pressure

• Pregnancy and childbirth

• Hip and low back stability

When we look at all the functions of the pelvic floor, it’s really no wonder that living in a hypermobile body can affect the functionality of the pelvic floor. 

The Impact of Hypermobility on the Pelvic Floor

Hypermobility can affect the pelvic floor in many different ways. People can have weakness, prolapse, overactive pelvic floor muscles or many other complaints. Researchers have found that individuals with EDS/HSD experiencing pelvic pain are significantly more likely to report issues such as pain with vaginal intercourse, low back pain, stress urinary incontinence, hip pain, and irritable bowel syndrome.

People with EDS/HSD often develop hypertonic pelvic floors, meaning their muscles are excessively tight and overactive. Hypertonic pelvic floors can occur to anyone, but often people with hypermobility have tight pelvic floors to help compensate for weakness elsewhere, such as the hips, back, even the neck. This can lead to fatigue, pain, and dysfunction. This imbalance can work for a time allowing people to function, but eventually these imbalances become maladaptive and can lead to things like:

• Urinary and fecal incontinence

• Pelvic organ prolapse

• Chronic pelvic pain

• Sexual dysfunction

• Gastrointestinal issues such as constipation or irritable bowel syndrome

• SI joint instability and low back pain

• Frequent Urination

• Difficulty voiding (slow stream, leaking, hesitancy)

So, what do we do about these conditions and how do we treat the pelvic floor? 

Kegels are the solutions sometimes, but pelvic floor dysfunction is complex. Kegels are the pelvic floor exercise we most often hear about. A kegel is an exercise where you engage the pelvic floor muscles - as if holding back gas or urine - to help strengthen the pelvic floor muscles. Unfortunately, the pelvic floor is not that simple and not everything can be solved by doing kegels.

I recommend working with a physical therapist that has training in pelvic floor dysfunction and a bonus if they also have training in HSD/EDS. Working with a trained provider will help you reach a more accurate diagnosis and will improve the efficacy of your treatments. 

Your tailored physical therapy should focus on:

• Proprioceptive training – Learning to enhance body awareness and improve full body system regulation.

• Manual techniques – Various techniques for releasing excessive tension in and around the pelvic floor. 

• Stabilization and mobility exercises – Addressing whole-body movement patterns to reduce compensations.

• Pelvic floor relaxation techniques – Learning to release tension and balance overactive and underactive muscles. 

• Pain management – Addressing central sensitization, nociplastic pain and understanding the nervous systems role in chronic pain. 

• Breathwork - Improving the pressure systems and reducing muscle guarding/bracing..

The Effectiveness of Pelvic Floor Therapy

Research shows that pelvic floor physical therapy is a very effective treatment for various types of pelvic dysfunction including chronic pelvic pain, low back pain, vulvodynia, dyspareunia (painful intercourse), and hypertonic (tight) pelvic floor muscles, pelvic organ prolapse, pregnancy and so many more!

Studies show significant improvement in pain levels and quality of life with the use of pelvic floor physical therapy techniques like manual therapy and targeted exercises.

As a pelvic floor physical therapist, I strongly advocate for early and proactive care. Establishing a relationship with a skilled pelvic floor PT before symptoms become severe can help mitigate long-term complications and improve quality of life.

If you have EDS/HSD and experience pelvic health concerns, know that you are not alone. Working with a pelvic floor PT who understands the intricacies of connective tissue disorders can make a profound difference in managing pain, restoring function, and enhancing your overall well-being.

And to quote Dr. Casperson, MD again “Pelvic floor physical therapists are hard to come by. They're not everywhere, but they're amazing.”

Reach out to learn more!

References:

1. Testosterone is Essential for Women with Dr. Kelly Casperson (Ep 131) - https://www.bendybodiespodcast.com/testosterone-is-essential-for-women/

2. https://urology.stanford.edu/content/dam/sm/urology/JJimages/publications/Pelvic-floor-physical-therapy-in-the-treatment-of-pelvic-floor-dysfunction-in-women.pdf

3. Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019 Dec;31(6):485-493. doi: 10.1097/GCO.0000000000000584. PMID: 31609735.

4. https://uroweb.org/guidelines/chronic-pelvic-pain/chapter/management