Let's uncover how hypermobility can affect digestion, common bowel symptoms we see, and how a pelvic health physio can help!
When we think of hypermobility, we often think of flexible joints or frequent injuries. But for many people with hypermobility or connective tissue disorders like Ehlers-Danlos Syndrome (EDS) or Hypermobility Spectrum Disorder (HSD), the impact runs much deeper—right down to gut function and bowel health. The connective tissue that supports your joints also helps stabilise the organs in your pelvis. When that support becomes compromised, bowel symptoms can follow.
How does hypermobility impact digestion?
From the moment you chew and swallow your food, your digestive system is set into motion. As food travels through the stomach and small intestine, nutrients are absorbed before waste is passed on to the large intestine. The colon reabsorbs water, forming stool that eventually moves to the rectum, where your body signals it’s time to empty.
This process seems simple, but it relies on the smooth coordination of your organs, nerves, and muscles—including the pelvic floor. People with hypermobility often experience dysfunction along this pathway, affecting how efficiently their gut can move and how effectively they can empty their bowels.
Why do bowel symptoms occur in people with connective tissue disorders?
People with HSD or EDS may have more elastic or “looser” connective tissue, which can make the gastrointestinal system less efficient overall. Sometimes, comorbidities like POTS (postural orthostatic tachycardia syndrome) may also contribute to digestive dysfunction.
Here are some commonly reported symptoms:
– 40% experience reflux
– 16% report unexplained abdominal pain
– 16% have food intolerances
– 26% have delayed gastric, bowel, or colonic transit
– 33% experience dyssynergic defecation (poor coordination when emptying bowels)
– 50% report gynaecological issues like prolapse, which can further affect bowel function
Every presentation is unique, and symptoms don’t always correlate with how flexible a person appears.
What bowel-related pelvic floor dysfunctions are common in hypermobile people?
The pelvic floor has a big role to play in bowel health, especially for people with hypermobility. When the connective tissue in the pelvis is weakened, the muscles must work harder to hold everything together—especially under the pressure of constipation, lifting, or pregnancy.
Some common pelvic floor dysfunctions seen in hypermobile people include:
Dyssynergic defecation: Difficulty coordinating pelvic floor and anal muscles to effectively empty the bowels
Pelvic organ prolapse: When the bowel, bladder, or uterus descends, it can create a bulge and make bowel emptying more difficult
Rectal hyposensitivity: Poor sensation of bowel urgency due to an overstretched rectum—people with EDS or HSD are twice as likely to experience this
Pelvic health physiotherapists can support these conditions with education, muscle coordination training, biofeedback, and tools like vaginal pessaries for prolapse support.
When should you see a pelvic health physio for constipation?
If you’re experiencing ongoing bowel difficulties, it’s worth checking in with a pelvic health physio. It’s especially important to seek support if:
– Your bowel movements are irregular or urges are hard to feel
– You regularly feel incomplete emptying
– You need to strain or use your hands to assist in emptying
– You rely on laxatives
– You feel constipated most days
– You’ve noticed a vaginal or rectal bulge
Pelvic health physiotherapy can help improve defecation mechanics, strengthen coordination, and reduce the impact of prolapse or dyssynergia on your quality of life.
Who else may be involved in managing bowel health connected with hypermobility?
Because hypermobility-related bowel issues can be complex, support may come from multiple professionals. For example, if you’re managing chronic pain with medication, some drugs (like opioids) may worsen constipation. GPs, gastroenterologists, dietitians, and pain specialists often work alongside pelvic health physios to create a balanced, manageable plan.
References:
Ritelli M, Colombi M. Molecular Genetics and Pathogenesis of Ehlers-Danlos Syndrome and Related Connective Tissue Disorders. Genes (Basel). 2020 May 13;11(5):547. doi: 10.3390/genes11050547. PMID: 32414079; PMCID: PMC7288446.
Hakim A. Hypermobile Ehlers-Danlos Syndrome. 2004 Oct 22 [Updated 2024 Feb 22]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1279/
Thia, I., & Jeewa, F. (2024). Management of Pelvic Floor Dysfunction in Connective Tissue Disorders Including Ehlers-Danlos Syndrome. IntechOpen. doi: 10.5772/intechopen.114013
Zhou, W., Zikos, T. A., Halawi, H., Sheth, V. R., Gurland, B., Nguyen, L. A., & Neshatian, L. (2022). Anorectal manometry for the diagnosis of pelvic floor disorders in patients with hypermobility spectrum disorders and hypermobile Ehlers-Danlos syndrome. BMC gastroenterology, 22(1), 538. https://doi.org/10.1186/s12876-022-02572-8
Choudhary, A., Vollebregt, P. F., Aziz, Q., Scott, S. M., & Fikree, A. (2022). Rectal hyposensitivity: a common pathophysiological finding in patients with constipation and associated hypermobile Ehlers-Danlos syndrome. Alimentary pharmacology & therapeutics, 56(5), 802–813. https://doi.org/10.1111/apt.17104
Other Blogs in the Hypermobility Series
Deep dive into education written by our pelvic physiotherapist, Courtney, all about hypermobility – including symptoms across a range of pelvic health areas, treatment options for hypermobile patients & emerging research in the hypermobility space.
Do you want to learn more about pelvic health, specialised to your symptoms?
