Do You Have Hypermobility? Why It Matters For Your Pelvic Floor

Can you bend your thumb back to touch your forearm? Do your knees hyperextend when you stand? Can you bend forward and place your palms flat on the floor without bending your knees? If you answered yes to these questions, you might be hypermobile, and this could be affecting your pelvic floor in ways you may not have considered.

Hypermobility, particularly hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorder (HSD), is far more common than many people realize. Research suggests it may affect up to 2% of the population, with women being significantly more affected than men. Yet many women don't realize they're hypermobile or understand how it connects to their pelvic floor symptoms.

If you've been struggling with pelvic pain, bladder urgency, painful intercourse, or other pelvic floor issues and haven't found relief with standard treatments, hypermobility might be the missing piece of your puzzle.

The Hypermobility-Pelvic Floor Connection

Hypermobility disorders affect your connective tissue, the collagen-based structures that support and stabilize every part of your body, including your pelvic organs and pelvic floor muscles. When your connective tissues are more flexible and stretchy than they should be, your body has to work overtime to provide the stability that normally comes from these tissues.

The research is clear: women with hypermobility have significantly higher rates of pelvic floor dysfunction. A large international survey of over 1,300 women with Ehlers-Danlos Syndrome found striking rates of pelvic symptoms:

• 71% experienced pelvic pain (including muscle and joint pain, painful periods, and back pain)

• 60% reported stress urinary incontinence

• 54% had urgency urinary incontinence

• 24% experienced fecal incontinence

• 21% had pelvic organ prolapse

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Even more revealing: women under age 40 with hypermobility reported that prolapse symptoms had a greater impact on their quality of life than older participants, suggesting these issues start earlier in this population and affect daily functioning significantly.

But here's what often gets missed: the pelvic floor dysfunction in hypermobile women doesn't always look like "weakness." In fact, it often looks quite different.

What Pelvic Floor Dysfunction Looks Like in Hypermobile Women

If you're hypermobile and have pelvic floor issues, you've probably been told to "just do your Kegels" or "strengthen your pelvic floor." But for many hypermobile women, this advice misses the mark entirely. Here's why: your pelvic floor muscles are likely already working too hard, not too little.

Pelvic Floor Muscle Overactivity

One of the most common findings in hypermobile women is hypertonic (overly tight) pelvic floor muscles. Research shows that women with EDS/HSD commonly have pelvic floor muscle overactivity rather than weakness.

Why does this happen? Your pelvic floor muscles are trying to compensate for the instability created by loose ligaments and overly flexible connective tissue. They're gripping and guarding, attempting to provide the stability your joints and organs need. Over time, these muscles become chronically tight, fatigued, and develop trigger points (painful, tight spots that can refer pain throughout your pelvis).

This overactivity can cause:

• Pelvic pain

• Painful intercourse (dyspareunia)

• Urinary urgency and frequency

• Difficulty emptying your bladder or bowels completely

• A feeling of pelvic heaviness or pressure

• Pain with sitting

Surprisingly, these are many of the same symptoms you'd experience with "weak" pelvic floor muscles, which is why so many hypermobile women are initially given the wrong treatment approach.

Altered Breathing Patterns

If you're hypermobile, there's a good chance your breathing pattern isn't optimal, and this directly affects your pelvic floor.

Research on hypermobile individuals has found that altered breathing patterns are extremely common. Up to 50% of people with hEDS report shortness of breath with exertion, and studies have documented decreased strength of the inspiratory (breathing in) muscles.

Here's what typically happens: The fascia and connective tissues that support your diaphragm, ribcage, and lungs are overly stretchy and lack the normal tension needed to provide structural feedback to your nervous system. This leads to shallow, upper-chest breathing rather than full diaphragmatic breathing. You might notice:

• Breathing from your upper chest and shoulders rather than your belly

• Holding your breath during activities

• Feeling like you can't take a full, deep breath

• Sighing frequently

• Feeling breathless or anxious about breathing

  
  

Why does this matter for your pelvic floor? Your diaphragm and pelvic floor work together as a pressure management system. With every inhale, your diaphragm descends and your pelvic floor gently descends too. With every exhale, both rise back up. This rhythmic coordination is essential for pelvic floor function.

When you're chest breathing, you're not using your diaphragm properly, which means your pelvic floor also isn't getting the movement and coordination it needs. Additionally, chest breathing keeps your nervous system in a more stressed, "fight or flight" state, which reinforces muscle tension throughout your body, including your pelvic floor.

Lack of Deep Core Coordination

Your core is more than just your "abs." It's an integrated system that includes your diaphragm (the top), your pelvic floor (the bottom), your deep abdominal muscles (the front and sides), and your back muscles. In a well-coordinated system, these work together to manage pressure and provide stability during all activities.

In hypermobile bodies, this coordination is often disrupted. Research has shown that:

• Poor proprioception affects motor control and core stability

• Diaphragm dysfunction can compromise trunk stabilization

• Joint instability leads to compensatory muscle patterns

  
  

What this looks like in real life: you might find yourself constantly "bracing" your abs or holding your breath to feel stable. You might have difficulty engaging your deep core muscles without gripping your outer muscles. You might feel unstable or wobbly during activities that require core control.

This lack of coordination means your pelvic floor is often working in isolation rather than as part of a team, which leads to overwork, fatigue, and dysfunction.

Decreased Body Awareness (Proprioception)

Proprioception is your body's ability to sense where it is in space—to know your joint positions and movements without having to look. It's what allows you to scratch your head without looking in a mirror or walk up stairs without staring at your feet.

Multiple studies have shown that people with hypermobility have significantly impaired proprioception. For your pelvic floor, this decreased body awareness means:

• Difficulty sensing whether your pelvic floor is tense or relaxed

• Trouble "finding" or isolating your pelvic floor muscles

• Difficulty knowing when you're gripping or holding tension

• Challenges with coordinating your pelvic floor with breathing or movement

• You might describe feeling "disconnected" from your pelvic floor

  
  

Many hypermobile women describe feeling very aware of pain and muscle tension throughout their body, but have difficulty with the precise control or effective strategies needed to relax overly tense muscles or properly activate underactive ones. This is a proprioceptive issue, not a lack of effort.

Why Standard Pelvic Floor Advice Often Doesn't Work

Now you can see why the typical "strengthen your pelvic floor" advice often falls flat for hypermobile women:

1. Your pelvic floor isn't weak—it's overworking. More strengthening just adds to the problem.

2. Your breathing pattern is affecting everything. You can't fix your pelvic floor without addressing how you breathe.

3. Your whole core system needs retraining. Isolated pelvic floor exercises miss the bigger picture of core coordination.

4. You need better body awareness first. Without improved proprioception, you're working with incomplete information.

   
   

How Pelvic Floor Physical Therapy Helps Hypermobile Women

At Gaia, we understand that hypermobile women need a different approach. Here's what effective pelvic floor PT for hypermobility looks like:

Assessment of your whole system. We don't just assess your pelvic floor in isolation. We look at your breathing patterns, your posture, your joint stability, your movement patterns, and how your whole body is compensating for hypermobility.

Addressing pelvic floor overactivity. Rather than strengthening tight muscles, we use manual therapy techniques to release tension, reduce trigger points, and help your pelvic floor learn to relax. Internal pelvic floor work, when appropriate, can be incredibly effective for releasing chronically tight muscles.

Breathing retraining. We teach you diaphragmatic breathing patterns that restore the normal rhythm between your diaphragm and pelvic floor. This helps calm your nervous system and reduces overall muscle tension.

Core coordination, not just core strengthening. We focus on teaching your diaphragm, pelvic floor, and deep core muscles to work together as a coordinated team. This often involves gentle, controlled exercises that emphasize timing and coordination rather than maximum effort.

Improving body awareness. Through hands-on cues, verbal feedback, and specific exercises, we help you develop better proprioception of your pelvic floor. This might include using touch to help you sense when muscles are tense, using visual feedback, or practicing movements that challenge your spatial awareness.

Joint stability work. We address the underlying joint instability that's causing your pelvic floor to overwork. This might include hip strengthening, postural retraining, and strategies to improve overall stability without creating more tension.

Pain neuroscience education. Understanding how hypermobility affects your nervous system and pain experience is empowering. We help you understand why you're experiencing symptoms and what you can do about it.

Do You Have Hypermobility?

If you're wondering whether hypermobility might be affecting your pelvic floor, consider these questions:

• Are you more flexible than most people?

• Can you bend your joints further than others (hyperextend knees or elbows, bend thumb to forearm)?

• Do you describe yourself as "clumsy" or frequently bump into things?

• Do you have a history of joint dislocations or subluxations?

• Do you bruise easily or have stretchy, soft skin?

• Do you experience widespread joint or muscle pain?

• Have you been diagnosed with conditions like POTS, Mast Cell Activation Syndrome, ADHD, or chronic fatigue?

• Do you have digestive issues like IBS or constipation?

• Does your family have similar symptoms?

If several of these resonate, it's worth discussing hypermobility with your healthcare provider or pelvic floor physical therapist.

The Bottom Line

Hypermobility isn't just about being flexible or "double-jointed." It's a connective tissue condition that affects your entire body, including your pelvic floor. Understanding this connection is crucial for getting the right treatment.

If you've been struggling with pelvic floor symptoms and haven't found relief with standard approaches, if you've been told your pelvic floor is "weak" but strengthening exercises make things worse, or if you just have a sense that something about your body is different—hypermobility might be the missing piece.

At Gaia Women's Physical Therapy, we have providers with extensive experience treating hypermobile women with pelvic floor dysfunction. We understand that your body needs a tailored approach that addresses muscle overactivity, breathing dysfunction, core coordination, and proprioceptive deficits—not just generic strengthening exercises.

You don't have to keep living with pelvic pain, urgency, or other symptoms that interfere with your daily life. With the right assessment and treatment approach, hypermobile women can absolutely improve their pelvic floor function and quality of life.

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If you suspect hypermobility might be affecting your pelvic floor, we're here to help. Contact us to schedule an evaluation with a therapist who understands the unique needs of hypermobile bodies.