Pelvic Floor Health in Hypermobility

hypermobility

by Jeannie Di Bon, March 12th, 2021

Pelvic Floor Health in Hypermobility

The pelvic floor can often try to act as a trunk stabiliser all the time. This leads to tightness not just in the pelvic floor but with all it’s close relations like the hip, low back and abs. In turn this presents as tightness and pain. Recent research from Australia has shown a tight pelvic floor can lead to SI joint issues, which makes perfect sense due to its intimate connection.

If you follow me on social media, you will know I’m not a fan of ‘core’ training in the ‘traditional’ sense of pulling belly button in and pelvic floor up to exercise. The last thing someone with a hypertonic pelvic floor needs to do is more gripping and sucking in. We are so often diagnosed with pelvic floor weakness. We are instructed we need to strengthen and tighten the pelvic floor muscles. And yet we actually need the opposite so that all the surrounding structures can learn to glide happily together. We need to unwind the pelvis and teach it that it is safe to move. This takes time, as you are dealing with some of the deepest muscles – be patient and gentle.

Here’s my personal story of my pelvic floor issues. After the birth of my second son, things started to change. Let’s just say running and jumping was out of the question. I felt weak, out of control and extremely upset. My GP sent me for women’s health physio. I was given pelvic floor exercises that involved squeezing and holding in the pelvic floor. I did these religiously three times a day for weeks.

At each appointment, I would be strapped up to a machine and pelvic floor strength assessed. Every week I got worse. Every week I got more upset. I was discharged because the physios didn’t know how to help me.

Thankfully I found a pelvic floor expert a three-hour drive away. She diagnosed a hypertonic pelvic floor. No wonder I was getting weaker. The more I squeezed and pulled up my pelvic floor, the more fatigued the muscles became. They couldn’t support me. The muscles gave up.

But at last, I had an answer. Pelvic floor exercises that contract may not be the right strategy. I didn’t know I had EDS then, but I now see this pattern a lot in my EDS clients too. Many people with hypermobility and EDS end up with imbalances and pain caused by a hypertonic pelvic floor.

The strategy to a healthy pelvic floor (and now I can run – see my very proud photo) was 1) unwinding the pelvis, 2) treating all the muscles around the pelvis with mobility and stability and 3) breathwork. Breathing was a game changer. For a hypermobile body, bracing or guarding is a common occurrence in daily life. This inhibits the breath. I call this guarding false stability because either we think it’s helping, or we are not even aware we do it. To be told to brace or guard more before doing an exercise is going to lead to more tension and pain. That’s why I never tell my clients to pull in their abs or ‘activate their core’.

Learning the intimate relationship between the diaphragm and the pelvic floor, learning not to guard or brace my abs or glutes, re-learning correct belly breathing. To belly breathe, we must learn to expand the thoracic spine first.

I have added both pelvis and pelvic floor classes to The Zebra Club app. Members can also find a pelvic-floor meditation in the audio meditations section of the app.

I have several videos on breathing over on my YouTube channel if you’d like to explore the power of your breath too.

20 Comments

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Julie - 27th November 2023

I was recently diagnosed with a connective tissue disorder. It’s not EDS, but perhaps some type that hasn’t been identified yet. I am 49, no kids, but have had three complete prolapses (rectal, uterine, and cervical). The bracing you describe resonates with me. I have so much hip, back, and hip flexor pain. It seems like my muscles are always working extra hard to hold everything in place. Doctors have no idea what to do for me. And I have not had much success finding physical therapists who can teach me how to move to not further aggravate everything. I feel like traditional recommendations accomplish the opposite!

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    jeannie-admin - 28th November 2023

    Thank you for sharing your experience. I am so glad this resonated with you too.

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J - 26th November 2023

Thankfully I realised quickly that the pelvic floor exercises were making everything worse. I am back at step 1 in terms of finding new exercises but at least it seems the internet (as usual) has the answer to most of my issues 😂

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    jeannie-admin - 28th November 2023

    I have a great video on pelvic floor health on my live section on my YouTube channel.

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Amare - 22nd November 2023

I have hEDS and this so desciñes my experience. I’m still looking for a good PFT.

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    jeannie-admin - 22nd November 2023

    Thank you for sharing. I am glad this resonated with you. Have you checked The Ehlers Danlos Society healthcare directory – they may have someone listed there who is EDS aware.

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emilyrose - 26th September 2023

Really appreciate and agree with your approach Jeannie, thank you so much for sharing your knowledge and experience for free like this. I just got diagnosed with EDS several months ago but it makes a lot of sense.

I have had PF pain for about 15 years in total, over half my life. Like the many others I had no idea what was going on for most of it and was in such debilitating pain that I frequently considered dying by suicide.
Eventually after meeting some PT’s that guided me in the wrong direction (fear mongering, suggesting massively invasive and severe surgeries within the first minutes of meeting me and giving me the wrong exercises for me) I met a PT who’s approach I agreed with. She retaught me how to breathe, stand up/sit down, reach for things, driving and sleeping positions and pillows, food, mindfulness and then began helping me stabilise my body with pilates. I was so scared to strengthen after years of being told I was tense, and sending myself into flares after workouts. I started by taking a class a week. Still having a lot fo pain, but feeling a little more confident and safer in my movement. Once I became capable of doing all the exercises while maintaining alignment and stability without causing flares, I moved up to a higher class. One thing I’ve noticed about myself is I neeeeeed to stay ‘Slow and Steady’ (and I find it very hard not to overdo things) and gradually increase the intensity. I baby stepped my way into being a yoga/pilates teacher and not to toot my own horn, but one of the healthiest and strongest people in my peer groups. I say this not to brag, but to paint a picture of hope. I went from being stuck in bed/on the toilet/totally suicidal for about a decade to being someone who experiences very little to no pain or restrictions in my day to day life and activities. This was because I found the right guidance, the right movement, the right explanations.

Since then I stopped teaching and stopped my healthy practices (because I was feeling so NORMAL I forgot)and experienced a slow relapse into pain and disfunction. This time its been more focused on my neck than my PF. Dips are scary as heck, especially when you have history and trauma more than likely. I decided I needed to drop my intense physical activities like surfing and go back to basics. SO back I went to physio starting from ground 0. Already I’m moving back out of pain, and back into a place of stability and confidence in my movement. I’m back again to a place where I can surf again (just maybe for 2 hours not 6!) and don’t have to base every move around my pain.

Anywho, bit of a ramble but I hope it resonates/helps someone worrying out about the idea of strengthening and relaxing in a gentle holistic way. Slow n steady! 🙂

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    Jeannie Di Bon - 1st October 2023

    Thank you so much for taking the time to share your personal journey and experience. I’m so glad you found the way to strengthen without force and pressure. Wishing you a continued successful journey.

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T.L. - 21st June 2023

after 15 years of seeking an answer to my urinary urgency and urge incontinence problems, I’ve finally been told I have a hypertonic pelvic floor likely due to my Hypermobility. I was sent home to do nothing but breathwork and trigger point release work.
I am having a hard time not doing anything else, but reading about your scenario gives me hope. I am hopeful to find relief .

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    Jeannie Di Bon - 26th June 2023

    Thank you. I am so glad to hear this was useful.

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Elisa Pretsky - 16th January 2023

I was given a presumed hEDS diagnosis by a neurologist recently in my quest to figure out my low back, gluteal pain. Lifelong GI issues as well. Just had a thorough workup including an MRI that shows the pelvic floor during straining and it shows pelvic floor laxity, pelvic organ descent, rectocele and cystocele (and a posterior, coccyx level fibroid). I’m planning to start pelvic floor PT and am also worried about increased pain. I was doing glute and core work this past summer for ankle weakness and feet pain and I felt like it was making my pelvic girdle pain worse. It’s all confusing to me- strengthen or release or both?

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    Jeannie Di Bon - 16th January 2023

    Sorry to hear you have been struggling. I cannot give any specific advice here as I do not know your full history. I would recommend the pelvic floor specialist checks whether your pelvic floor is hypertonic – that will determine the best treatment.

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Taylor - 25th May 2021

Thank you for posting this. I am a former ballet dancer and was diagnosed with hypertonic pelvic floor 8 years before my EDS diagnosis. I had been suffering with severe pelvic pain for at least 6 years before that, and though I’ve had EDS symptoms my whole life, my pelvic pain was one of my first really debilitating issues. It has been really confusing and difficult for me to know how to exercise or strengthen my body, knowing I have to work to convince my core to settle down. My hypertonia never really goes away, maybe because I went so long without being properly diagnosed. I think it is my body’s coping mechanism, and sometimes I think my whole body tenses up to hold me together. I’d be interested to know eventually if certain hypermobile subtypes are genetically prone to this, as this is common in my family. Thank you so much for posting about it.

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    Jeannie Di Bon - 25th May 2021

    Thank you for your comment. I’m so glad the post was useful.

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Kathleen Van de Velde - 8th May 2021

Hello, I also have EDS and i found you on YouTube and so i learned to relax my PF. Over 2 years ago i had to start with PFT and Kegel excercises. After a few times i developped Pudendus Neuralgia. Verry painfull. After a few months i stopped going to PFT. But PN didn’t go away. Thanks to you i now know how to try to relalx my pf.

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    Jeannie Di Bon - 10th May 2021

    Thank you – I am glad you found the article useful.

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Maria - 17th March 2021

Thank you for an interesting post! Does it mean that the use of Kegel balls can lead to unwanted results if one doesn’t have any specific pelvic floor issues?

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    Jeannie Di Bon - 23rd March 2021

    Not necessarily. I think Kegals are sometimes required – especially after pregnancy or pelvic operations – but they are a short term solution. Ideally we want the pelvic floor to begin working naturally in response to its demands. I’m not sure why we would do them if we had not been told we definitely had a weak pelvic floor.

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Bonnie Southgate - 15th March 2021

HI Jeannie,
It would be great if we could meet and have a good chat one day. I definitely agree that a number of hypermobiles have very held and have hypertonic over active pelvic floors. I also find this in the normal population. I can see it now when I look at my clients. I was taught to assess this in Nuero kinetic training a number of years ago. I think it partly goes with the sympathetic overdrive, and poor breathing patterns as you have said.
I however am the opposite. I have had three children , was told by my Pilates trainer Susanne Scott not to ever cue pelvic floor. I tried not to due pelvic floor exercises when doing Pilates, but ended up with multiple hernias and a prolapse. I knew I felt way better when I did recruit my pelvic floor but it took some time to really work out how to do it correctly. It was a game changer for me. My proudest moment was going on a pelvic course with Diane Lee in New York. I was the only non gynaecological physio in the room and we used ultra sound to look at one another. She declared I was the only one in the room who had a proper functioning pelvic floor and TVA which let me know what felt right and what I had been doing was correct.I do not suffer with many of the commorbidites, but I suffered more with dislocations and was seriously unstable. I don’t think I have found anyone bender than myself yet. It just goes to show how individual Zebras are and how important it is to treat each one individually.

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    Jeannie Di Bon - 17th March 2021

    Thank you for taking the time to reply and sharing your personal experience. Always happy to chat and discuss.

    Yes I agree, every zebra is different – I see around 20 different people a week in my clinic with EDS, HSD or symptomatic hypermobility. And everyone needs different things and every session is different.

    There are some common themes however and seeing this many people a week, I do see a tendency towards the hypertonic pelvic floor. This is what has informed my work and research. We of course want the pelvic floor to function, but in a natural way in response to the load being put through the tissue, rather than mechanically contracting it prior to movement. This is what I teach my clients and it has proven to be very important for them.

    Lederman’s paper on the contraction of so called core muscles is also a useful read. I also discuss this more in my book Hypermobility Without Tears if you’d like a read too.