Managing Pelvic Pain in EDS: The Role of Pelvic Floor Physical Therapy

By Dr. Zarina Vitebsky, DPT, MSPT, PRPC, TPS, LPF, DN on 2/13/2024

Pelvic Floor Physical Therapist Advising a Patient on Ehlers Danlos Syndrome


Explanation of EDS (Ehlers-Danlos Syndrome)

Ehlers-Danlos Syndrome (EDS) is a group of genetic disorders that affect the connective tissues in the body. These tissues provide support and structure to the skin, bones, blood vessels, and other organs. EDS is caused by mutations in the genes responsible for producing collagen, a protein that gives strength and elasticity to these tissues. EDS can cause a range of symptoms, including joint hypermobility, skin hyperextensibility, and tissue fragility.

Definition of Pelvic Pain

Pelvic pain refers to any discomfort or pain in the pelvic region, which includes the lower abdomen, pelvic floor muscles, and reproductive organs. It can be caused by a variety of factors, such as inflammation, nerve damage, or muscle tension.

Importance of Pelvic Floor Physical Therapy for EDS Patients

For individuals with EDS, pelvic floor physical therapy can be a crucial component of their treatment plan. EDS can cause weakness and laxity in the pelvic floor muscles, leading to pelvic pain and dysfunction. Pelvic floor physical therapy can help strengthen these muscles and improve their function, reducing pain and improving overall quality of life.

Additionally, EDS can also cause issues with joint stability and alignment, which can contribute to pelvic pain. Pelvic floor physical therapy can address these underlying joint issues and help improve overall pelvic stability.

Understanding EDS and its Impact on Pelvic Pain

Types of EDS and their symptoms

There are currently 13 recognized types of EDS, each with its own set of symptoms and characteristics. The most common types include Classical EDS, Hypermobile EDS, and Vascular EDS. Symptoms can vary greatly between individuals, but some common features include joint hypermobility, skin that bruises easily, chronic pain, and gastrointestinal issues.

How EDS can cause pelvic pain

EDS can cause pelvic pain in several ways. The laxity of connective tissues in the pelvic area can lead to instability and misalignment of the pelvic bones, causing pain and discomfort. Additionally, the pelvic floor muscles, which support the pelvic organs, may also be affected by EDS, leading to weakness and dysfunction. This can result in pelvic pain, urinary and bowel issues, and sexual dysfunction.

Common pelvic pain symptoms in EDS patients

Pelvic pain is a common symptom experienced by individuals with EDS. This pain can manifest in various ways, including aching, burning, or stabbing sensations in the pelvic region. EDS patients may also experience pain during sexual intercourse, urination, or bowel movements. Other symptoms may include pelvic pressure or a feeling of fullness, as well as urinary or bowel incontinence.

Role of Pelvic Floor Physical Therapy in Managing Pelvic Pain

Definition of Pelvic Floor Physical Therapy

Pelvic floor physical therapy is a specialized form of physical therapy that focuses on the muscles, ligaments, and connective tissues in the pelvic region. These muscles and tissues play a crucial role in supporting the pelvic organs, maintaining bladder and bowel control, and facilitating sexual function. Pelvic floor physical therapy aims to improve the strength, flexibility, and coordination of these muscles to alleviate pain and dysfunction in the pelvic area.

How it Differs from Traditional Physical Therapy

While traditional physical therapy may address general musculoskeletal issues, pelvic floor physical therapy specifically targets the muscles and tissues in the pelvic region. This type of therapy involves internal and external techniques, such as manual therapy, biofeedback, and therapeutic exercises, to address specific pelvic floor dysfunctions. Additionally, pelvic floor physical therapy is often performed by a specially trained physical therapist who has a deep understanding of the anatomy and function of the pelvic floor muscles.

Benefits of Pelvic Floor Physical Therapy for EDS Patients with Pelvic Pain

For individuals with Ehlers-Danlos Syndrome (EDS), pelvic pain is a common and often debilitating symptom. EDS is a connective tissue disorder that can cause weakness and laxity in the pelvic floor muscles, leading to pelvic pain and dysfunction. Pelvic floor physical therapy can help EDS patients by strengthening and stabilizing the pelvic floor muscles, improving bladder and bowel control, and reducing pain and discomfort in the pelvic region. It can also address any underlying issues, such as pelvic organ prolapse, that may be contributing to pelvic pain.

How it Can Improve Quality of Life for EDS Patients

Pelvic floor physical therapy can have a significant impact on the quality of life for EDS patients with pelvic pain. By addressing the root cause of their pain and dysfunction, this type of therapy can help individuals manage their symptoms and improve their overall well-being. It can also provide patients with the tools and techniques to self-manage their pelvic pain, reducing the need for medications or invasive procedures. Additionally, pelvic floor physical therapy can help EDS patients maintain their independence and engage in activities they may have previously avoided due to pelvic pain.

The Pelvic Floor and its Connection to Pelvic Pain

Functions of the Pelvic Floor Muscles

The pelvic floor muscles have several important functions, including:

  • Supporting the pelvic organs: The pelvic floor muscles help to keep the bladder, uterus, and rectum in their proper positions.

  • Controlling bladder and bowel function: These muscles play a key role in maintaining urinary and fecal continence.

  • Maintaining sexual function: The pelvic floor muscles are involved in sexual arousal and orgasm.

How Pelvic Floor Dysfunction can Contribute to Pelvic Pain

Pelvic floor dysfunction occurs when the muscles of the pelvic floor are too tight, weak, or have poor coordination. This can lead to a variety of symptoms, including pelvic pain. When the pelvic floor muscles are tight, they can compress nerves and blood vessels in the pelvis, causing pain. Weak pelvic floor muscles can also contribute to pelvic pain by not providing enough support for the pelvic organs, leading to organ prolapse and discomfort. Additionally, pelvic floor dysfunction can cause referred pain to other areas of the body, such as the lower back and hips.

Common Pelvic Floor Issues in EDS Patients

Individuals with Ehlers-Danlos Syndrome (EDS) may be more prone to pelvic floor dysfunction due to the connective tissue abnormalities associated with the condition. Some common pelvic floor issues in EDS patients include:

  • Hypertonic pelvic floor muscles: EDS patients may experience tightness and spasms in their pelvic floor muscles, leading to pelvic pain and difficulty with bladder and bowel function.

  • Pelvic organ prolapse: The weakened connective tissue in EDS patients can make them more susceptible to pelvic organ prolapse, which can cause discomfort and pain.

  • Joint hypermobility: EDS patients may have hypermobile joints in the pelvis, which can contribute to pelvic floor dysfunction and pain.

Pelvic Floor Physical Therapy Techniques for EDS Patients

Assessment and Evaluation of Pelvic Floor Function

Before beginning any pelvic floor physical therapy, it is important for EDS patients to undergo a thorough assessment and evaluation of their pelvic floor function. This may include a physical examination, medical history review, and possibly imaging tests. This will help the therapist understand the specific issues and limitations of the patient's pelvic floor muscles and tailor the treatment accordingly.

Manual Therapy Techniques for Pelvic Floor Muscles

Manual therapy techniques involve the use of hands-on techniques to manipulate and mobilize the pelvic floor muscles. This can include soft tissue massage, myofascial release, and trigger point therapy. These techniques can help improve blood flow, reduce tension and pain, and improve overall function of the pelvic floor muscles.

Strengthening and Relaxation Exercises for the Pelvic Floor

EDS patients may experience both weakness and tightness in their pelvic floor muscles, which can contribute to pelvic pain. Strengthening exercises, such as Kegels, can help improve muscle tone and support for the pelvic organs. Relaxation exercises, such as diaphragmatic breathing and pelvic floor drops, can help reduce tension and improve flexibility in the pelvic floor muscles.

Biofeedback and Other Specialized Techniques for EDS Patients

Biofeedback is a technique that uses sensors to provide visual or auditory feedback on muscle activity. This can be helpful for EDS patients who have difficulty connecting with and controlling their pelvic floor muscles. Other specialized techniques, such as electrical stimulation and acupuncture, may also be used in conjunction with pelvic floor physical therapy to help manage pelvic pain and improve muscle function.

Additional Considerations for EDS Patients with Pelvic Pain

Tips for Managing Pelvic Pain at Home

While working with healthcare professionals is crucial for managing pelvic pain in EDS patients, there are also steps that can be taken at home to help alleviate symptoms. These may include practicing relaxation techniques, using heat or ice therapy, and incorporating gentle stretching and strengthening exercises into daily routines. It is important to consult with a healthcare professional before starting any new at-home treatments.

Potential Long-Term Benefits of Pelvic Floor Physical Therapy for EDS Patients

Pelvic floor physical therapy has been shown to be an effective treatment for pelvic pain in EDS patients. Not only can it help to improve pelvic floor muscle function and decrease pain, but it can also provide long-term benefits such as improved bladder and bowel control, increased sexual function, and better overall quality of life. It is important for EDS patients to work with a physical therapist who is knowledgeable about the condition and can tailor treatment to their specific needs.

If you’re experiencing pelvic floor dysfunctions associated with the issues above, please reach out to us at Pelvic Health Center in Madison, NJ to set up an evaluation and treatment! Feel free to call us at 908-443-9880 or email us at

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