Pelvic pain is rarely the result of a single cause. It is often complex, influenced by a combination of physical, psychological, and social factors — including how the body moves, how the nervous system processes pain, and a person’s past experiences and environment.
For some people, local physical factors such as joint hypermobility or connective tissue differences — including conditions like Ehlers-Danlos Syndrome (EDS) — may be one contributing piece of this broader picture.
At Sydney Pelvic Clinic, we take a whole-person, biopsychosocial approach to understanding pelvic pain. This means looking beyond any single diagnosis to identify the key drivers of symptoms, allowing for more targeted and effective care.
What is Ehlers-Danlos Syndrome?
Ehlers-Danlos Syndrome (EDS) is a group of genetic conditions that affect the body’s connective tissue. This tissue provides support to your joints, muscles and organs all over your body.
The most common type is hypermobile EDS (hEDS) and common signs include:
- Joint hypermobility (being very flexible or “double-jointed”)
- Frequent injuries, clumsiness, sprains, or joint dislocations
- Chronic pain or fatigue
Because connective tissue is found in many structures throughout the body, EDS can affect many systems—including those involved in pelvic health.
How Does EDS Cause Pelvic Pain?
How Does EDS Cause Pelvic Pain?Pelvic pain linked to EDS is usually multifactorial, meaning there are several contributing factors rather than one single cause.
1. Pelvic joint instability
The pelvis relies on ligaments for stability. In EDS, these ligaments can be more flexible, leading to increased micro-movement through the sacroiliac joints, hips, and lower back. This instability can contribute to local inflammation at the joints or even cause joint subluxations.
2. Pelvic floor dysfunction
The pelvic floor muscles and associated stabilising muscles must work harder to compensate for this extra movement or instability. This can lead to overactive or tight pelvic floor muscles. If the pelvic muscles have difficulty relaxing it can cause pain with prolonged postures as the muscle tension builds. It can also impact intimacy with many experiencing pain during intercourse. Read more on tight pelvic floor muscles here.
3. Reduced organ support
Stretchier connective tissue increases the risk of pelvic organ prolapse. This is also one of the diagnostic criteria of hEDS. It can commonly cause symptoms like pelvic heaviness, pressure, or dragging sensations. Learn more here.
4. Bladder symptoms
EDS is commonly associated with bladder urgency or frequency but medical screening such as mid-stream urine samples come back negative for a urinary tract infection. Bladder urgency can be caused by the reduced connective tissue support at the bladder neck allowing some urine to enter the upper urethra; or from pelvic floor muscle tightness causing pressure on the bladder when it tries to expand.
5. Bowel Symptoms
Tightness in the pelvic floor muscles can impact the way we empty our bowels. If you are unable to relax your pelvic muscles appropriately it can cause a problem called obstructed defecation. Not opening your bowels well can further contribute to pelvic discomfort and pain but is often overlooked.
6. Autonomic Dysfunction
Many people with hEDS also have autonomic dysfunction—meaning the nervous system that controls automatic body functions (heart rate, blood pressure, digestion, temperature) doesn’t regulate things properly. This can affect how quickly or slowly our intestines move food along and can appear as diarrhoea or constipation. It may also be a contributing factor to bladder urgency and frequency.
How Pelvic Floor Physiotherapy Can Help
The good news is that pelvic pain related to EDS can be effectively managed with the right approach.
At Sydney Pelvic Clinic, treatment focuses on improving stability, control, and confidence in movement. This may include:
- Pelvic floor physiotherapy Focusing on coordination and relaxation—not just strengthening
- Targeted strength and stability exercises To better support joints without overloading them. Strengthening the muscles of the hip also may have a role in improving pelvic floor muscle and bladder function.
- Pain management and pacing strategies To reduce flare-ups and improve consistency
- Breathing, yoga & relaxation techniques To help calm an overactive nervous system and pelvic floor
Treatment is always individualised, especially for people with hypermobility syndromes, where a gentle and progressive approach is key.
When to Seek Help for Pelvic Pain and Hypermobility
When to Seek Help for Pelvic Pain and HypermobilityIf you have Ehlers-Danlos Syndrome, hypermobility, or ongoing pelvic pain that hasn’t improved with general treatment, a specialised assessment with one of our physiotherapists can help identify the underlying drivers. Book online today.
Pelvic pain is common—but we don’t want it to affect your quality of life.
With the right support, it’s possible to improve symptoms, build stability, and return to the activities you enjoy.
Find out more about general EDS symptoms here: What is EDS? – The Ehlers Danlos Society
