Hypermobility Syndrome And The Pediatric Pelvic Floor

Over the past several years, pediatric physical and occupational therapists have been seeing a trend in clinic. Hypermobility diagnoses and patterns are on the rise. Not because they’re new, but because they’re finally being recognized.

As a pediatric pelvic floor therapist, you are familiar with the typical suspects: kids with chronic constipation, ongoing bladder dysfunction, and poor pressure management. But for some of these kiddos, the story goes beyond constipation or developmental delay.

Talk around the hypermobility syndromes, including Ehlers-Danlos Syndrome (EDS), and their relationship with the pelvic floor and visceral systems is on the rise.

This isn’t an encouragement to diagnose every bendy kid with a connective tissue disorder. This is an invitation to broaden our lens of assessment and treatment when it comes to bowel and bladder symptoms, especially when they are longstanding or not completely resolved with more traditional approaches.

Many of the kids you see in pediatric pelvic floor therapy share similar presentations. They are often W-sitters, with low postural tone and low endurance. Their core activation is inefficient. Their pressure management is lacking. Their bowel or bladder issues have often been longstanding and explained away as downstream symptoms of weakness, withholding, or behavior.

And sometimes, it fits.

However, with emerging research and clinical experience, therapists may come to realize an interesting parallel. Adults with hypermobility syndromes—often undiagnosed for many years—frequently report that their constipation, urinary symptoms, or pelvic floor dysfunction began in childhood. Many were “that kid” with stomach issues or leaking. As adults, their unexplained symptoms never truly resolve.

That overlap between children and adults raises an important clinical question:

Are some of the bowel and bladder patterns we’re seeing in kids related not just to function, but to connective tissue and nervous system differences present from the beginning?

When you think about hypermobility syndromes, it’s easy to focus on musculoskeletal findings. Excessive range of motion, joint instability, and frequent injuries come to mind. However, differences in connective tissue don’t just involve joints. They also involve smooth muscle, fascia, blood vessels, and the visceral system.

From a pelvic floor perspective, this connection matters.

In children with hypermobility, you may see decreased peristalsis efficiency, variations in autonomic regulation, and difficulty generating or managing intra-abdominal pressure.

Constipation in these kids is not always the result of stool being retained in the rectum for long periods of time (though that certainly does happen). In some cases, it may have been slow to develop from the very beginning.

Understanding this difference is important because it informs treatment.

Clinically, slow transit constipation can be categorized into two main types. The first is functional outlet constipation, where stool is withheld in the rectum for extended periods of time and results in downstream impacts. This causes dilation of the rectum and inhibition of motility.

The second type is when kids have globally slow peristalsis despite a normal rectal diameter. This presentation often overlaps with hypermobility syndromes. These kids may show markers throughout the colon on transit studies rather than clustered in the rectum. They often don’t respond well to laxatives alone, and repeated cleanouts become the norm.

When bowel care becomes entirely medication-driven, you must also consider the implications for the developing nervous system, the microbiome, and long-term gut function.

One of the more challenging clinical realities with hypermobile kids is that strength does not equal control.

Many of these children, especially adolescents, are strong. Gymnasts, dancers, and athletes may have exceptional gluteal and lower extremity strength, yet still struggle with pelvic floor activation. This is where pediatric pelvic floor therapy becomes highly specialized.

The pelvic floor doesn’t always activate automatically in hypermobile systems. Proper activation must be taught deliberately, starting with isolation before integration. Asking a child to “use their core” or “squeeze their glutes” rarely translates into improved continence or bowel emptying if the pelvic floor itself has never been mapped.

This is why layering strengthening on top of dysfunction often falls short.

Another consistent finding in these kids is poor stability around the thoracolumbar junction. This region is central to both movement and autonomic regulation.

When the diaphragm, abdominal wall, and pelvic floor don’t work as a coordinated pressure system, bowel and bladder symptoms are almost inevitable. Hypermobility can amplify this problem, making it harder for the system to stabilize, particularly during growth spurts or increased athletic demands.

From a treatment perspective, this reinforces the need to assess and address pressure management globally, not just locally at the pelvic floor.

While medication can play an important role in pediatric bowel management, it cannot be the only intervention, especially for children with suspected hypermobility syndrome. Chronic reliance on stimulant laxatives can alter gut responsiveness over time and raises concerns about long-term dependence and microbiome disruption.

Pelvic floor therapy offers additional tools that directly target the systems involved. Visceral mobilization, neuromodulation techniques such as interferential current, and nervous system regulation strategies support motility and coordination in ways that medications cannot. When introduced early, these approaches reduce the need for escalating medical management later in life.

Equally important is family education, to help parents understand the role of good nutrition and the microbiome. Setting realistic expectations for bowel function allows parents to support their child without fear or overcorrection.

Hypermobility syndromes are often under-recognized in children, especially when symptoms are primarily visceral rather than orthopedic. You are uniquely positioned to notice these patterns because you see how visceral function, posture, breathing, and movement mechanics intersect.

Early recognition doesn’t mean making a diagnosis or alarming families. You need to recognize when something doesn’t quite fit the typical model and adjust your care accordingly. You may need to recommend further evaluation when signs point beyond benign hypermobility.

By broadening your perspective and intervening earlier, you can play a key role in changing long-term outcomes for kids with bowel and bladder dysfunction.

These are the kinds of clinical presentations addressed in Peds Level 1–Treatment of Pediatric Bowel and Bladder Disorders. The course is designed for therapists who already know pediatric pelvic floor dysfunction exists, but want clearer frameworks for evaluation, clinical reasoning, and treatment.

Peds Level 1 gives you practical tools to address pressure systems, pelvic floor coordination, visceral mobility, and nervous system involvement in pediatric patients.

As we continue to see more children with complex, overlapping presentations, this depth of understanding becomes not just helpful but necessary.

Join me on February 28–March 1, 2026 for our live, virtual Peds Level 1 course. I can’t wait to see you there!