Can You Prevent Pelvic Floor Issues in A Hypermobile Child?

So many hypermobile kids and adults develop pelvic floor problems.  They surface as issues with bowel and bladder control, mobility problems, and when kids become sexually active, a host of sexual dysfunctions.

Wouldn’t it be better to prevent problems than solve them?  Of course it would.

That was a rhetorical question, posed out of frustration and concern.

So what can you do to help hypermobile kids have the best chance at avoiding pelvic floor issues now and in the future, or at least delaying or minimizing pelvic floor issues?

1. Address chronic constipation issues with everything you have.  The sustained pressure on the pelvic floor from chronic constipation is a huge contributor to muscle weakness and tissue laxity.  Day after day, month after month.  I didn’t say fixing this is easy.  It isn’t.  But it is essential to go full-court-press on this one.  Changing diet, finding the right combo of stimulants/fiber/exercises/compression clothing/etc. is needed for almost everyone with hypermobility.  Leave no reasonable idea unexamined, and do not back down when you get pushback from your child or your providers who accept chronic constipation as the default.  Educate a child that managing their bowels is no less important to their health than flossing or eating breakfast every morning.  When they get older and do not want to discuss their poop schedule with you, make it clear that their alternative is demonstrating the ability to be fully responsible.  As soon as they show an interest in sex (see #4), use that as the “carrot” for bowel management, as well as fitting into those skinny jeans without pain and feeling great.
2. Explain why “holding it” isn’t a good plan for peeing.  Not taking the time to empty a full bladder, or ignoring the fact that it has been hours since the last time they hit the loo, will create something called (really, this is a thing w/urologists) “lazy bladder”.  Overstretching the bladder wall can result in a permanent state of tissue distention, and thus the receptors that should trigger urgency don’t fire.  There is less proprioceptive input to the brain.  Translation?  Your kid won’t have the sensory info to know they are about to piddle on the floor or that they have to find a tree at the park…fast.  That heavy bladder presses on the pelvic floor too, overstretching it.  The combo of constipation with a full bladder is almost a perfect setup for pelvic floor and prolapse issues.  Oops.  They need to be mindful of using the toilet both when they feel urgency AND when they will be far from a potty.  Don’t interpret recommendations not to pee very frequently with the idea that “holding it” somehow strengthens things down there or builds awareness.  It doesn’t.
3. Learn why many therapists and doctors believe the pelvic floor begins a lot higher than you might think.  A lot higher, like the neck.  Some healthcare providers feel that breath control and swallowing issues in infancy that aren’t fully resolved contribute to alterations in fascial tension and movement patterns all the way down to the genitals.  Yup, that far down.  I am one of the providers who think this way.  We know that fascia has true contractile properties, and we have a mind/body that works in tandem, not a mind separate from a body.  It is hard to ignore these connections.  Actually…it is impossible!  What does this mean for kids?  Control and alignment in movement and at rest matter far more than we think it did.  Awareness and acceptance affect physical health and function.
4. Sex shouldn’t hurt.  This is true for everyone, at every age.  When a hypermobile teen becomes sexually active, they probably do not know how their instability will affect them during sex.  They are definitely not thinking about pelvic floor integrity and health!  Instability isn’t always comfortable, but pelvic pain in sex isn’t normal either.  This doesn’t mean it can’t be treatable.  Almost everyone with a vagina experiences their first episode of penetration in heterosexual sex as less pleasurable than they had imagined.  The first use of a dildo or another object into the vagina or anus can also be somewhat-to-significantly uncomfortable.  It should not remain that way.  Protecting the pelvic floor can require excellent communication skills with partners as well as with healthcare providers.  Kids who are becoming sexually active need to know that they don’t have to agree to acts that are consistently painful.  They can learn their body’s limits, and learn ways to receive and give sexual pleasure that don’t harm them.

Looking for more information on hypermobility?  Read Puberty and the Hypermobile Child  and  Why Joint Protection Solutions for Hypermobility Aren’t Your Granny’s Joint Protection Strategies .

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