Unexplained Abdominal Pains & Problems – Could Be Hypermobility

In patients with unexplained abdominal problems referred to a tertiary centre, half had evidence of joint hypermobility syndrome (JHS).

Though Hypermobility is noted for its relation to Fibromyalgia, it appears abdominal problems are even more likely  – something that would validate the symptoms in many patients. There is now an association with constipation as well.

The relation with abdominal symptoms was published here:
Neurogastroenterol Motil (2010) 22, 252–e78
Unexplained gastrointestinal symptoms and joint hypermobility: is connective tissue the missing link?
N. ZARATE,1,* A. D. FARMER,1,* R. GRAHAME, S. D. MOHAMMED,* C. H.  KNOWLES,* S. M. SCOTT* & Q. AZIZ   abstract here

  • 129 cases – 97 females – referred to a neurogastroenterology clinic
  • Use Modified Brighton for delineating hypermobility:
  • (see separately to print -make sure enlarge first  – here)

There was much similarity between JHS and functional stomach trouble:

What difference they did find was JHS subjects were

  • JHS bit younger 37 versus 44 (p=0.01),
  • more likely female – 86% versus 65% (P<0.001),
  • more likely to have reflux symptoms (heartburn, waterbrash or regurgitation): 56% versus 30%

A typical case would be:

  • A 25-year-old woman with  unexplained multiple GI symptoms
  • dysphagia (trouble swallowing)to solids since childhood
  • nausea,
  • severe reflux,
  • postprandial abdominal pain,
  • bloating
  • severe constipation.
  • Worsening symptoms as teenager-  severely limited her food intake resulting in 12 kg weight loss, thought  anorexia nervosa though denied
  • chronic joint pains especially wrists and knees.
  • underweight
  • features suggestive of JHM.

The link with constipation was just published:
Neurogastroenterol Motil. 2010 Oct;22(10):1085-e283.
Joint hypermobility and rectal evacuatory dysfunction: an etiological link in
abnormal connective tissue?
Mohammed SD, Lunniss PJ, Zarate N, Farmer AD, Grahame R, Aziz Q, Scott SM.
abstract here

  • Constipation scores worse than those with JHS
  • Rectal evacuatory dysfunction (RED) – represents a problem with a rectocele – out-pouching of rectum in vagina – this leads to “ineffective propulsive force”
  • Symptoms would include:
    • constipation
    • need for manual assistance (finger in rectum or vagina to help push out contents)
    • abdominal pain
    • use of laxatives
    • incomplete evacuation
    • significant rectocele

Comments – Unexplained abdominal pains and constipation might suddenly become explainable is one looks for Hypermobility issues.  The idea that just because a cause is not immediately identifiable means it’s psychosomatically psychological is such tripe.

There is an association of Ehlers–Danlos syndrome and bladder diverticulum causing bladder obstruction:

Clinical and Experimental Dermatology Volume 23, Issue 3, pages 109–112, May 1998
Giant bladder diverticulum in Ehlers–Danlos syndrome type I causing outflow obstruction
BURROWS1,4, MONK2, HARRISON4, POPE1 abstract here

This was confirmed in a recent study:
Neurogastroenterol Motil. 2015 Apr;27(4):569-79. doi: 10.1111/nmo.12535.
Functional gastrointestinal disorders are associated with the joint hypermobility
syndrome in secondary care: a case-control study.
Fikree A(1), Aktar R, Grahame R, Hakim AJ, Morris JK, Knowles CH, Aziz Q.

It effected:

  • postprandial distress syndrome (51%, ORadj: 1.99, CI: 1.06-3.76, p = 0.03).
  • increased chronic pain (23.2% vs 11.9%, p = 0.01)
  • fibromyalgia (10.5% vs 3.1%, p = 0.01),
  • somatization scores (13 vs 10, p < 0.001),
  • urinary autonomic scores (30.5 vs 20.7, p = 0.03),
  • worse pain-related QOL scores (45.0 vs 63.5, p = 0.004).

One wonders if hypermobility will be associated with premature Bowel  diverticular disease as well… I have couple patients with hereditary interstitial cystitis and hypermobility so increased “autonomic scores” are interesting.

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3 Responses to Unexplained Abdominal Pains & Problems – Could Be Hypermobility

  1. Bee says:

    Hi I have Ehlers Danlos Hypermobility Type and thought you might find these links to Mast Cell Disorders useful

    This condition looks prevalent in EDS… suspect if you have Hypermobility EDS & POT/OI likely that
    you have this

    and another

    And my web site, which is venting!!! A lot about pain from EDS/POTS/Mast Cell related…. OUCH! thought your pages very interesting. mine are at http://www.smellthebees.com (a totally non-commercial site) Thankyou for your efforts, wish I’d found it a long time ago. I think you will find the Mast Cell / hypersensitivity reactions info very interesting, if you don’t have it already. Bee (:

  2. Bee says:

    P.S. I get lots & lots of abdominal pain, “IBS” which ended up being food intollerances and Mast cell related. Definate hypermobility link to abdo pain!

  3. Bee says:

    another note… sorry, the anorexia and post prandial fullness of HMS is related to reduced gastric motility. I suffer gastroparesis which is helped by gastric motility agents. Not all with HMS will have constipation (if IBS present…think mast cell)

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