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

One wonders if hypermobility will be associated with premature Bowel  diverticular disease as well…

This entry was posted in Abdominal pain. Bookmark the permalink.

Leave a Reply

Your email address will not be published.

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>