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.
http://www.ncbi.nlm.nih.gov/pubmed/25817057

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. air max air max

This entry was posted in Abdominal pain, Interstial Cystitis/Gynecologic. Bookmark the permalink.

4 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

    http://www.jhoonline.org/content/4/1/10
    This condition looks prevalent in EDS… suspect if you have Hypermobility EDS & POT/OI likely that
    you have this

    and another
    http://hyper.ahajournals.org/content/45/3/385.long

    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)

  4. Christina L says:

    I have extreme hyper mobility and unexplained stomach pains as well. The stomach pains had began as a child and food intolerance as well as laxatives were provided. I too began limiting certain foods for various reasons at a young age i.e. 3-7 before limiting diet for known psychological reasons i.e. Anorexia/ Dysmorphic body disorder, beginning at about age 9 from my recollection. The stomach pains were diagnosed numerous times throughout my life from growing pains, allergies, anxiety… multiple ambulatory “gull bladder attacks” to GERD, ovarian cysts, stomach virus and food poisoning (while overseas), back to peptic ulcers and burst cysts that have landed me literally on the floor and in the emergency room at least yearly for all of my life. I have been tested and do have gluten and cows milk allergies as well as allergies to almost everything: to note: the animal and enviro allergies didn’t seem to become an issue until my early teens when I also had diagnosed athletic asthma( for a few years only). Now, age 32, I have constant constipation/IBS and what seems like either yearly or possibly seasonal stomach pains that they diagnose as ulcers or cysts. I’m wondering if it’s not a bug? I have always suffered with some psychological issues, however I have also had continuous emotional and physical traumas that have made healing almost impossible lol. I spent my teens on multiple SSRI’s as well as Venafelaxine and some sort of tranquilizer i.e. Clonazepam, lorazepam, multiple others and my twenties on and off increasingly stronger opioids as physical injuries took place. Note: also finding in these times of my inability to handle any NSAIDS (even with stomach coater). So it made sense to me that opioids=gastric issues. Or is there something more? I read an article on the relation between EBV and thyroid issues as well as auto immune disease ( have been in process of/ diagnosed with hypo thyroid, bouts of psoriasis (started after a slip and fall in which I broke skin on the knee and soon after found skin plaque) as well as high rheumatoid factor, reynauds syndrome and arthritis found in X-rays in low back, hips, and around foot joints where previous surgery had been done. Note: pins put in my feet later found by another orthopedic surgeon that the wrong surgery was done back in 2010 as improper healing continued for years post. I have known adolescent scoliosis, multiple car accidents including neck
    Injury and blunt force trauma to multiple areas, the last being to head, neck and knees(2006). And since then a few major slip and falls, which over the last year has been causing extreme pain. I had a slipped/bulged disc diagnosed years ago and re occurs almost yearly. Joint pains seemingly connected to rheumatoid with fever, redness, swelling and then of course chronic fatigue that varies from mild to extreme mixed with insomnia, ptsd and now unexplained almost noctual sleep disorder in which I find myself asleep standing, or shortly after falling, in odd sitting positions or areas, possibly tied to times of extreme stress… i.e. Flying? Apologies for all the information, it keeps coming to me so I hope to maybe shed some light in well, any of the areas. The major point being pain, hypermobility, and stomach issues… I hope it’s ok I have so much info that’s unrelated. There is more… much, much more, but sadly my ADHD and lack of memory has my vocabulary and categorization skills quite limited. Plus years of moving, short doctor visits and inability to figure out one issue at a time has me now frozen and all this + + + to deal with and few to no doctors that care to try and figure it out. I don’t blame them. None the less, thanks for the space to let me share. I’m open to answer any other questions anytime here : missbliss7@hotmail.com or in office. Bless your heart for having me. You’re one of the only ones to have actually helped improve my daily struggle. So thank you. Good luck and take care.

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