Pelvic pain can be one of the most distressing — and least talked about — symptoms in hypermobility conditions. For many people with HSD or hEDS, pain may involve the hips, sacroiliac joints, pelvic floor, bladder region, or deep internal aching that is difficult to describe. It can fluctuate with the menstrual cycle, worsen after activity, or flare without a clear trigger.
If you’ve been told your scans are normal, or that it’s “just tension,” this can feel invalidating. Pelvic pain in hypermobility is real, and there are understandable reasons it occurs.
The pelvis is a structurally complex area. It includes:
All of these structures rely on connective tissue for stability.
In hypermobility, connective tissue may provide less passive support. That means muscles often have to work harder to stabilise the region. Over time, this increased load can contribute to pain, fatigue, and protective muscle tension.
The sacroiliac joints and pubic symphysis are designed to allow very small, controlled movements. In hypermobility, these movements may become less predictable.
This can lead to:
Instability does not always show clearly on imaging. Pain may arise from micro-movements and repeated strain rather than obvious structural damage.
The pelvic floor is a group of muscles that support the bladder, bowel, and reproductive organs. In hypermobility, these muscles may respond in two common ways.
Some people develop weakness or poor coordination due to tissue laxity.
Others develop overactivity or guarding — where the muscles stay partially contracted in an attempt to create stability. This protective tightening can cause pain with sitting, intercourse, tampon use, or bowel movements.
It is possible to have both weakness and overactivity at the same time, which is why generic “do your Kegels” advice is often unhelpful without assessment.
Hormones influence connective tissue and ligament laxity. Many people with hypermobility notice pelvic pain worsening:
Fluctuating oestrogen and progesterone levels can temporarily alter tissue stability and pain sensitivity. This does not mean the pain is “just hormonal,” but hormones can act as amplifiers.
Pelvic pain in hypermobility may also be associated with:
These patterns can relate to pelvic floor coordination, autonomic nervous system involvement, or connective tissue differences affecting organ support.
Again, these symptoms are common in hypermobility — even if they are not always discussed.
Pelvic pain is often investigated for conditions like endometriosis, infection, or structural abnormalities. Sometimes those are present. Sometimes they are not.
When scans and tests return normal, people may be told nothing is wrong.
But pain does not require visible damage to be real. In hypermobility, pain may arise from:
Because these factors are functional rather than structural, they are not always captured on imaging.
Pelvic pain can occur in both HSD and hEDS. The mechanism — connective tissue laxity combined with muscular compensation — is similar in both.
Diagnosis category does not reliably predict who will develop pelvic pain. Functional patterns matter more than labels.
Management usually focuses on stability, coordination, and nervous system regulation rather than aggressive stretching or high-intensity strengthening.
Pelvic health physiotherapy can be particularly helpful. A clinician experienced in hypermobility can assess:
Treatment may involve very small, targeted exercises aimed at improving control rather than range.
Pacing also matters. Repeated end-range loading, prolonged standing, or sudden increases in activity can aggravate symptoms. Learning your body’s early warning signs can reduce flare cycles.
Addressing bowel regularity, sleep quality, and overall stress load can indirectly improve pelvic pain by reducing nervous system sensitivity.
In some cases, supports such as SI joint belts or tailored bracing may provide temporary relief during flare periods.
Medical review is important if pelvic pain is:
Assessment for conditions such as endometriosis, infection, or inflammatory disorders may still be appropriate alongside hypermobility-informed care.
If pain is persistent, interfering with intimacy, bladder function, or daily movement, a pelvic health clinician familiar with connective tissue conditions is often a helpful next step.
Pelvic pain in hypermobility is not uncommon, even if it is under-recognised. Your pelvis works hard to stabilise a body with more flexible connective tissue. Sometimes the muscles become exhausted. Sometimes they tighten protectively. Sometimes the nervous system amplifies signals after repeated strain.
None of this means your body is broken. It means it may need a more tailored, stability-focused approach. With the right support, many people find that pelvic pain becomes more predictable — and more manageable — over time.
