Pelvic pain and pressure are common experiences for people with hypermobility and Ehlers–Danlos syndrome (EDS). Symptoms can look different from person to person and often change with posture, activity, time of day, or even breathing.
As our understanding of hypermobility continues to grow, we’re learning that pelvic symptoms are rarely driven by one single system. Muscles, joints, nerves, circulation, and the autonomic nervous system all play a role. One area that is sometimes missed is how blood flow and pressure are managed in the abdomen and pelvis.
For some individuals, adding a vascular and pressure-regulation lens can provide helpful context and open up new, supportive treatment options.
Why Blood Flow Matters in the Pelvis
Veins are responsible for returning blood back to the heart and depend on surrounding tissues, posture, and pressure changes to function efficiently.
In people with hypermobility and EDS, connective tissue tends to be more flexible. This means veins may rely even more on:
- alignment of the rib cage and pelvis
- coordinated breathing
- balanced muscle support
When these systems are working well together, blood moves more efficiently. When the system is under strain, blood can pool more easily in gravity-dependent areas like the pelvis, especially during prolonged standing or sitting.
This pattern is sometimes referred to as pelvic venous congestion.
How Pelvic Venous Congestion Can Present
Pelvic venous congestion doesn’t always present as sharp or localized pain. Many people notice sensations such as:
- a feeling of heaviness or fullness in the pelvis
- dull aching that increases as the day goes on
- discomfort with prolonged standing or walking
- symptoms that ease when lying down
- pressure or aching after physical activity
These experiences are often subtle and variable and can coexist with other pelvic or musculoskeletal findings.
What Are Vascular Compression Patterns?
Vascular compression refers to situations where blood vessels, usually veins, experience partial compression from surrounding structures such as muscles, fascia, bones, or organs.
In hypermobile bodies, these compressions are often dynamic, meaning they change with:
- posture
- alignment
- breathing patterns
- muscle tone
Rather than being a fixed abnormality, they reflect how the body organizes itself in space.
Posture, Breathing, and Pressure Regulation
Posture and breathing are not just about alignment or technique. They are how the body manages pressure.
Many people with hypermobility naturally adopt breathing and postural strategies that help them feel stable, supported, or well-oxygenated. Over time, certain patterns can increase downward pressure into the abdomen and pelvis, particularly when upright.
Examples may include:
- rib flaring during inhalation
- increased use of neck and chest muscles to breathe
- abdominal bracing or holding
- limited movement of the lower rib cage
They are adaptive strategies; however, refining how pressure is distributed can improve comfort and circulation.
Why Muscles and Veins Work Together
Muscles play an important role in supporting venous return. The pelvic floor, abdominal wall, diaphragm, and even the legs all contribute to moving blood against gravity.
When venous flow is challenged, muscles may increase tone to provide additional support. From a treatment perspective, this means muscle findings and vascular considerations often exist together.
Supporting muscles while also optimizing pressure and circulation can be a more complete approach for some people.
Connections With Autonomic Symptoms
Many individuals with hypermobility also experience symptoms related to the autonomic nervous system, such as lightheadedness, fatigue, temperature sensitivity, or POTS.
Venous return, blood pressure regulation, breathing, and autonomic balance are closely linked. This helps explain why pelvic symptoms, upright intolerance, and fatigue can influence one another and why addressing one system often benefits others.
When This Perspective May Be Helpful
A vascular and pressure-based lens may be worth considering if you notice:
- pelvic pressure or heaviness that changes with position
- symptoms that build throughout the day
- relief when lying down
- sensitivity to prolonged standing or walking
- overlap with autonomic or circulatory symptoms
While vascular factors aren’t necessarily the primary driver for everyone, they may be one of several contributors.
How Pelvic Physical Therapy Can Support Pressure and Circulation
Pelvic physical therapy plays an important role when pelvic pain or pressure is influenced by circulation and pressure regulation. In this context, PT is not just about strengthening or relaxing muscles. It is about helping the body manage load and gravity more efficiently.
A pelvic PT trained in working with hypermobility may focus on:
- Improving how pressure is distributed through the rib cage, abdomen, and pelvis
- Supporting more efficient breathing patterns that reduce downward pressure
- Optimizing posture and alignment in a way that feels supportive rather than rigid
- Reducing unnecessary muscle guarding while maintaining functional support
- Gradually improving tolerance to upright positions and activity
For some people, these changes can reduce pelvic heaviness, improve tolerance to standing or walking, and make other forms of exercise feel more sustainable.
As a pelvic floor PT, my approach is gentle and individualized. The goal is not to force change, but to give the body more options so it doesn’t have to work as hard to feel supported.
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