Download Summer 2013 - Connective tissue disorders and pelvic floor muscle

Connective tissue disorders and pelvic floor muscle dysfunction:
Is there a connection? By Stephanie Stamas, SPT
Connective tissue disorders (CTD) cause dysfunction in the structures that support,
bind, and protect the organs of the body, such as bone, fascia, cartilage, muscle and skin.
There are over 200 identified CTD’s with the majority of the disorders affecting women
more than men. Some CTD’s are heritable, such as with Elhers-Danlos Syndrome, Marfan
Syndrome and Osteogenesis Imperfecta, although in most cases the cause is unknown.
Here at Beyond Basics Physical Therapy, we have noticed that several patients not only
report issues involving bowel, bladder, or sexual dysfunction, but also have a history of
systemic issues including fatigue, general joint pain, Reynauds phenomenon or dryness.
These complaints have led us to look into the possible relationship between pelvic floor
muscle dysfunction (PFMD) and connective tissue disorders, specifically Ehlers-Danlos
syndrome and Sjogren’s syndrome.
Ehlers-Danlos Syndrome (EDS) is a genetic CTD resulting from defective synthesis
of collagen. Collagen is a foundational matrix in the body which forms skin, bone, blood
vessels, organ capsules and other body structures. There are several subtypes of the syndrome, each affecting a different type of collagen and therefore presenting with different
symptoms. Hypermobility-type EDS is the most common subtype and presents with general joint hypermobility, chronic subluxation, skin elasticity, easy bruising and chronic joint
pain1. Classical-type EDS also presents with general hypermobility and skin extensibility
but has increased skin involvement, such as tissue fragility and atrophic scarring over bony
prominences2. The relationship between EDS and PFMD has been explored in several
studies and a correlation between dyspareunia (painful intercourse), stress urinary incontinence, pelvic organ prolapse and EDS have been identified, with the trend toward increased symptoms with classical-type EDS1,2,3,4.
Sjogren’s Syndrome (SS) is an autoimmune CTD where the body attacks the moisture producing (exocrine) glands of the body leading to the hallmark signs of dry eyes and/
or dry mouth. This is the second most common rheumatic disease and primarily affects
women (9:1 ratio). Another common complaint in this population is vaginal dryness, causing dyspareunia is up to 65% of women with SS5. A study by Mulherin et. al., examined
women with chronic dyspareunia, Raynaud’s phenomenon, chronic joint pain and dry eyes
and/or mouth and found that 63% of these women had either a definite or probable diagnosis of SS6. In all but one of the women, vaginal dryness presented before ocular or oral
symptoms.
Continued on Page 2
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IPPS 2013 Annual Meeting
October 17-20, 2013
The Peabody Hotel
Orlando, FL
SUMMER NEWSLETTER 2013
Connective tissue disorders are difficult to identify and can take years until a correct
diagnosis is made. It is therefore important that individuals with a suspected connective tissue
disorder are evaluated and treated by a multidisciplinary team with an experienced rheumatologist as the primary care provider. Early diagnosis is especially important with individuals
with SS because they have a 20 times increased risk of developing lymphoma than the general population7. If you suspect that you are dealing with a systemic issue, please inform your
physical therapist at Beyond Basics Physical Therapy so that you can receive a more focused, comprehensive and effective plan of care.
References
1. Castori M, Camerota F, Celletti C, et al. Gynecologic and obstetric implications of the joint hypermobility syndrome (a.k.a. Ehlers-Danlos
syndrome hypermobility type) in 82 Italian patients. Amer J Med Gene. 2012; 158A(9):2176-2182
2. McIntosh LJ, Mallett VT, Frahm JD, et al. Gynecologic Disorders in Women With Ehlers-Danlos Syndrome. J Soc Gynecol Investig. 1995;
2(3):559-564.
3. Carley ME, Schaffer J. Urinary Incontinence and pelvic organ prolapse in women with Marfan or Ehlers-Danlos syndrome. Am J Obstet
Gynecol. 2000; 182:1021-1023.
4. Sorokin Y, Johnson MP, Rogowski N, et al. Obstetric and gynecologic dysfunction in the Ehlers-Danlos syndrome. J Reprod Med. 1994;
39:281-284
5. Shiboski SC, Shiboski CH, Criswell LA, et. al. American College of Rheumatology Classification Criteria for Sjogren’s Syndrome: A DataDriven Expert Consensus Approach in the Sjogren’s International Collaborative Clinical Alliance Cohort. Arthritis Care Res. 2012; 64(4):
475-487
6. Mulherin DM, Sheeran TP, Kumararatne DS, et al. Sjogren’s syndrome in women presenting with chronic dyspareunia. Brit J Obstet Gynecol. 1997; 104:1019-1023.
7. Zintzaras E, Voulgarelis M, Moutsopoulos HM. The risk of lymphoma development in autoimmune diseases: a meta-analysis. Arch Intern
Med 2005; 165:2337–44.
BEYOND BASICS PARTICIPATED IN THE REVLON RUNWALK ON MAY 4, 2013!
We have raised $2170 toward the fight against women’s cancers, but
there is still time to donate! Please visit revlonrunwalk.org for details!
BEYOND BASICS IS NOW OFFERING PILATES MAT CLASSES!
DENISE VIDAL WILL BE TEACHING PILATES MAT CLASSES ON WEDNESDAYS
FROM 6:45-7:45PM
COST $30 PER CLASS, OR IF YOU SIGN UP FOR 5 CLASSES, $25 EACH
Save the Date!
IPPS 2013 Annual Meeting
October 17-20, 2013
The Peabody Hotel
Orlando, FL
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SUMMER NEWSLETTER 2013