Joint hypermobility syndrome for the urogynaecologist - A narrative review

Joint Hypermobility Syndrome (JHS), also referred to as hypermobile Ehlers-Danlos Syndrome (hEDS), is increasingly recognised as a significant contributor to gynaecological, pelvic floor and lower urinary tract symptoms. This review aims to highlight the current evidence on the relationship between JHS and key urogynaecological conditions, with particular attention to recent developments in epidemiology, clinical presentation, and management.

Emerging research demonstrates a strong association between JHS and pelvic organ prolapse (POP), with meta-analytic data showing more than a twofold increased risk. Large cohort studies highlight substantial symptom burden, including high rates of stress and urgency incontinence, bladder pain, pelvic floor dysfunction and sexual difficulties. Recent work also reveals distinct challenges in perioperative care, such as dysautonomia-related anaesthetic risks, tissue fragility, impaired wound healing and higher rates of surgical complications in some series. Studies document higher prevalence of urinary incontinence, bladder diverticula, recurrent urinary infections and voiding dysfunction linked to increased bladder capacity and elevated residual volumes.

Women with JHS experience a wide and often severe spectrum of urogynaecological symptoms that significantly affect quality of life. Although management generally mirrors standard care pathways, the unique connective-tissue and systemic features of JHS necessitate tailored assessment and multidisciplinary involvement. Further high-quality research is required to develop specific management algorithms and clarify the role of conservative versus surgical treatments in this complex clinical population.