Aims
of
study
Articular
hypermobility
is
not
a
distinct
entity,
but
a
graded
trait,
and
normal
individuals
with
a
considerable
degree
of
joint
laxity
will
lie
at
one
end
of
that
spectrum.
Joint
laxity
is
also
a
component
of
a
variety
of
genetically
determined
syndromes
(connective
tissue
disorders
such
Ehlers-Danlos
and
Marfan’s
syndrome)
although
it
can
occur,
in
the
absence
of
other
stigmata,
as
a
simple
inherited
entity.
These
syndromes
are
characterised
by
joint
hypermobility,
caused
by
a
connective
tissue
weakness,
which
may
also
affect
other
organ
systems.
In
general
however,
women
are
more
mobile
than
men
and
racial
variation
exists.
Genitourinary
dysfunction,
specifically
genuine
stress
incontinence
(GSI)
and
genitourinary
prolapse,
is
a
common
problem
with
a
number
of
predisposing
factors.
Theories
into
the
origin
of
pelvic
floor
support
have
debated
the
role
of
fascial
and
ligamentous
failure,
and
muscle
weakness.
Collagen,
a
fibrous
protein,
plays
a
major
role
in
pelvic
floor
support
imparting
high
tensile
strength.
A
reduction
in
vaginal
collagen
has
been
implicated
in
the
development
of
genitourinary
dysfunction
with
biochemical
studies
demonstrating
a
reduction
in
total
collagen
in
women
with
stress
incontinence
and
genitourinary
prolapse
when
compared
to
controls1.
Joint
mobility
has
been
associated
with
stress
incontinence2
and
genital
prolapse3
but
not
in
the
same
study.
No,
one,
study
has
looked
at
both
these
conditions
on
their
own
when
compared
to
controls.
We
set
out
to
demonstrate
whether
there
is
an
association
between
genitourinary
dysfunction
and
joint
hypermobility
thus
suggesting
a
common
connective
tissue
weakness.
Methods
This
was
a
controlled
study
performed
in
our
unit
between
1998-9.
All
women
recruited
into
this
study
were
premenopausal
and
placed
into
three
groups:
incontinence
alone,
prolapse
alone
and
control
(no
incontinence
or
prolapse).
GSI
was
confirmed
by
conventional
cystometric
testing.
The
validated
Bristol
Female
Lower
urinary
tract
symptom
questionnaire
was
used
to
exclude
urinary
incontinence
in
the
control
and
prolapse
group.
The
International
Continence
Society’s
female
pelvic
organ
prolapse
grading
system
was
used
to
assess
genitourinary
prolapse
and
women
were
withdrawn
from
the
incontinence
or
control
group
if
their
score
was
greater
than
1.
The
9
point
validated
Beighton
score
was
used
to
assess
articular
mobility
which
involved
assessing
the
mobility
of
the
5th
finger,
wrists,
elbows,
and
knees4
Results
There
were:
31
women
in
the
control
group
with
a
mean
age
of
41
years
(range
28-56),
29
women
in
the
GSI
group
with
a
mean
age
of
43
years
(range
26-53)
and
22
in
the
prolapse
group
with
a
mean
age
of
40
years
(range
28-50).
The
data
was
analysed
using
Wilcoxon
non
parametric
testing.
|
|
Control
|
GSI
|
Prolapse
|
Beighton Score
|
1.1
(± 1.8)
|
1.8
(± 2.3)
|
2.6
(1.8)*
|
*
Cont
v
Prol
(p
=
0.01)
Conclusion
We
have
demonstrated
that
joint
hypermobility
is
associated
with
genitourinary
prolapse
when
compared
to
controls
as
reported
in
other
studies.
There
was
a
higher
degree
of
joint
hypermobility
in
the
incontinent
group
however,
when
compared
to
controls
this
was
not
significant.
These
findings
agree
with
previous
work3
even
though
a
more
rigorous
9
point
scoring
system
was
used
and
the
control
group
were
women
without
a
history
of
genitourinary
dysfunction.
If
joint
hypermobility
is
considered
together
with
the
known
reduction
of
vaginal
collagen
in
women
with
genitourinary
dysfunction
we
must
assume
a
common
underlying
connective
tissue
abnormality
must
exist.
GSI
may
therefore
be
expressed
as
a
milder
form
of
this
abnormality
as
suggested
with
biochemical
analysis1
which
shows
prolapse
has
a
lower
overall
collagen
concentration
than
GSI.
However,
joint
mobility
can
be
acquired,
e.g.
ballerinas,
and
therefore
excess
strain
on
the
pelvic
floor
should
also
be
considered.
Continuation
of
this
study
with
larger
numbers
may
clarify
these
suppositions.
1.
Neurourol Urodyn 1999; 18:283-5
2.
Gynecol Obstet
Inv 1996; 41:135-9
3. Obstet Gynecol 1995; 85:225-228
4.
Ann rheum Dis 1973; 32:413-18
