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Summary: There are a number of relatively simple things that we can all try to reduce stomach acidity, bloating, pain and constipation.

If these do not work then a doctor may be able to assist you with medications and help you determine if you have a food allergy or underlying condition such as Coeliac disease.

Sometimes it is necessary to do further tests and a Gastroenterologist is the key specialist here– these tests looking to see if there is anything wrong with either the anatomy or the function of the bowel.


Over the last 10-15 years medical professionals have realized that bowel symptoms are very common in hypermobility-related disorders.

Akin to the symptoms of Irritable Bowel Syndrome, patients will very often describe symptoms of:

  • Generalized abdominal pain,

  • Bloating,

  • Nausea,

  • Heartburn (acid reflux from the stomach in to the gullet),

  • Vomiting,

  • Constipation, and

  • Diarrhoea.

  • Hernias (bowel pushing through the abdominal wall) are common.


Perhaps most familiar to the public is the hiatus hernia– part of the stomach squeezes into the chest through an opening in the diaphragm. This can cause symptoms of pain, heartburn, fullness and nausea and vomiting. A hernia might also be found, for example, in the midline of the abdominal wall, around the belly button, or at the groin. Most often they present as a tender lump that might also expand on straining or coughing.

Up to 10-15% of individuals with EDS also describe a sense of urgency when needing to pass faeces; haemorrhoids (piles) or skin tears with bleeding; and may also be incontinent, soiling themselves due to the inability to control when they pass faeces.

Medication side effects

Medication side effects

Individuals who take painkillers may get bowel side effects from these too. The most common side effects are:

  • Heartburn and Nausea (e.g. from Non-Steroidal Anti-inflammatory Drugs (NSAIDS))

  • Ulcers and bleeding (e.g. from NSAIDs)

  • Constipation (e.g. from Codeine or Tramadol)

Less common and rare Bowel Problems

Occasionally the muscles of the pelvic floor are so weak, and the tissues holding the bowel so stretchy in an individual that the end of the bowel literally falls out of the body. This is called a prolapse. It is often possible, once taught to push the bowel back up and to use a ring pessary support. Sometimes the problem is so painful and the tissues so inflamed that it becomes an emergency and requires medical attention.

Very rarely, and seen mainly in the Vascular form and occasionally in the Classical form of EDS, the bowel may be very dilated, it may split (perforate), become blocked as it folds in on itself (obstruction), or it may spontaneously bleed. These are surgical emergencies that require immediate attention.

These rare problems are not usually seen in the more common forms of symptomatic hypermobility.

Rarer bowel issue
Tests and treatment

Tests and Treatment

There are lots of ways to help bowel symptoms. For the majority of individuals the self-management and medical treatments used to manage Irritable Bowel Syndrome will work. Types of treatments used in IBS for which there is evidence of effectiveness include:

  • Exercise,

  • Pelvic Floor Exercises (see more information on that here)

  • Pelvic Floor Biofeedback,

  • CBT and Hypnotherapy,

  • Probiotics,

  • Herbal remedies (Peppermint Oil, STW5 (Iberogort), Padma Lax),

  • Medications [serotonin antagonists (e.g. Ondansteron),

  • 5HT4 agonists (e.g. Prucalopride), and Guanylate

  • Cyclase C agonists (Linaclotide)],

  • and exclusion diets.

Exclusion Diets

Exclusion Diets

A doctor might recommend an ‘exclusion diet’ as a test for an intolerance to food products and also as a treatment. If the stimulant(s) causing the intolerance is removed the irritable bowel-like symptoms may settle.

The three most common exclusion diets that may be helpful are described below. If you click on the highlighted word it will take you to more detailed information on other websites.

  • Gluten free diet. There is no evidence to suggest that allergy to gluten or the presence of Coeliac disease is more common in people with symptomatic hypermobility than the general population.  Your doctor can do a blood test to exclude Coeliac disease. 

  • Lactose free diet. A person may find that they are intolerant of dairy products. There are several tests for lactose intolerance that your doctor might do. If not able to take dairy products it is important to find other foods rich in Calcium and Vitamin D, to maintain health bones.

  • A low-FODMAP diet. These are sugars that trigger irritable bowel. Lots of information about what they are and what foods they are in can be found at the American website IFFGD.

It is always sensible to maintain a healthy balanced diet and to keep hydrated by drink sufficiently and often– in particular, the FODMAP diet is quite restrictive and you may want to seek a nutritionists / dieticians advice.

It is noted here that a few individuals also find they have intolerance to very specific things. Two things that seem to be a concern (based on the authors clinical experience) are an intolerance to:

  • Citric acid (used in a number of food products – read the label) and,

  • Binding products used to constitute tablets (here, individuals may be helped by trying a liquid, patch, cream, or injectable version of the medication (if available).


Your doctor might prescribe medications that help with reducing:

  • Stomach acidity

  • Nausea and Vomiting,

  • Colic (spasm), and

  • Constipation or Diarrhoea




Constipation will often make bladder symptoms worse and straining to empty your bowels will place a lot of pressure on the pelvic floor muscles and ligaments which can cause damage to these over time.  Below are a few tips to help prevent / manage constipation:

  • Exercise. Taking part in regular exercise is great for your general health but it also helps to stimulate the gut to work effectively.

  • Fibre. Eat foods high in fibre such as fruit, nuts, seeds and vegetables.  These are a good source of magnesium too which is good for constipation.

  • Routine. Bowels often respond well to routine.  It is most common for your bowels to empty after your first meal of the day so that’s why it’s important to not miss breakfast.  If you can’t face eating anything when you first get up have something warm to drink.  Try not to delay the urge to empty your bowels as this causes water to be reabsorbed from your stool making it drier and harder to pass.

  • Position. Sitting in the correct position on the toilet can make a big difference to how easy it is to empty your bowels. Try leaning your forearms on to your thighs and relaxing.  Some people find it really helpful to have a footstool under their feet (one like toddlers use to reach the sink is perfect).  When you empty your bowels your back passage needs to relax. Remember to keep breathing – don’t hold your breath and push as this means you are straining and this often causes your bottom to close more tightly.


A gastroenterologist may wish to do a camera study of the upper or lower bowel (endoscopy or colonoscopy) and during this may take a biopsy of the bowel lining to examine in more detail for inflammation and other changes. Other common investigations include imaging of the bowel and abdominal organs with either ultrasound or CT scanning.


Article by Dr Alan J Hakim MA FRCP,  Consultant Physician and Rheumatologist. . Edited by the HMSA.

Last Updated June 2021

Please email for the list of references used.

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