Joint Hypermobility and Female Lower Urinary Tract Symptoms: A Systematic Review

PURPOSE: To systematically evaluate the association between joint hypermobility and female lower urinary tract symptoms (LUTS). METHODS: A PubMed/MEDLINE search was performed, and eligible studies included original English-language studies evaluating women with joint hypermobility, benign joint hypermobility syndrome (BJHS), hypermobility spectrum disorder, or Ehlers-Danlos syndrome, including hypermobile Ehlers-Danlos syndrome, and reporting urinary outcomes. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools and the Newcastle-Ottawa Scale, as appropriate. Owing to substantial methodological heterogeneity, a narrative synthesis was performed. RESULTS: Fifteen studies met the eligibility criteria. Urinary incontinence (UI), stress urinary incontinence, urgency urinary incontinence, urinary frequency, nocturia, incomplete bladder emptying, and voiding symptoms were the most frequently reported outcomes. Comparative studies demonstrated higher rates of UI among women with BJHS, with increased voiding symptoms also reported in one cohort, whereas other studies found no significant association between joint hypermobility and specific UI subtypes or urodynamic abnormalities. Five studies were judged to have a high risk of bias, and considerable heterogeneity existed in hypermobility definitions, urinary outcome measures, and study design. CONCLUSIONS: Women with joint hypermobility and related connective tissue disorders frequently experience LUTS, particularly UI and voiding symptoms. However, the available evidence remains heterogeneous and does not support a consistent independent association between joint hypermobility and specific lower urinary tract dysfunction. Standardized prospective studies using validated hypermobility classifications and objective urinary assessments are needed.