Breast Cancer and the Pelvic Floor

Hello friends! As I’m sure many of you know, October is Breast Cancer Awareness month. Breast cancer is the second most common type of cancer in women. (CDC)

Early detection of breast cancer can be important in beating it. This can include mammograms and other testing, but you can also perform a self-exam at home monthly. A great way to remember is to do your self-exam at the same time each month. Set a date on your calendar to remind you!

Watch this great video from Jeanice on how to do a self-breast exam. You can also visit the article from breastcancer.org here.

Science and treatments are advancing every day, which is wonderful! But these treatments can have lasting effects on the functioning of the rest of the body and can impact survivor’s quality of life. More than 50% of women will experience changes in the functioning of the pelvic floor (which includes peeing, pooping, and sex) after treatment for breast cancer. (Crean-Tate, 2020) Nearly 90% of cancer survivors report a major concern with sexual health and functioning (Crean-Tate, 2020)

Many of the treatments provided for breast cancer, like chemotherapy, radiation, or hormone therapy, can lead to early menopause (Crean-Tate, 2020; Bo, 2015) The most common cause of early menopause is from a surgical procedure called an oophorectomy, in which a surgeon removes either one or both ovaries. (Bo, 2015) Hormonal treatments and chemotherapy also can cause a change in the hormones of the body leading to early menopause. The goal of many hormone therapies is to limit the amount and effect of estrogen on the cancer cells, but this also limited their effect on the rest of the body. (Drãgãnescu, 2017)

Hormones are important for the pelvic floor to work properly. Changes in these hormones can cause vaginal dryness and itchiness. It can also cause the tissue to be less elastic leading to pain, especially with penetrative sex. Hormones are also important for creating a sexual desire. You can use estrogen creams or vaginal moisturizers to help reduce vaginal dryness, increase genital arousal, and decrease pain with sex. (Bo, 2015) Check out our Amazon Store for some of our favorite vaginal creams. Be sure to talk with your provider before applying any creams to the vulva and vagina, especially if you are undergoing chemotherapy or radiation.

Surgeries can also impact the functioning of your pelvic floor. Scar tissue or tightness anywhere in the core (pelvic floor muscles, abdominals, or back muscles) can change the way the pelvic floor moves and works. This can lead to constipation, incontinence, and other pelvic floor problems. Remember, leaking pee or poop (even just a little) is a sign that your pelvic floor is not working properly. A pelvic floor physical therapist is specially trained in treating these issues to help you restore your quality of life and return to moving freely!

Radiation therapy can burn body tissues and limit their ability to move and stretch. A pelvic physical therapist can help you learn how to stretch, move, and massage these tissues once you get clearance from your oncologist. Physical therapists can also guide you in dilator training and pelvic wand use to help your pelvic floor function at its best! There are many vaginal dilators and pelvic wands on the market, but we have our favorites in our Amazon Store.

There are so many other things physical therapists can help manage after breast cancer treatments, like lymphedema, shoulder problems, and more. Be sure to discuss ANY concerns or problems with your providers and ask for help. Physical therapists are trained providers who are there to help restore your quality of life and help you live your best life!

Has your life been impacted by breast cancer treatments? Here are some helpful resources:

• Ask your healthcare provider for a referral to a pelvic therapist.

• Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.

• Visit our YouTube channel for more on the pelvic floor.

• Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics: Learn where the pelvic floor muscles are, what they do, and how they work

• Sign up for our email newsletter!

• Visit our Instagram page for more on pelvic health.

For providers, check out these courses to help breast cancer survivors restore their quality of life. Consider joining our Ambassador Program and most of our courses are included FREE with your membership!

• Dilators: Evidence-Based Research Review with Dr. Amanda Olson, PT, DPT, PRPC

• Birth Control, Hormones, and your Vulva with Dr. Jill Krapf MD, Med, FACOG

And more! Check the rest of our courses here.

Watch our FREE video with Jennifer Cumming PT, MSPT, CLT, WCS on Cancer and the Pelvic Floor below.

What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  

Written by Emily Reul, PT, DPT

References

1. Breast cancer statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/statistics/index.htm. Accessed October 14, 2020.

2. Drăgănescu M, Carmocan C. Hormone therapy in breast cancer. Chirurgia (Bucur). 2017 Jul-Aug;112(4):413-417. doi: 10.21614/chirurgia.112.4.413.

3. Crean-Tate KK, et al. Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy. Am J Obstet Gynecol. 2020 Feb;222(2):103-113. Doi: 10.1016/j.ajog.2019.08.043. Epub 2019 Aug 29.

4. Bo K, Berghmans B, Morkved S, Van Kampen M. Evidenced-based physical therapy for the pelvic floor bridging science and clinical practice. 2nd edition. 2015.