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How Does Breast Cancer Affect My Pelvic Floor Muscles?

Hi friends! It’s October which means it’s Breast Cancer Awareness Month. Breast cancer is the second most common cancer in women in the US. Many of the treatments for breast cancer can increase the risk of developing pelvic floor muscle dysfunction. Today we are going to talk about the warning signs of breast cancer because early treatment and prevention are the best medicine!


How can we catch breast cancer?

Tests like a mammogram or an ultrasound can help find cancerous tissue, but there are some warning signs that may be present with breast cancer. These include:

  • A new lump in the breast or armpit

  • Thickening or swelling of part of the breast

  • Skin that looks like an orange peel

  • Inversion of the nipple

  • Pain in the nipple or any other area of the breast

  • Nipple discharge, including blood

  • Any changes in size or shape of the breast


Note that these signs suggest breast cancer may be present, but these symptoms are not a guarantee that cancer is present.


It is important to perform monthly self-breast checks to look for any lumps or irregularities in the tissue. If cancer is present, early treatment can be life-saving.

What are the risk factors for getting breast cancer?

  • Getting older

  • Having dense breasts

  • Starting periods before age 12 or starting menopause after age 55

  • Family history of breast cancer or ovarian cancer

  • Not being physically active

  • Being overweight after menopause

  • Certain forms of hormone replacement therapy

  • Reproductive history—having the first pregnancy after age 30, not breastfeeding, never having a full-term pregnancy

  • Alcohol consumption


Science and treatments for breast cancer 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:


For providers, check our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!


References

  1. Breast cancer statistics. Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/statistics/index.htm. Accessed October 19, 2022.

  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.


Written by Emily Reul, PT, DPT

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