The Impacts of Breast Cancer on Pelvic Health

According to the American Cancer Society, 1 in 8 women in the United States will be diagnosed with breast cancer in their lifetime and, currently, there are 4 million women with a history of breast cancer. These are staggering statistics and demonstrate how prevalent breast cancer is within our society. Many of us know or have known someone who has had breast cancer and we have watched them recover from surgery, chemo, and/or radiation. We have seen or experienced firsthand how hard cancer treatment is on the body and how difficult it is to recover. 

One of the lesser-known effects of breast cancer treatment is the effect on the pelvic floor and pelvic function. Unfortunately, many women who have had breast cancer are suffering from pelvic floor dysfunction symptoms simply because they don’t know how common these side effects are, and thus do not seek care for improvement. 

So let’s discuss how and why breast cancer treatment affects the pelvic floor. 

The most common treatments for breast cancer include breast surgery, radiation, hormone treatment, and chemotherapy. There are several direct and indirect ways that each of these treatments influence/affect the pelvic floor:

• Surgery: There is a significant relationship between dysfunctional breathing mechanics and pelvic floor muscle function. If breathing is disrupted or dysfunctional, the pelvic floor muscles lose their coordination and have to work harder during everyday activities. Chest surgery alone can change breathing mechanics due to protection or pain around the ribs.  In addition, those who have undergone a DIEP flap surgery (taking abdominal tissue to reconstruct the breast), are unable to use their core muscles for 6 weeks post-op, causing core weakness and potential loss and dysfunction of the pelvic floor muscles as well. 
• Radiation: This treatment typically has the least influence on pelvic floor function. However, there can be instances where it can cause changes in breathing mechanics from skin restrictions and pain. There is also a significant level of fatigue associated with radiation. This can further lead to deconditioning which may impact the pelvic floor strength.
• Chemotherapy: There are several medications that cause neuropathy (nerve dysfunction) and/or muscle wasting. These side-effects often have a direct impact on the pelvic floor if the nerve function or muscles affected are located in the pelvis. 
• Hormone Therapy: These treatments have been known to cause drying of the vaginal tissue, which then causes pain and irritation to the pelvic floor. They may also cause muscle and joint pain, which can affect the muscles of the pelvis as well as the pelvic and hip joints. 
• Several other aspects of cancer treatment disrupt digestion and bowel/bladder function. Anesthesia used during surgery and medications prescribed for pain management are known causes of constipation, further impacting pelvic floor muscle function. Also, general deconditioning during treatment can have an impact on muscle strength and coordination- causing a potential for pelvic floor muscle loss and dysfunction. 

Now that we’ve covered the many ways that breast cancer treatment influences the pelvic floor, let’s talk about how to identify those who would benefit from pelvic floor physical therapy. 

• All breast cancer survivors should be screened for pelvic floor dysfunction 
  • Asking about urinary incontinence, bowel incontinence, painful sex, pelvic pain, urinary or bowel frequency/urgency, heaviness in the pelvis, and nagging hip/low back pain is an important part of both a medical and  rehab screening
• There are self-report measures such as the Cozean Screen and Pelvic Floor Impact Questionnaire (PFIQ-7) that can be included in intake paperwork to identify people who would benefit from a pelvic floor physical therapy assessment

Above all else, identifying breast cancer survivors that are struggling with pelvic floor dysfunction symptoms and getting them pelvic floor physical therapy can have a huge impact on improving their quality of life. Many of those suffering from pelvic floor dysfunction opt to self-isolate or avoid activities they would typically enjoy due to their symptoms. For instance, they refrain from participating in playful and recreational activities because they’re scared they’ll leak urine or gas.  Or they decide not to attend an event because they’re worried there won’t be a bathroom readily available or they won’t make it to the bathroom on time.  They may even avoid sexual activity due to pain or discomfort. These can all have devastating impacts on relationships and mental and emotional well-being.  After the difficult journey of cancer recovery many have already faced, pelvic floor dysfunction should not be something they should “just have to live with”. 

If you are a clinician working with survivors of breast cancer, be sure to screen them for pelvic floor dysfunction and get them to a specialist that can help. If you are a survivor suffering with these symptoms, be sure to ask your oncologist for a referral to a pelvic health physical therapist!

Have more questions about pelvic floor symptoms and/or breast cancer treatment? Call/email us at Level Up Wellness and Physical Therapy to schedule a free 15-minute consult.