Recent studies show that breast cancer patients are experiencing pelvic floor dysfunction including urinary incontinence, fecal incontinence, and sexual dysfunction during and after receiving treatment. Up to 58 percent of survivors report difficulty with bladder control or urinary incontinence. 1 Painful sex is never normal and 52 percent of women up to six months post-breast cancer treatment report sexual dysfunction and 19-26 percent continue to report sexual dysfunction five to 10 years after their diagnosis. 2
Constipation is a common problem post-cancer treatment patients face. Constipation can be related to medications, decrease in activity, abnormal toilet posturing, pelvic floor muscle dysfunction, and diet. Normal bowel habits can vary from person to person. The frequency of having a bowel movement can be between three times per week to three times a day. Abnormal bowel symptoms include straining, hard stools, loose stools, not completely emptying, or fecal leakage. Constipation can be associated or cause other problems like urinary incontinence, fecal incontinence, pelvic organ prolapse or pelvic pain.
Pelvic floor symptoms in women with breast cancer may be related to hormonal changes after chemotherapy or endocrine therapy use. Breast cancer treatment can cause weakness, thinning, and dryness in the pelvic floor muscle tissue that can cause pain, tightness, weakness, and/or leakage. Fatigue and decreased activity along with changes in hormone levels can cause further atrophy (muscle loss) in the pelvic floor muscles, worsening symptoms. Urinary incontinence can also be caused by improper
bowel and bladder habits, abnormal pressure management, and diet. A pelvic floor physical therapist can help with these symptoms, teach proper bowel and bladder habits, and help coordinate the muscles of the core and pelvic floor.
Scar tissue from breast cancer surgeries can not only contribute to shoulder pain and dysfunction, but can also cause fascial restrictions in the trunk. Fascial restrictions in the trunk can contribute to abnormal posture and breathing strategies, which can greatly affect the pelvic floor.
Participants in a 2022 study reported there needs to be more awareness about Pelvic Floor dysfunction in women undergoing treatment for breast cancer. 3 They would have liked to receive information about pelvic floor dysfunction prior to starting cancer treatment, to be screened for pelvic floor dysfunction during cancer treatment, and be offered therapies for their pelvic floor dysfunction after primary cancer treatment. Therefore, a greater focus on managing pelvic floor symptoms by clinicians may be warranted in women with breast cancer to help decrease Breast Cancer patients and survivors from being frustrated
Patients experiencing leakage, constipation, pressure, or pain are encouraged to mention it to your health care team as pelvic floor therapy can cure or significantly improve incontinence issues and sexual dysfunction. It is an important component of survivorship and thriving and should not be ignored. Incontinence, urgency, and pelvic/genital pain can be addressed and your pelvic health is important for your quality of life.
Pelvic floor therapy can include treatments such as hands-on techniques to decrease muscle tension and pain, deep breathing and relaxation techniques, and conscious control of pelvic floor musculature. Control and coordination of pelvic floor muscles does NOT mean performing kegels at home. Those with pelvic pain and leakage are discouraged to perform kegels on their own, as this exercise can contribute to worsening of symptoms. Significant education is provided by Pelvic Floor PTs on vulvar care, lubrication, sexual positioning, proper diet, and proper toileting mechanics. Exercises are individualized
for each patient and progressed as tolerated. Exercise prescription should include functional training, mimicking activities that patients perform on a daily basis.
If you are having any of these problems, talk with any of your doctors. Ask for a referral to pelvic floor physical therapy to help address any of these issues! A pelvic floor physical therapist is a licensed physical therapist who has gone through specialized training to be able to evaluate, assess, and treat the pelvic floor and its associated problems.
Jennifer Self Spencer, PT, DPT, CLT, OCS, has advanced training in the treatment of Pelvic Floor as well as Lymphedema and Cancer Rehab. She has over 14 years’ experience as a PT. She sees clients in the Birmingham, Alabama, region as well as virtually.
Magic City Physical Therapy
3075 John Hawkins Parkway, suite J
Hoover, AL 35244
@magiccitypt (Facebook and Instagram)
- Donovan KA, Boyington AR, Ismail-Khan R, Wyman JF. Urinary Symptoms in Breast Cancer: A
Systematic Review. Cancer. 2012 Feb 1; 118(3): 582–593.
- Seav SM, Dominick SA, Stepahyuk B, Gorman JR, Chingos DT, Ehren JL, Krychman ML, Su HL.
Management of sexual dysfunction in breast cancer survivors: a systematic review. Women’s Midlife
Health 2015 1:9.
- Colombage UN, Lin KY, Soh SE, Brennen R, Frawley HC. Experiences of pelvic floor dysfunction
and treatment in women with breast cancer: a qualitative study. Support Care Cancer. 2022
Oct;30(10):8139-8149. doi: 10.1007/s00520-022-07273-2. Epub 2022 Jul 5. PMID: 35788772; PMCID: