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Dr. Aimee Anagnostos

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Breast Cancer + Pelvic Health

October is breast cancer awareness month. Breast cancer treatment requires a multimodal approach and involves working with an interdisciplinary team. Did you know that breast cancer survivors, upon returning or rebuilding their routine, may find symptoms of pelvic pain or dysfunction?

What may happen?
As a pelvic floor therapist, I often hear that pain and dysfunction with the bladder, bowels, and sex was something these breast cancer patients had not foreseen. Common bladder dysfunctions can be defined as incontinence, painful urination, urgency and frequency. Bowel dysfunctions include, but are not limited to, constipation, straining, and feeling incomplete when emptying. In terms of sexual dysfunction, pain with penetration, lack of lubrication, muscle tightness are common- given hormone changes, stress, diet modifications, and more.

Pelvic Health and Breast Cancer

What do the studies show?
In research, it can be found that 58% of survivors report difficulty with bladder control, 23% of women rated their symptoms as severe. Factors attributing to this loss of bladder control include: new medications, decrease in activity, stress, diet changes, altered hormone levels, and more. A pelvic physical therapist can conduct an evaluation to assess musculoskeletal or neuromuscular involvement in the lack of bladder control.

Constipation tends to be an under reported and long lasting side effect of chemotherapy. Depending on the medication, research states the incidence of constipation can be 50%-85%. Many people are unaware that pelvic physical therapy is a conservative way to optimize bowel movements. “Physical exercise facilitates bowel movement and is recommended for patients with chronic constipation or irritable bowel syndrome . Abdominal massage has also been emphasized as a non-pharmacological intervention to improve chronic constipation”.

Painful intercourse is also common, but not normal. 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. There is evidence that pelvic floor muscle training with counseling and yoga or core exercises were beneficial for sexual function. A pelvic floor therapist can work with you to discuss position modifications, breathing techniques, work on pelvic floor muscle relaxation, and more.

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Reference List
1. 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.
2. https://link.springer.com/article/10.1007/s10549-015-3652-4
3. https://lovelacecancercenter.com/blog/incontinence-pelvic-pain-constipation-and-sexual-dysfunction-associated-breast-cancer#:~:text=Pelvic%20floor%20dysfunction%20is%20a,bladder%20control%20or%20urinary%20incontinence.
4. https://pubmed.ncbi.nlm.nih.gov/32367126/