October 25, 2019

Breast Cancer and Pelvic Health

Many women who have been treated for Breast Cancer may experience pelvic floor changes like vaginal dryness and urinary leakage. And they may not know that pelvic floor therapy can help.

Breast cancer treatment can affect your pelvic floor

If you (or someone you know) has been treated for breast cancer, your vagina may have gone through some… changes. Now I know you’re probably asking yourself “What can breast cancer possibly have to do with my pelvic floor?” The answer is LOTS!

Many forms of breast cancer are estrogen positive cancers. That means an increased level of estrogen in the blood may cause an increased risk of breast cancer in women. Treatment typically includes medication that blocks the reception of estrogen, which can delay or slow cancer growth. While this has proven to be an effective treatment against estrogen positive breast cancer, it often has negative effects on the health of the vulvar and vaginal tissues.

Estrogen does what??

Estrogen is hugely important for lubrication, blood flow and overall health of your vagina. So when a woman has a large reduction in estrogen during breast cancer treatment, her vaginal tissues may become dry, thin, and weak. These tissue changes can lead to vaginal dryness, vaginal burning or itching, tearing, increased risk of infections, pain with intercourse, and a change in urinary function. Hormone replacement therapy or using a topical estrogen cream to rejuvenate your vulvar and vaginal tissues is likely not a comfortable option for many breast cancer survivors. However, there are several other options that can be helpful.

What to do for vaginal dryness

First and foremost, stay well hydrated. While this seems silly, staying well hydrated will help keep all your tissues lubricated and receiving good blood flow. This will also help you feel better in general.

Next, seek the care of a pelvic floor physical therapist (PT). A pelvic floor PT can perform an assessment of the external tissues (abdomen, buttock muscles, inner thighs, etc.) to determine if there are restrictions that may contributing to some of your symptoms. We can also perform an internal pelvic floor assessment to determine the health of your vulvar and vaginal tissues and make recommendations specific to your needs. These recommendations will often include :

  1. Daily moisture to the tissues to reduce atrophy and tissue irritation. This can include vitamin E oil, coconut oil, or all natural options. A few of my favorite are Key-E Vitamin E suppositories or Good Clean Love’s Restore.

  2. ALL THE LUBE for intercourse! In addition to a daily moisturizer, you’ll want to have a hefty dose of lube on hand for sex. This will provide adequate lubrication to reduce tissue irritation or tearing. Products should be paraben and fragrance free, pH balanced, low osmolality, and should not cause discomfort. I always say “Anything that glitters, sparkles, tingles or smells should not go on your vagina!”

  3. Gentle manual therapy to the tissues. This can be performed and instructed by a physical therapist and may include the use of vaginal dilators. Dilators are like tampons of different sizes and help keep your pelvic floor muscles relaxed and help prepare your muscles and tissues for intercourse to decrease painful sex. Some of my favorite dilators are by Intimate Rose.

  4. Topical estrogen, DHEA, and testosterone compounds are also treatment options for atrophic vaginitis. However, these items may not be recommended for women who have estrogen positive breast cancer. The research is inconclusive as to whether or not these topical creams can increase systemic estrogen. If you have specific questions about these as a treatment option, please speak with your oncologist first.

Considering Pelvic Floor Physical Therapy? Here is what to expect.

You may have some bladder changes, too

In addition to dryness, estrogen deprivation can also lead to changes in your bladder function. Low estrogen and thin vulvar tissues can lead to decreased vaginal wall support of the urethra and bladder, resulting in urinary leakage with coughing, sneezing or a strong urge to pee. Some treatment options may include:

  1. Pelvic floor strengthening (aka kegels). This can include strengthening with quick contractions, long duration contractions, and focus on improved coordination of the pelvic floor muscles so they activate when you actually need them (before coughing, sneezing, etc).

  2. Good bladder habits. This means avoiding straining or pushing when you pee to avoid increased pressure on compromised vaginal wall tissues. Chronic straining or pushing can contribute to pelvic organ prolapse, pelvic floor muscle weakness, and more leakage!

  3. Use of an internal support. Depending on your lifestyle, some internal supports may be helpful to provide support for the urethra and bladder. Some options are the Poise Impressa or a pessary. Poise Impressa can be purchased on Amazon and a sizing kit is available to determine which size fits you best. A pessary must be prescribed a healthcare provider (typically a urogynecologist). Also be cautious if your tissues are sensitive or easily tear as an internal support may not be the best option.

See a Pelvic Health PT

When a woman experiences breast cancer and undergoes successful treatment, many of the changes in the body (and the pelvic floor) are not addressed. There are treatment options that can help reduce your symptoms and improve your quality of life. Pelvic health and breast health are so important, and we are here to help!

We are here to aid your pelvic health

Emily McElrath PT, DPT, MTC, CIDN is an orthopedic and pelvic health physical therapist with a passion for helping women achieve optimal sports performance. She is an avid runner and Crossfitter and has personal experience modifying these activities during pregnancy and postpartum. She is certified in manual therapy and dry needling. When not working, Emily enjoys time with her husband and two kids.

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