Look at surviving breast cancer through the pelvic lens

October is National Breast Cancer Awareness Month and Physical Therapy Month. Both my paternal aunt and paternal grandmother passed away from breast cancer. So, it is something that I take pretty seriously, and am conscious about. Growing up, all I knew of breast cancer was that you get mammograms where they flatten your boobs into pancakes, it has a genetic link, and it has turned many families lives upside down. When I was in my early 20’s, I learned about monthly screenings. Taking the pads of your fingers and gently patting/ pressing around your breast in a systemic way to feel for any lumps, nods, etc… The goal is help with early detection so that you can tackle treatment before the cancer spreads too much.

Risk factors that can lead to breast cancer include: family or personal history of breast cancer, personal history of breast issues, beginning period before the age of 12, beginning menopause after the age of 55, dense breast tissue, being female, having your first child older than the age of 30, obesity, radiation exposure, increase in age at time of onset, and never having children. Signs to look out for may include; a lump or thickened area of skin that feels different from the surrounding tissue; changes in the color of the breast skin; nipple looks flattened or turns inward; changes to the skin over the breast, such as skin that looks dimpled or looks like an orange peel; change in the size, shape or appearance of a breast; and/ or peeling, scaling, crusting or flaking of the skin on the breast. If you notice any of these signs, tell your doctor immediately so that testing can be done.

I don’t mean to make this into a list, but I want you to understand what is out there in terms of how to recognize this disease, and how you may potentially prevent it, or ensure that you catch it early and help you fight it!

Let’s say you or someone you know ends up with a diagnosis of breast cancer, (not to speak that into existence), but, then you or someone you know survives breast cancer, (because we’re speaking life over here!). Those who have survived breast cancer noticed an increased occurrence of urinary incontinence, fecal incontinence, and sexual dysfunction; all signs of pelvic floor dysfunction. Breast cancer treatment can cause pelvic floor dysfunction in women, which can lead to a number of issues including:

Urinary incontinence: Up to 58% of breast cancer survivors report difficulty with bladder control. Bladder incontinence can be a caused by pelvic floor muscle weakness, pelvic floor muscle tension, pelvic floor discoordination and poor pressure management, and impaired nerve impulses that can all be treated by a pelvic floor therapist. Working with a therapist, we can assess your pelvic floor function and compare with your detailed experiences and goals to allow you to regain control of your bladder. The incontinence product industry is valued at $15.4 billion in 2022 and projected to grow 7.8% over the next 8 years; and specifically for female stress incontinence, we’re looking at $770 million in 2024 and expected to be at double that in the next 10 years. Instead of putting your money into band-aids, put your time and effort into healing your body.

Constipation: A common problem after breast cancer treatment, constipation can be caused by medications, decreased activity, pelvic pain, and diet. Constipation can definitely be addressed by a pelvic floor therapist, looking at if there is any tension in the pelvic floor, the patient’s diet, coordination of pelvic floor muscles and more. From someone who had extreme constipation after my cesarean, I can tell you how horrible it feels to be constipated for days on end. Breathing techniques and body positions play a large role in allowing a full and complete bowel movement.

Sexual dysfunction: if you have pelvic floor dysfunction, such as muscle tension, impaired coordination, or muscle weakness, this can lead to pain with sexual penetration or impaired orgasms. Again, working with a pelvic floor therapist, who can help give you the tools or resources to assist with mentally preparing for healing from sexual dysfunction is important. Having a proper assessment of your pelvic floor, to determine what factors are producing your dysfunction is also important. Remembering that healing from sexual dysfunction, is not just about the ability to have sex, but also ensuring that the tissues, muscles, nerve signals are properly working to maintain the feedback loop that our hormones have a large role in as well.

Pelvic organ prolapse, when present, lets you know pelvic floor dysfunction is arise. The increase in laxity of structures that hold our pelvic organs in place, the decrease in pelvic floor muscle strength to work as backup for those structures, can lead to discomfort and fear. After healing from a disease that ignites so much fear, having fear surrounding your pelvic floor should not be an issue. So working with a pelvic floor therapist can help improve prolapse symptoms, and promote confidence with activities.  

Hormonal changes: breast cancer treatments can interfere with ovarian function and cause a prolonged estrogen deficiency, which can impair pelvic floor muscle function. Decreased estrogen can impair vaginal tissue, making it less elastic, more prone to tears and cuts, feeling dry and leading to the urinary incontinence, pelvic organ prolapse, pain with sex. Using topical estradiol can help with these symptoms, and has been proven to not put you at risk for developing cancer again. Please talk to your doctor about this! Working with a pelvic therapist while using a topical estrogen, or even a hyaluronic acid counterpart, can help assist with treating you in a more holistic manner, reaching your goals faster, and making them more sustainable.

Lastly, fatigue and decreased activity can cause atrophy of the pelvic floor muscles. Again, looking at a proper assessment to know what we are dealing with, and then developing a plan that addresses your specific needs can help you overcome this and heal your symptoms, allowing you to thrive.

So, I know this blog was filled with a lot of information, and as a woman, with breast, and a family history of breast cancer, I just want you to be educated, so that you know what to look out for, and how to tackle it. Like Suga Free says, stay ready, so you ain’t got to get ready.