How Cancer Treatment Affects the Pelvic Floor

Claudia N. Benavides, PT, BSc PT, DPT

Pelvic floor dysfunction refers to a variety of conditions that affect the muscles, ligaments, and connective tissues in the pelvic region. Some common examples of pelvic floor dysfunction include urinary incontinence, fecal incontinence, pelvic organ prolapse, and pelvic pain syndromes. Cancer treatments such as surgery, radiation therapy, and chemotherapy can contribute to pelvic floor dysfunction by causing damage to the pelvic floor muscles or nerves.

One side effect of cancer treatment is pelvic floor muscle weakness. This can lead to symptoms such as urinary or fecal incontinence, as well as pelvic organ prolapse, where the pelvic organs descend into the vaginal canal due to weak pelvic floor muscles. Additionally, cancer treatments can cause scar tissue formation and damage to the nerves in the pelvic region, which can contribute to pelvic pain syndromes.

Hysterectomy

Gynecological (vagina owners) cancers can affect the pelvic floor depending on the size, stage or how aggressive the tumour is, they can sometimes cause physical pressure. This pressure can lead to pain, obstruction, and tissue necrosis (lack of circulation to the tissues).

In cases where cancer has spread to the uterus or cervix, a hysterectomy may be recommended as part of the treatment plan. A hysterectomy is a surgical procedure to remove the uterus, and sometimes the cervix as well. This can help prevent the spread of cancer and alleviate symptoms such as bleeding and pain. The surgery may also include surgical-induced menopause contributing to changes described as “genitourinary syndrome of menopause”, also present in people who retain their ovaries but need to continue treatment with radiotherapy or chemotherapy.

After a hysterectomy, some people may experience changes in pelvic floor function. This can include pelvic organ prolapse, urinary incontinence, and pelvic pain. These symptoms can be due to weakened pelvic floor muscles or nerve damage from the surgery.

The pelvic floor muscles can also feel tight (increased tone), and stiff, with lower coordination (leaks when coughing/sneezing), and have an endurance deficit (long walks feel heavy in the vulva or lower abdomen). You may present with leaks (incontinence), and pain with insertion or penetration (pain with penile penetration or a toy, with an intravaginal ultrasound or speculum). We can also find these symptoms after hysterectomy and radiotherapy for endometrial cancer.

Radiotherapy

Radiotherapy is another common treatment for cancer that can affect the pelvic floor. This treatment uses high-energy radiation beams to destroy cancer cells. While effective in treating cancer, radiotherapy can also cause damage to the pelvic floor muscles and tissues.

Side effects of radiotherapy on the pelvic floor may include gastrointestinal inflammation (diarrhea and fecal incontinence), vaginal scarring and stenosis, fibrosis, which can lead to symptoms such as pain, radiation cystitis (urgency to pee, toilet frequency, and urine leaks), and sexual dysfunction. You may also experience fatigue and muscle weakness, further impacting pelvic floor function.

Chemotherapy

Chemotherapy is a common cancer treatment that involves the use of powerful drugs to kill cancer cells. While chemotherapy can be effective in treating cancer, it can also have several side effects on the body, including those related to the pelvic floor. Chemotherapy can weaken these muscles, leading to symptoms such as urinary incontinence, pelvic pain, and difficulty with bowel movements. Because of the gastrointestinal side effects, diarrhea can also be present and because of pelvic floor weakness be associated with fecal incontinence.

If you are undergoing chemotherapy you may also experience fatigue, which can further exacerbate pelvic floor symptoms. You need to communicate with your pelvic floor physiotherapist about any pelvic floor issues you may be experiencing during chemotherapy treatment. Co-treatment with a pelvic floor physiotherapist can improve your quality of life.

What to Do Next

If a friend, family member, or you are receiving cancer treatment and experiencing symptoms of pelvic floor dysfunction, consult with a pelvic health physiotherapist to develop a personalized treatment plan to address the specific symptoms. Treatment options for pelvic floor dysfunction may include pelvic floor physical therapy, biofeedback, electrical stimulation, pelvic floor exercises, pelvic wands, dilators, and lifestyle modifications. In some cases, surgery may be necessary to repair pelvic organ prolapse or address other structural issues contributing to pelvic floor dysfunction.

Maintaining good pelvic floor health is essential for overall well-being, especially for cancer survivors who may be at increased risk of developing pelvic floor dysfunction. You can take steps to support your pelvic floor health by practicing pelvic floor exercises (not just kegels), staying hydrated, maintaining a healthy weight, and avoiding activities that put excessive strain on the pelvic floor muscles or strain during bowel movements.

People who have undergone cancer treatment should be aware of the potential for pelvic floor dysfunction and seek appropriate evaluation and treatment from a physiotherapist specializing in pelvic floor rehabilitation. With the right interventions and support, you can improve your pelvic floor health and quality of life following cancer treatment.

Source:

Evidence-based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice

Bo, Kari; Berghmans, Bary; Morkved, Siv; Van Kampen, Marijke