You may not give much thought to the science behind some of your more private bodily functions—such as the ability to move your bowels, urinate or have sex—until you experience a problem. But these issues are not uncommon for cancer patients.
Several cancer types and treatments may impact what’s known as your pelvic floor, an important group of muscles that play a pivotal role in maintaining the body’s bowel, bladder and sexual function. If you have a cancer that impacts the pelvic floor, knowing what to expect may help you to manage related issues.
What is the pelvic floor?
Extending from the tailbone to the pubic bone, the pelvic floor comprises three layers of hammock-shaped muscles inside the base of the pelvis. These muscles support the pelvic organs, the uterus, bladder and rectum. They also support the cervix and vagina in women and the prostate in men.
Women with gynecological cancers, including endometrial, ovarian, cervical, vulvar, and vaginal cancer, and men with prostate cancer, as well as anyone with bladder or anal cancer, are most at risk for experiencing problems with bowel, bladder and/or sexual function, according to Heather Sandler, Physical Therapist and certified pelvic floor therapist at Cancer Treatment Centers of America® (CTCA), Philadelphia.
“Radiation for gynecological cancers, which are located in the pelvic region, may cause fibrosis, a hardening of tissue that may narrow or shorten the vaginal canal,” Sandler says. “This may cause generalized pelvic pain and pain with intercourse (dyspareunia).”
Tissue changes to the vaginal wall and pelvic floor muscles may also lead to urinary and fecal incontinence, or the inability to control urination and bowel movements. Pelvic floor muscles are involved in opening and closing the sphincters that control the bowels and bladder. The muscles around the rectum that relax to allow a bowel movement are the same muscles that relax when we urinate. These muscles contract when we hold our urine or bowels.
“And painful intercourse may be due to tightness in those muscles or narrowing of the vaginal canal,” Sandler says.
Similarly, men who have radiation therapy for prostate cancer treatment, or who undergo a prostatectomy—the surgical removal of the prostate—may develop incontinence and/or erectile dysfunction. Sandler says she usually sees prostate cancer patients before prostatectomy surgery to educate them on pelvic floor muscle strengthening exercises and behavioral techniques which are effective in reducing post-prostatectomy urinary incontinence and erectile dysfunction.
Several types of surgery may affect the pelvic floor, including:
- Tumor debulking to remove as much of a cancerous tumor as possible
- Hysterectomy to remove the uterus
- Salpingo-oophorectomy to remove the ovaries and fallopian tubes
“The patient may develop deep scar tissue, affecting the pelvic floor,” says Sandler. Internal organs and other tissue may shift during surgery, which may challenge the function of the pelvic floor muscles. Tissue structure can change, too.
What is pelvic floor therapy?
Pelvic floor therapy involves a combination of physical exercises to strengthen the body’s core, and in turn, the pelvic floor. Kegel exercises—contracting, holding and releasing the pelvic floor muscles—are perhaps the most well-known, but there are others. Because the hip and abdominal muscles are connected to the pelvic floor, exercising them helps strengthen pelvic floor muscles.
Aerobic exercise may help with pelvic floor function, as does maintaining a healthy weight. “Carrying excess weight increases the pressure placed on the pelvic floor,” Sandler says.
She recommends patients with incontinence and other urinary symptoms avoid certain beverages, especially alcohol and caffeinated beverages, that may irritate the bladder’s lining and exacerbate incontinence. To help calm the nervous system, which relaxes pelvic floor muscles and suppresses the need for urgency, Sandler works with patients on relaxation, deep breathing and mental distraction techniques while learning how to relax their pelvic floor muscles. “People may not even be aware they’re doing it, but these muscles can tense up,” says Sandler.
For patients who don’t have a lot of awareness of their pelvic floor, Sandler’s team may use vaginal biofeedback to pick up signals when these muscles contract or relax, and the activity is displayed on a computer screen, letting the patient learn about their pelvic floor muscle activity with the help of a visual aide.
Vaginal dilators may be recommended to help women with pain during intercourse. The devices come in different sizes and help stretch the vaginal canal. A topical vaginal moisturizer, applied daily, may be used to help with general vaginal dryness, while a vaginal lubricant during sex may reduce discomfort and help prevent tearing of vaginal tissue.
Sandler may also refer patients for supportive care therapies, such as support groups or counseling, if she thinks it would be helpful for him or her to address stressors related to having cancer and its impact on the patient’s sex life and overall well-being. Combining physical pelvic floor treatments with the opportunity to discuss emotional concerns associated with related conditions has helped many patients, she says.
“Cancer patients want to have these issues addressed, but they don’t always want to bring it up,” Sandler says. “Studies have shown patients want health care providers to bring up these issues and ask these questions rather than them having to bring it up. By the time they come to me, they’re happy to have somebody address these issues with them. Patients feel very vulnerable, so I try to create an environment that’s comforting.”
Learn more about maintaining intimacy during and after cancer treatment.
