Incontinence, pelvic pain, constipation, and sexual dysfunction associated with breast cancer

“Incontinence doesn’t kill you, it just takes your life away.” Patient

Pelvic floor dysfunction is a common and less talked about problem many breast cancer survivors face. Pelvic floor dysfunction includes incontinence, pelvic pain, constipation, and sexual dysfunction. Up to 58 percent1 of survivors report difficulty with bladder control or urinary incontinence. Urinary incontinence is caused by pelvic floor muscle weakness and dysfunction, improper bowel and bladder habits, altered hormone levels and diet. Pelvic floor muscle strengthening, core exercises and a proper diet can significantly decrease urinary incontinence. A pelvic floor physical therapist is trained to evaluate and treat urinary incontinence and assist a patient in regaining continence control4.   

Constipation is a common problem post-operative and post-cancer treatment patients face. Constipation can be related to medications, decrease in activity, pelvic pain and diet. Normal bowel habits can vary from person to person. The frequency of having a bowel movement can be between four times a week to three times a day. Abnormal bowel symptoms include straining, hard stools, loose stools, not completely emptying or fecal incontinence. The Bristol Stool Chart  is a good reference for determining if your bowel consistency is normal. To keep proper bowel habits, drink plenty of water, eat or take fiber, and do not strain to have a bowel movement. Constipation can be associated or cause other problems like urinary incontinence, fecal incontinence, pelvic organ prolapse or pelvic pain. A pelvic floor physical therapist can help with these symptoms, teach proper bowel and bladder habits, and help strengthen the core and pelvic floor muscles.

Painful sex is never normal and 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 diagnosis2. Painful sex can be caused by decreased lubrication, hormone changes, muscle tightness, joint dysfunction, muscle weakness or imbalances and nerve entrapment. A pelvic floor physical therapist can evaluate and treat your symptoms and give a specialized exercise and stretching program to improve sexual function3.

If you are having any of these problems, talk with your doctor. You can ask for a referral to pelvic floor physical therapy to help address any of these issues. A pelvic floor physical therapist is a licensed physical therapist who has gone through specialized training to be able to evaluate, assess and treat the pelvic floor and its associated problems. Lovelace Women’s Hospital currently has two pelvic floor physical therapists: Laurie Griffis, MPT, PRPC who is a Certified Pelvic Rehabilitation Practitioner and has treated pelvic floor dysfunction for 10 years, and Mary Beth Johnston, PT, DPT who has treated pelvic floor dysfunction since 2014.

This blog was written by Mary Beth Johnston, PT, DPT for Lovelace Women’s Hospital Outpatient Therapy Services located at 4600 Montgomery Blvd. NE Albuquerque, NM 87109. 505-727-4620.

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.     Seav SM, Dominick SA, Stepahyuk B, Gorman JR, Chingos DT, Ehren JL, Krychman ML, Su HL. Management of sexual dysfunction in breast cancer survivors: a systematic review. Women's Midlife Health 2015 1:9.

3.     Section on Women’s Health. Pelvic Pain. Patient Information.  American Physical Therapy Association. Published Online: //

4.     Section on Women’s Health. Urinary Incontinence. Patient Information.  American Physical Therapy Association. Published Online: //