Breast cancer is the second most common cancer in women, following skin cancers. In the United States, 1 in 8 women will develop breast cancer in their lifetime.

The treatments used in breast cancer also affect the pelvic floor.
Survivors report issues with pelvic floor dysfunction including incontinence, pelvic pain, sexual dysfunction, and constipation. Up to 58% of survivors report issues with bladder urgency and incontinence. (1) Around 52% of women report sexual dysfunction six months following post-breast cancer treatment, and 19-26% continue to have sexual dysfunction five to ten years after their diagnosis. (2) When compared to individuals without breast cancer, those with breast cancer presented with significantly weaker pelvic floor muscles when measured by maximal squeeze pressure and digital examination.

Additionally, the ability to relax the pelvic floor was poorer in participants with breast cancer compared to controls. (3) These are problems that pelvic rehabilitation practitioners can assist survivors with. However, not all survivors are being referred to therapy. Barriers to individuals accessing treatment for pelvic floor dysfunction include a lack of awareness about pelvic floor dysfunction following breast cancer treatments and health care professionals “not focusing on the management of pelvic floor symptoms during cancer treatment.” (4<)

We as rehabilitation clinicians should strive to correct this!
We can educate providers and patients regarding the potential to develop pelvic floor dysfunction with breast cancer treatment and how therapy can help.

Learn more about cancer treatment and pelvic-related complications in the Oncology of the Pelvic Floor Series. In the first course, you will learn about general oncology treatment, (certified lymphatic therapists can skip this course). The second course (Oncology of the Pelvic Floor Level 2A) in the series focuses on penile, testicular, and prostate cancer, along with colorectal cancers. The third course (Oncology of the Pelvic Floor Level 2B) in the series focuses on gynecological cancers and bladder cancer. In the series, you will learn about the medical treatment of cancer, how this affects the body, and how rehabilitation clinicians can help patients. Hands-on techniques are learned that can help patients return to activities they love. The first course in the series, Oncology of the Pelvic Floor Level 1, is being offered November 2-3. Join us to learn more about helping individuals with cancer!

Resources:

1. Donovan KA, Boyington AR, Ismail-Khan R, Wyman JF. (2012) Urinary Symptoms in Breast Cancer: A Systematic Review. Cancer. 118(3): 582–593.
2. Seav SM, Dominick SA, Stepahyuk B, Gorman JR, Chingos DT, Ehren JL, Krychman ML, Su HL. (2015). Management of sexual dysfunction in breast cancer survivors: a systematic review. Women's Midlife Health 1:9.
3. Colombage UN, Soh SE, Lin KY, Frawley HC. (2023). Pelvic floor muscle function in women with and without breast cancer: a cross-sectional study. Continence. 5; 100580.
4. Colombage UN, Lin KY, Soh SE, Brennen R, Frawley HC. (2022). Experiences of pelvic floor dysfunction and treatment in women with breast cancer: a qualitative study. Supportive Care in Cancer. 30; 8139-8149.

AUTHOR BIO:

Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC

Allison Ariail has been a physical therapist since 1999. She graduated with a BS in physical therapy from the University of Florida and earned a Doctor of Physical Therapy from Boston University in 2007. Also in 2007, Dr. Ariail qualified as a Certified Lymphatic Therapist. She became board-certified by the Lymphology Association of North America in 2011 and board-certified in Biofeedback Pelvic Muscle Dysfunction by the Biofeedback Certification International Alliance in 2012. In 2014, Allison earned her board certification as a Pelvic Rehabilitation Practitioner. Allison specializes in the treatment of the pelvic ring and back using manual therapy and ultrasound imaging for instruction in a stabilization program. She also specializes in women’s and men’s health including conditions of chronic pelvic pain, bowel and bladder disorders, and coccyx pain. Lastly, Allison has a passion for helping oncology patients, particularly gynecological, urological, and head and neck cancer patients.

In 2009, Allison collaborated with the Primal Pictures team for the release of the Pelvic Floor Disorders program. Allison's publications include: “The Use of Transabdominal Ultrasound Imaging in Retraining the Pelvic-Floor Muscles of a Woman Postpartum.” Physical Therapy. Vol. 88, No. 10, October 2008, pp 1208-1217. (PMID: 18772276), “Beyond the Abstract” for Urotoday.com in October 2008, “Posters to Go” from APTA combined section meeting poster presentation in February 2009 and 2013. In 2016, Allison co-authored a chapter in “Healing in Urology: Clinical Guidebook to Herbal and Alternative Therapies.”

Allison works in the Denver metro area in her practice, Inspire Physical Therapy and Wellness, where she works in a more holistic setting than traditional therapy clinics. In addition to instructing Herman and Wallace on pelvic floor-related topics, Allison lectures nationally on lymphedema, cancer-related changes to the pelvic floor, and the sacroiliac joint. Allison serves as a consultant to medical companies, and physicians.