Cancer has a special place in my heart. The biggest reason is my mom is a 20 year survivor of an extremely rare form of cancer that was in her cervix. I have learned SO much from her experience not only through her treatments, but what she has dealt with as a survivor, especially now that I am able to filter it through my pelvic Physical Therapy lens.

Here’s the thing, the cancer my mom had was not cervical cancer or hormonal, but it did involve her reproductive organs. I’m telling you this, because you may know someone or are someone who may benefit from this post, even if at first glance you think it doesn’t pertain to you. So I urge you to keep reading.

Since, October is Breast Cancer Awareness Month, this post will be interwoven with breast cancer treatment and other reproductive organ treatment, which many times overlaps. This post is in no way all encompassing and I will be focusing on a broader theme that is very common for those who are survivors. But it may be a good starting point for you to dive a little deeper and ask more questions of your providers.

My main goal as a women’s pelvic health Physical Therapist is to help you improve your quality of life. That may be to decrease pain, improve mobility and strength so you can perform certain tasks or activities with more ease, etc. For those who are survivors, what I see as a common concern stems from a change in Estrogen leading to muscle atrophy, dryness & muscle tension.

These changes can severally alter quality of life when bladder or bowel control are impacted or sexual desire and intimacy is reduced or painful.

First, let’s take a look at the two main ways estrogen is impacted by treatment, surgical and pharmacological. For many excision of the cancerous tissue is the main form of treatment. Depending on where that tissue is, it may include a hysterectomy. There are three forms of hysterectomy, partial, total and radical. A partial hysterectomy is when just the uterus is removed. A total hysterectomy is when the uterus and cervix are removed. A radical hysterectomy is when the uterus, cervix, Fallopian tubes, ovaries, upper vagina and lymph nodes are removed. A radical hysterectomy may also be recommended to those who hormone-receptor positive breast cancer.

Even though all forms of hysterectomy can impact your pelvic health in a structural & emotional way, a radical hysterectomy has the biggest impact on your hormone balance, most notably estrogen. Estrogen is primarily made in the ovaries, however is also made in small amounts in the adrenal glands and fat cells. When the ovaries are removed during a radical hysterectomy, it takes away your primary source of estrogen.

For those who are estrogen+ (ER+) or progesterone+ (PR+) or triple + may be treated with hormone pharmaceuticals that block the production of estrogen or progesterone (or both). For some this is in addition to a hysterectomy.

These treatments put your body into medically induced menopause.

Menopause is when your body naturally produces less estrogen and is commonly associated with loss of your period, vaginal dryness, hot flashes & night sweats, brain fog, and more. A medically induced menopause, speeds up this process.

So how does the lack of estrogen impact pelvic health?

As a PT I look at estrogens role in musculoskeletal health. Estrogen not only improves bone health, it also improves muscle mass and strength as well as increases collagen content in connective tissue. When your body no longer has estrogen to impact your muscle and connective tissue health, you’ll see changes in function.

I like to call estrogen your “fluffing” hormone. I use this term in relation to your vulva and vagina. When the tissues and muscles of the pelvic floor are healthy, there is a suppleness to the area. The tissues are pink, moist and soft. In contrast when the pelvic floor isn’t healthy it can be dry and brittle, red or raw, stiff and hard. This can happen with low or no estrogen. Other contributing factors to this tissue change from cancer treatment are radiation and scarring. Radiation can make the pelvic floor tissue fibrous and tough. Scarring can cause adhesions and tissue restrictions. Both reduce blood and lymph flow to and from the area that is necessary for optimal healing. Further compromising the muscles and connective tissue.

Leaving you will connective tissue and skin that is less structurally supportive and flexible and muscles that are weaker and less dense or atrophied. Leading to difficulty holding your pee or poo in when you have an urge, or while sneezing, coughing, laughing, walking, running, jumping, lifting, etc. Or pain in your vaginal or anus making it uncomfortable to wear underwear or be touched in any way, including intimately.

Estrogen not only improves your ability to strengthen and maintain your muscles, but helps you connect and coordinate the control of your muscles that help you stop from peeing your pants or sharting. It also keeps your vagina moist “just enough” so there is no unnecessary friction causing burning and pain that can ultimately lead to muscle tension from guarding and unwanted protection motor patterns.

So what can you do about it?

See a pelvic PT!

If you have gone through all the medical treatment for your cancer, you may feel the need of a break. I completely get it. However, if you are having these common side effects that are diminishing your quality of life, it may be time to reach out to a pelvic PT.

I can not treat the changes in estrogen. However, I can help you connect to your muscles with targeted exercises to improve your bladder and bowel control. I discuss bladder and bowel habits and techniques that can reduce your urgency and help you gain more control over your bladder or bowels. I use manual therapy that improves blood flow to the area by treating barriers like scarring restrictions and fibrosis that can cause pain. As part of your team, I discuss the use of lubrications and pelvic floor tools like vaginal wands or dilators that can help you massage the area on your own to improve flexibility in the pelvic floor which can make intimacy more comfortable.

A great place for you to start on your own is with a self pelvic floor assessment. By doing a personal screen or check in you will be more body aware and can seek out the necessary care with more information. When you are ready check out the one I created!

As always, reach out with questions you may have regarding your pelvic health, I’m here to help.

*This is not medical advice if you have concerns regarding your cancer treatment reach out to your oncologist.