Everything you wanted to know about the pelvic floor but were afraid to ask.
The pelvic floor is an important group of muscles found at the bottom of our pelvis. These muscles influence bladder, bowel, and sexual function, and play an important role in spinal stability. They even help us breath! The pelvic floor is constantly working, and yet many people have no idea that these muscles even exists. It can be difficult to separate pelvic floor fact from fiction and patients often come to us with preconceived notions of pelvic floor health. You may have heard that we should do our Kegels every day, or that leaking a little urine when you sneeze is “normal”. These two statements are actually false! Although a majority of us need to do Kegels on a daily basis for general strengthening, some individuals actually have tight or too strong pelvic floor muscles. And even though it is common that many women may leak a little urine if they laugh, cough, or sneeze; it is never normal to leak urine at any age.
It is well documented that gynecologic cancers (endometrial, ovarian, cervical, vulvar, etc.) and their subsequent treatments can have a big impact on pelvic floor function, which can in turn negatively impact quality of life. We hope to help you learn about the pelvic floor and its typical function, how this can be affected by cancer treatments, and how you can take control and manage pelvic floor dysfunction.
What is the pelvic floor?
As previously mentioned, the pelvic floor is made of several layers of muscles that extend from your pubic bone to your tailbone, and has a few main functions:
- Bladder and bowel control by emptying and holding in urges
- Supporting our pelvic organs: bladder, uterus, and descending colon
- Sexual function in terms of sexual arousal and orgasm
- Stabilization for our spine and pelvis during normal activities
When the muscles of the pelvic floor are working together and at the right time, they perform all the functions listed above. However, this is not always the case. Pelvic floor dysfunction can happen to anyone, regardless of gender, age, or health status. Symptoms of pelvic floor dysfunction could include any bowel, bladder, or sexual problems (ie incontinence, pelvic pain, painful penetration or constipation).
How does treatment for cancer affect the pelvic floor?
Treatment for gynecologic cancers will depend on the tumor size, location, and stage. Surgical procedures can directly affect the pelvic floor through scar tissue restriction and swelling, and may also have an indirect effect due to hormonal changes associated with removal of ovaries.1 Adjuvant therapies, such as chemotherapy and radiation, may also impact the pelvic floor. Radiation, either external beam or internal brachytherapy, can cause fibrosis (hardening) in tissues of the pelvis, which may lead to narrowing and shortening in the vaginal canal. Fibrosis in the vaginal wall and pelvic floor musculature can contribute to incontinence and/or urgency of bowel and bladder, pelvic pain, and sexual dysfunction. 2,3,4 Studies have demonstrated that following surgery and radiotherapy for gynecologic cancers, patients are more likely to report lower libido, altered sexual response, change in body image, and distress related to changes in sexual health.5,6
Removal of pelvic lymph nodes also places patients at risk for developing lymphedema, or chronic swelling. Dissection of the pelvic lymph nodes can lead to swelling in the abdomen, genitals, and legs. There is some evidence to suggest that genital lymphedema can impact bladder function, and it may have implications for sexual health as well.7
The degree to which cancer treatment affects pelvic floor varies. Some patients may have no symptoms, and some may have multiple, severe impairments. Some issues may arise immediately following treatment, and some may take time to develop.
Why aren’t more people talking about pelvic floor health after cancer treatment?
There are many reasons why patients don’t get help for pelvic floor dysfunction right away. After cancer treatment, many patients are so grateful that they feel guilty complaining about these “minor” issues.6 Many patients are also not aware that pelvic floor treatment exists, or feel that they will just have to live with their symptoms. As a result, many patients suffer in silence –sometimes for years– before they receive the treatment they need. Patients are also very resilient, and find ways to deal with issues of bladder, bowel, and sexual dysfunction on their own. Even so, everyone can use a little help sometimes!
What is pelvic floor physical therapy?
Specialized treatment exists to address pelvic floor dysfunction. Pelvic floor physical therapists are trained in the evaluation and treatment of the pelvic floor muscles, and look at pelvic floor dysfunction in the context of the whole person. For an in-depth look into what pelvic floor physical therapy is, check out this recent blog by our colleague Betsey Stec, PT, DPT.
If you think you might have symptoms of pelvic floor dysfunction (or even if you just want to find out if you do), ask your gynecologic oncologist for a referral to pelvic floor physical therapy. Patients are usually quite relieved to find out that there is care available for these issues that are sometimes difficult to discuss. With the right treatment, it is entirely possible to decrease or eliminate symptoms of pelvic floor dysfunction. Visit our website to learn more about our company, schedule an appointment or take our online assessment questionnaire.
Huffman LB, Hartenbach EM, Carter J, Rash JK, Kushner DM. Maintaining sexual health throughout gynecologic cancer survivorship: A comprehensive review and clinical guide. Gynecol Oncol. 2016;140(2):359-368.
Hazewinkel MH, Sprangers MAG, van der Velden J, et al. Long-term cervical cancer survivors suffer from pelvic floor symptoms: A cross-sectional matched cohort study. Gynecol Oncol. 2010;117(2):281-286.
Bergmark K, Åvall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Vaginal Changes and Sexuality in Women with a History of Cervical Cancer. N Engl J Med. 1999;340(18):1383-1389.
Bernard S, Ouellet M-P, Moffet H, Roy J-S, Dumoulin C. Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review. J Cancer Surviv 2016;10(2):351-362.
Rutledge TL, Heckman SR, Qualls C, Muller CY, Rogers RG. Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study. Am J Obstet Gynecol. 2010;203(5):514.e1-e514.e7.
Hazewinkel M, Sprangers M, Taminiau-Bloem E, van der Velden J Burger M, Roovers J-P. Reasons for not seeking medical help for severe pelvic floor symptoms: a qualitative study in survivors of gynaecological cancer: Pelvic floor symptoms in survivors of gynaecological cancer. BJOG Int J Obstet Gynaecol. 2010;117(1):39-46.
Bergmark K, Avall-lundqvist E, Dickman PW, Henningsohn L, Steineck G. Lymphedema and bladder-emptying difficulties after radical hysterectomy for early cervical cancer and among population controls. Int J Gynecol Cancer. 2006;16(3):1130-9.