Cancer & Pelvic Pain Conditions

Cancer & Pelvic Pain Conditions

On today’s blog, I wanted to bring attention to female pelvic pain and dyspareunia (pain with intercourse) secondary to cancer treatments.

Often, when a woman has gone through adjuvant hormonal treatments, chemotherapy, abdominal/pelvic radiation, or fertility-saving drugs during active treatment, the body goes into a state of menopause or “chemopause” as it’s commonly referred to in the cancer world.

Low estrogen levels during chemopause can cause symptoms like:

  • Amenorrhea (loss of menstrual cycle)
  • Low libido
  • Vaginal dryness or atrophy
  • Hot flashes
  • Mood changes
  • Joint aches and pains

In particular, vaginal dryness or atrophy can have a huge impact on sexual health, emotional health, and relationships post-cancer. If the pelvic floor muscles are compromised by treatment, it can result in pelvic pain (like pain from overactive or tight pelvic floor muscles, pain in the tailbone, lower abdominal pain, or pain around post-surgical scars), bladder/bowel changes, or painful sex.

Thankfully, a pelvic floor physical therapist with specialized training in examination and treatment of the pelvic floor muscles can treat these conditions and are an amazing asset to oncology patients on their road to recovery. Some PT treatments for pelvic pain and dyspareunia may involve:

  • Pelvic floor muscle strengthening or relaxation exercises with or without biofeedback training (computer or ultrasound-based pelvic floor training technology)
  • Stretches for tight muscles around the abdomen, pelvis or hips
  • Manual therapy including general massage, pelvic floor muscle release techniques, or scar tissue mobilization
  • Education and lifestyle strategies surrounding posture, nutrition, bowel and bladder habits, and lubrication options during intercourse
  • Education in the use of vaginal dilators to reduce pain that occurs with tampon insertion, gynecological exams, or sex
  • Encouragement around body image and sexual health (this could include referral to a sex therapist or psychologist when appropriate)

If you’re reading this, and you feel like you could benefit from pelvic floor physical therapy during or after cancer treatment, you can find a qualified pelvic floor PT in your area here or here. Ask your doctor for a referral today!

And a quick reminder for all of us…
The path to recovery from cancer involves a whole host of treatments including chemo, hormonal treatments, surgery, and radiation just to name a few. Each of these treatments can come with significant side effects or long-lasting comorbidities. Just because someone is “cured” from cancer doesn’t always mean they are living without long-term effects from treatment. Keep this in mind, and be kind!

*This blog is part 2 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Chemo & Constipation

Chemo & Constipation

Chemo and constipation. Oh, poop! As a pelvic floor physical therapist and breast cancer thriver who is currently in the home stretch of chemotherapy, I can personally testify that constipation is no joke!

Having regular bowel movements during chemo is important to help detox the body of chemotherapy medications. In doing so, other side effects of chemo can be reduced. Backed-up bowels can contribute to or worsen nausea and vomiting. Unmanaged constipation during chemo can cause painful hemorrhoids or anal fissures that can put a patient at risk of infection while immunocompromised.

So how do we treat or avoid constipation during chemo? Well, let’s start with the basics and go from there…

What is constipation?

Typically, a person should expect to have a bowel movement anywhere from three times per day to three times per week. Stools should be soft and easy to pass (like #3 or 4 on the Bristol Stool Chart below). You may have constipation if your bowel movements are irregular (several days pass between BM’s) or your stool is very firm and is painful or requires straining to pass. Sometimes, it may feel that you’re not able to empty your bowels completely as well.

Borrowed from abc.net.au1

What causes constipation?

Generally, constipation is related to not getting enough water or fiber in your diet. It can also be from not getting enough exercise or from changing your routine when you travel. Unfortunately for some people going through cancer treatment, certain chemotherapy medications can cause gastroparesis (slow or paused digestion of food), which can lead to constipation.

How can you relieve constipation?

*Drink warm liquids (water, tea, coffee) first thing in the morning to kick start digestion and bowel movements, and be sure to drink plenty of water throughout the day (aim to drink half your body weight in ounces of water).

*Exercise! Take a short 10-15 minute walk or try these gentle stretches to stimulate the bowels.

*Eat plenty of fiber. Try to eat 25-30 grams of fiber daily with foods like broccoli, Brussels sprouts, beans, lentils, oatmeal or whole grains.

*Practice good toileting habits:

  • Use proper pooping posture – place your feet on a stool or rest your elbows on your knees to make it easier to empty the rectum.
  • Relax your pelvic floor muscles & breathe!
  • Don’t strain – come back later if you’ve got to push!
Borrowed from MacMillan Cancer Support3

*Try supplements and medications if the above fail. Ask your doctor about magnesium supplements, fiber/psyllium supplements (like Benefiber or Metamucil), stool softeners, or laxatives that might be helpful.

Remember: When it comes to constipation – consistency is key! Don’t scale back on your bowel routine because things begin to lighten up. During chemotherapy, you’ve got to stay on top of things to stay comfortable. If you need help getting a routine that works well for you, ask your doctor about a referral to a pelvic floor physical therapist in your area!

*This blog is part 1 of Pink October’s Pelvic Floor Series, a way to raise awareness of pelvic floor problems during cancer treatment and discuss sex & intimacy after a cancer diagnosis.

Aloha ❤

Pink October

Pink October

Today is October 1, and there are so many things to celebrate this month! Before I get carried away – I want to remind you all that the first of the month is a great time to schedule or do your preventative screenings including your breast self-exam! Performance of routine self-exams help to identify cancerous tumors in earlier stages and can save your life! Go ahead and #FeelItOnTheFirst, and if you haven’t yet, schedule your annual mammogram!

Fun fact: 40% of all breast cancers are discovered by a self-exam!1

October has always been one of my favorite months for many reasons, but as a pelvic floor PT, I am thrilled that I get to celebrate National Physical Therapy Month and Breast Cancer Awareness month in one shot! I consider myself an “educator” by nature, and I always look forward to sharing information with my family and friends about the benefits of physical therapy, especially for our breast cancer thrivers and survivors.

I have several posts lined up for the next few weeks regarding breast cancer surgery, rehabilitation, and complications as well as some common pelvic floor concerns during breast cancer treatment. I look forward to sharing how a physical therapist can play an important role for our oncology patients as I experience my first Breast Cancer Awareness Month as someone living through breast cancer.

I also wanted to bring some awareness to something I hadn’t really given any thought to before I was diagnosed with breast cancer. It’s no secret that every October, things turn pink all over the place. I’m talking pink products in stores, pink foods, pink cleats in the NFL…you catch the drift. Companies all over the place are eager to jump on board with Breast Cancer Awareness Month, and yet, not all of these companies have the best intentions in mind.

In fact, many companies profit tremendously by slapping a pink label on their product and saying that a certain amount of proceeds go to breast cancer research. We call this “pinkwashing,” and as it turns out, many companies are capitalizing on this terrible disease and only donate a small portion of their sales (or none at all) to support breast cancer research or patients.

Unfortunate as it is, I ask that if you do want to support those who are or who will be affected by breast cancer (remember 1 in 8 women will be diagnosed with breast cancer in their lifetime), please do your research on which companies provide support to breast cancer research or directly to breast cancer patients before you buy that pink label.

Let’s turn Awareness into Action! Here are a few of my favorite breast cancer organizations to support:

  • Breast Cancer Research Foundation – your donation goes to sponsor research grants in many areas related to breast cancer. BCRF is recognized by Charity Watch as a top-rated cancer fundraising organization.
  • TNBC Foundation – your donation will go to improving research and quality of life and education for those living with Triple Negative Breast Cancer. I personally have benefited tremendously from the community associated with the TNBC Foundation and the educational events this foundation hosts!
  • METAvivor – your donation will go to improving research for those living with stage IV metastatic breast cancer.
  • Compassion that Compels – if you’re looking to donate to a smaller organization that provides direct support to cancer thrivers – this is a great one! Your donation will go to providing emotional support, chemo care packages, and prayer to women with breast cancer. I loved receiving a Compassion Bag from this lovely organization!

I hope you are as excited about the possibilities in October as I am! I am also on track to complete chemotherapy at the end of the month (actually, I completed #13/16 TODAY) so it’s going to be a party for sure! Take care of yourselves and I look forward to sharing a TON of good info with you this month!

Aloha ❤