How Cancer Can Affect the Pelvic Floor and Treatment Options
A mastectomy, the surgical removal of one or both breasts, is a common procedure for individuals diagnosed with breast cancer. While the surgery itself is crucial for managing the disease, it often results in various physical and emotional challenges during recovery. Many individuals focus on upper body rehabilitation after a mastectomy, but pelvic floor physiotherapy is a crucial component of the recovery process that is frequently overlooked. Pelvic floor physiotherapy plays a significant role in supporting recovery, improving mobility, and enhancing overall quality of life following a mastectomy—particularly when tissue grafts, such as those from the stomach, are involved in breast reconstruction.
What is Pelvic Floor Physiotherapy?
Pelvic floor physiotherapy focuses on the muscles, ligaments, and connective tissues in the pelvic region, which support the bladder, bowel, and reproductive organs. These muscles also play a key role in core stability and movement. Pelvic floor physiotherapists are trained to assess and treat conditions related to pelvic floor dysfunction, including incontinence, pelvic pain, and prolapse. They use a combination of manual therapy, exercises, and education to help individuals regain function and improve their pelvic health.
Why is Pelvic Floor Physiotherapy Important After Mastectomy?
While a mastectomy primarily involves the upper body, the impacts of the surgery and subsequent treatments extend to the whole body, including the pelvic region. After surgery, the body goes through significant physical changes, which can affect the pelvic floor muscles and overall movement patterns. Here are several reasons why pelvic floor physiotherapy is essential during post-mastectomy recovery:
Changes in Posture and Alignment After a mastectomy, patients often experience changes in posture and alignment, especially if there is a loss of breast tissue or a reconstruction procedure. This shift in posture can lead to compensatory movement patterns and strain on the pelvic region. Pelvic floor physiotherapists work to address these changes by promoting proper alignment and helping patients restore a balanced posture.
Impact of Scar Tissue and Surgical Procedures Scar tissue from the mastectomy surgery or breast reconstruction can affect mobility and contribute to tension and discomfort in the body. Scar tissue may also impact the pelvic floor muscles indirectly by altering how the body moves or reacts during daily activities. Pelvic floor physiotherapists can use manual therapy techniques, such as myofascial release or massage, to improve mobility around the scar tissue and reduce its impact on the pelvic floor and surrounding areas.
Breathing and Core Stability After a mastectomy, core stability can be compromised due to changes in the abdominal and chest muscles. Since the pelvic floor is closely connected to the core, a weakened or unbalanced core can contribute to pelvic floor dysfunction, such as urinary incontinence or pelvic organ prolapse. Pelvic floor physiotherapists use specific exercises to improve core strength, stabilize the pelvis, and restore proper coordination between the pelvic floor and core muscles.
Impact of Chemotherapy and Radiation Chemotherapy and radiation treatments, commonly used in the post-mastectomy recovery process, can have wide-ranging effects on the body, including muscle weakness, fatigue, and decreased bone density. These treatments may also affect the pelvic region, increasing the risk of pelvic floor dysfunction. Pelvic floor physiotherapy helps to manage these side effects by strengthening the pelvic muscles and improving endurance, which can be crucial for returning to normal activities.
Urinary and Bowel Dysfunction Pelvic floor dysfunction, such as urinary incontinence or constipation, can sometimes arise after a mastectomy, particularly if there is damage to the pelvic floor muscles or nerve pathways during the surgery or from prolonged immobility. Pelvic floor physiotherapy helps address these issues by restoring function to the pelvic muscles and providing exercises to improve bladder and bowel control.
Sexual Health and Intimacy Many individuals who have undergone a mastectomy experience changes in their sexual health and intimacy due to both physical and emotional factors. Pelvic floor physiotherapists are trained to address these issues and provide support in restoring pelvic function, improving blood flow, and decreasing discomfort during sexual activity. This can be an important part of post-mastectomy recovery, helping individuals regain confidence and comfort in their bodies.
Impact of Stomach Grafts on Pelvic Floor Function For individuals who undergo breast reconstruction using tissue grafts from the stomach (such as the DIEP flap or TRAM flap procedures), the recovery process can have an additional impact on the pelvic floor. These procedures involve the removal of muscle and skin from the abdominal region, which can lead to changes in core stability and abdominal muscle function. The altered posture and muscle imbalances after such procedures can place increased strain on the pelvic floor muscles, potentially contributing to pelvic floor dysfunction such as incontinence or prolapse. Pelvic floor physiotherapists help address these changes by working on strengthening the core and pelvic muscles, improving posture, and retraining the body to compensate for the loss of abdominal tissue. This holistic approach supports recovery in both the abdominal and pelvic regions, ultimately improving overall function and quality of life.
Benefits of Pelvic Floor Physiotherapy in Post-Mastectomy Recovery
Pelvic floor physiotherapy offers several key benefits to individuals recovering from a mastectomy:
Pain Relief and Scar Tissue Management Scar tissue from the surgery or reconstruction can lead to pain and restricted movement. Pelvic floor physiotherapists use manual techniques to release tightness and break down adhesions in scar tissue, which can reduce pain and improve range of motion.
Restored Core and Pelvic Floor Function A strong, coordinated core is essential for pelvic floor health. Pelvic floor physiotherapy helps individuals regain strength in the pelvic floor muscles and surrounding core muscles, which is important for daily activities, posture, and overall movement.
Improved Mobility and Posture Pelvic floor physiotherapy helps address issues with posture and alignment that may arise after a mastectomy. Restoring proper posture reduces strain on the pelvic floor and other muscle groups, ultimately improving mobility and function.
Prevention of Incontinence and Prolapse Pelvic floor physiotherapy can help prevent or manage symptoms of urinary incontinence or pelvic organ prolapse, which can occur if the pelvic floor muscles weaken or become dysfunctional. By strengthening these muscles and improving their coordination, physiotherapists can help individuals maintain bladder and bowel control.
Enhanced Sexual Health and Confidence Pelvic floor physiotherapy plays a critical role in restoring sexual function and confidence after a mastectomy. By addressing pelvic muscle tension, improving blood flow, and reducing discomfort, physiotherapy can help individuals feel more comfortable and confident in their bodies during intimate activities.
Improved Emotional Well-being Recovering from a mastectomy can be an emotional journey. Pelvic floor physiotherapists provide a supportive environment to address physical concerns while also offering education and resources to help individuals manage the emotional aspects of their recovery. The focus on body awareness, function, and movement can contribute positively to emotional healing.
How Pelvic Floor Physiotherapy Works in Post-Mastectomy Recovery
Pelvic floor physiotherapy for post-mastectomy recovery is typically personalized based on each individual’s needs and recovery process. A session may include the following components:
Assessment and Evaluation The first step in pelvic floor physiotherapy is a thorough assessment. The physiotherapist will review the individual’s medical history, including details of the mastectomy surgery, reconstruction, and any treatments like chemotherapy or radiation. The therapist will assess pelvic floor function, posture, core stability, and any pain or discomfort in the pelvic region.
Manual Therapy and Soft Tissue Mobilization Manual techniques such as myofascial release, scar tissue massage, and gentle stretching are commonly used to improve mobility, reduce tension, and address any restrictions caused by scar tissue or muscle imbalances.
Pelvic Floor Exercises Pelvic floor physiotherapists teach specific exercises to strengthen the pelvic floor muscles and improve coordination with the core muscles. These exercises are aimed at improving bladder control, bowel function, and overall pelvic health.
Postural and Breathing Exercises Postural correction exercises and breathing techniques are used to improve alignment, restore core stability, and reduce stress on the pelvic region. These exercises also help patients regain full movement and reduce any discomfort from changes in posture following surgery.
Education and Self-care Strategies Physiotherapists provide education on proper body mechanics, self-care techniques, and lifestyle modifications that can support recovery. They may recommend exercises, stretches, or strategies for managing any pelvic health concerns that arise during the healing process.
Getting Started with Pelvic Floor Physiotherapy
If you are recovering from a mastectomy, consider consulting a pelvic floor physiotherapist who specializes in post-surgical recovery. Here’s how to get started:
Speak with Your Healthcare Provider Before beginning pelvic floor physiotherapy, speak with your oncologist, surgeon, or primary care provider. They can provide a referral or recommendation for a qualified physiotherapist.
Choose a Qualified Physiotherapist Ensure that the physiotherapist you choose has experience in post-surgical recovery, particularly after a mastectomy. Many pelvic floor physiotherapists specialize in helping individuals regain pelvic health after breast cancer treatment.
Commit to the Process Pelvic floor physiotherapy often requires multiple sessions to achieve meaningful results. Be patient and committed to the process, and work closely with your therapist to address any concerns that arise during your recovery.
Conclusion
Pelvic floor physiotherapy is an essential, yet often overlooked, aspect of post-mastectomy recovery. It addresses the physical changes that occur following surgery, including pelvic floor dysfunction, posture, and scar tissue management. The inclusion of a stomach graft in breast reconstruction adds another layer of complexity to recovery, affecting core strength and pelvic floor function. By incorporating pelvic floor physiotherapy into the recovery process, individuals can experience pain relief, improved mobility, better pelvic health, and enhanced quality of life. If you're recovering from a mastectomy, consider consulting a pelvic floor physiotherapist to ensure a well-rounded, effective recovery journey that promotes overall health and well-being.
