When you’ve gone through breast cancer treatment, your mind and body have already endured so much. Whether you’re still in active treatment or years into survivorship, you may be surprised to learn that some of the new symptoms you’re experiencing, like urinary leakage, pelvic pain, or changes in intimacy, could be related to your pelvic floor.
These issues are too often overlooked or completely ignored by medical teams. And they can be life-changing.
Research shows that up to 50% of women prescribed tamoxifen or aromatase inhibitors discontinue their hormonal therapy early, with side effects being one of the most common reasons. Genitourinary symptoms such as vaginal dryness, pain with sex, urinary urgency, and pelvic discomfort are a major contributor to this.
Supporting women in managing these symptoms matters, because staying on maintenance endocrine therapy significantly reduces recurrence risk and improves long-term survival.
And also, quality of life matters.
As a breast cancer PT and survivor, I want to shed light on this often-overlooked connection, because you deserve care that considers all of you, not just the part that was treated.
First Things First: What Is the Pelvic Floor?
Your pelvic floor is a group of muscles at the base of your pelvis. These muscles support your bladder, bowel, and uterus, and they play a major role in controlling urination, bowel movements, and sexual function.
When the pelvic floor isn’t working well (whether it’s too tight, too weak, or not coordinating properly) it can lead to symptoms like:
- Leaking urine or having to go urgently
- Pain during or after sex
- Constipation or straining with bowel movements
- A heavy, dragging sensation in the pelvis
Now you might be wondering: What does this have to do with breast cancer treatment?
How Breast Cancer Treatment Affects the Pelvic Floor
1. Hormonal Changes
Many breast cancer treatments, such as chemotherapy, tamoxifen, or aromatase inhibitors, lower estrogen levels. This can cause early menopause, menopause like symptoms, or significantly intensify menopausal symptoms.
Lower estrogen can lead to:
- Thinning of vaginal and pelvic tissues
- Vaginal dryness or discomfort
- Changes in pelvic floor muscle function
- Increased risk of urinary leakage or urgency
If your body changed in ways no one prepared you for, you’re not imagining it.
2. Surgery and Postural Changes
After a mastectomy or reconstruction, many women naturally guard their chest or adopt new postures to protect healing tissues. Over time, this can create tension through the torso and abdomen that affects the pelvis.
This can affect how your core and pelvic floor work together, sometimes leading to:
- Lower back or pelvic pain
- Urinary Incontinence or urgency
These are absolutely things we can address.
3. Radiation Effects
Radiation doesn’t just affect the area being treated. It can cause stiffness and restriction in surrounding fascia, which influences breathing mechanics, posture, and abdominal pressure.
All of these factors directly affect how well the pelvic floor can do its job.
4. Emotional Impact and Muscle Tension
Cancer doesn’t only affect the body; it affects the nervous system too.
The pelvic floor is closely connected to stress, trauma, and emotional holding. Many people unknowingly carry tension in these muscles, similar to clenching the jaw or shoulders. Over time, this can contribute to chronic pelvic pain or pain with intimacy.
You Need More Than “Just Kegels”
Pelvic floor dysfunction after breast cancer treatment is rarely caused by weakness alone.
Kegels can be helpful in some cases, but many survivors actually have pelvic floor tightness, or a combination of tightness and weakness. In those situations, doing kegels alone can make symptoms worse.
Pelvic floor function is closely tied to:
- Breathing and diaphragm movement
- Core and abdominal strength
- Hip mobility and strength
All of these need to be addressed to make meaningful, lasting changes.
This is why all Pink Badger Exercise Programs include intentional pelvic floor-friendly movement, not just isolated exercises.
What Can You Do?
These symptoms can feel persistent, especially if you’re on long-term hormonal therapy like tamoxifen or aromatase inhibitors.
The good news: there are options.
Helpful approaches may include:
- Exercises to stretch and/or strengthen the pelvic floor
- Pelvic floor physical therapy (ideally with a pelvic health or women’s health specialist)
- Manual therapy and individualized treatment
- Talk therapy or sex therapy
- Vaginal estrogen, when appropriate
What About Vaginal Estrogen?
This is an important, and nuanced, topic.
For many years, all forms of hormone therapy were considered completely off-limits for breast cancer survivors, especially those with estrogen-sensitive cancers. However, current research suggests that low-dose vaginal estrogen (not systemic hormone therapy) remains localized and is considered safe for many survivors, even those with a history of estrogen-positive breast cancer.
This decision is highly individual. If you’re experiencing painful sex, dryness, tightness, or ongoing pelvic floor symptoms, I strongly encourage a thoughtful conversation with your oncology team and gynecologist about whether vaginal estrogen may be an option for you.
You Deserve Whole-Body Healing
You’ve been through more than most people can imagine. If pelvic floor health hasn’t been part of your recovery conversation, it’s time it was.
Whether you’re leaking when you laugh, feeling disconnected during intimacy, or simply wanting to feel stronger and more supported in your body, pelvic floor care can help.
You’re not alone. And you don’t have to figure this out by yourself.
References:
van Herk-Sukel MP et al. Half of breast cancer patients discontinue tamoxifen and any endocrine treatment before the end of the recommended treatment period of 5 years. Breast Cancer Research and Treatment. 2010;122(3):843–851.
Bowles EJ, Boudreau DM, Chubak J, et al. Patient-reported discontinuation of endocrine therapy and related adverse effects among women with early-stage breast cancer. Journal of Oncology Practice. 2012;8(6):e149–e157.
