Pelvic Floor Therapy: What It Is & How It Can Help After Breast Cancer Treatment

Chemotherapy and hormonal therapy for breast cancer may affect your pelvic muscles, also called the pelvic floor. These muscles, which run from the tailbone to the pubic bone, help support your bladder and other organs. Damage to the pelvic floor can lead to unwanted bladder leakage, constipation, pelvic pain, pain with sex, and other issues. 

If you’re experiencing these or other painful symptoms in your pelvic region, you may be a good candidate for a type of physical therapy, or PT, called pelvic floor therapy. Ask your healthcare team about how to connect with a trained physical therapist who can evaluate your pelvic muscle strength and create exercises to help strengthen these muscles.

Your pelvic floor supports your bladder, large intestine, and reproductive organs. Your pelvic floor muscles keep these organs in place. These muscles also allow you to control when you pee and poop and to experience pleasure from sexual activities. 

When pelvic floor muscles become weak or injured, these muscles have a harder time working together and relaxing (also called pelvic floor dysfunction). Without these muscles working together, a person may be more likely to have accidents before making it to the bathroom (the medical term for this is urinary or fecal incontinence). 

Rachel Gelman, PT, DPT, CSC, is a pelvic floor specialist, sexuality counselor, and owner of Pelvic Wellness and Physical Therapy. Gelman lists the following as other symptoms of pelvic floor dysfunction:

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  constipation 

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  frequent urge to pee

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  inability to hold stool

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  pain during sex

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  pain when peeing

After breast cancer treatment, you may notice that your pelvic floor isn’t as strong as it used to be. Studies show that women with breast cancer have weaker pelvic floor muscles than those who don’t have breast cancer. 

Researchers aren’t exactly sure what causes pelvic floor problems in people with breast cancer, but some suspect that hormonal therapy may have something to do with it. Estrogen helps to maintain the health of the pelvic floor. But, some breast cancers use hormones like estrogen to grow. To prevent cancer growth, hormonal therapy is used to block estrogen and other hormones from reaching breast cancer cells. Blocking estrogen may lead to pelvic floor problems.

Hormonal therapy isn’t the only cancer treatment that can affect your pelvic floor. Chemotherapy can also cause ovaries to temporarily shut down, leading to early menopause. Early menopause can also cause a weak pelvic floor.

Pelvic floor issues may also be worse for people in breast cancer treatment because they don’t know about them. A small study published in 2022 in the journal Support Cancer Care suggests that women in treatment for breast cancer aren’t being told about the possibility of pelvic floor dysfunction. According to the study’s author, the participants reported that if they knew they had an increased risk of developing pelvic floor problems after treatment, they would have been better prepared to manage the condition. 

Pelvic floor therapy is a treatment that can retrain your pelvic muscles. This therapy is also known as pelvic floor muscle training or Kegels.

“Pelvic floor therapy is a specialized form of physical or occupational therapy," says Ruth Jenkins, PT, DPT. Jenkins is the National Director of Pelvic Health & Wellness at FYZICAL Therapy & Balance Centers in Sarasota, FL. The therapy is taught by trained physical therapists who teach people how to strengthen, relax, and coordinate the muscles, ligaments, and connective tissues that support the bladder, uterus, and rectum.

There are several treatments involved in pelvic floor therapy, including:

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  biofeedback: a mind-body technique that helps you regain control of your bodily functions

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  deep breathing and relaxation exercises: mindfulness practices that can help relax your pelvic floor muscles

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  exercises to strengthen your core and pelvic muscles: also known as Kegel exercises, these exercises involve squeezing and relaxing your pelvic floor muscles to improve muscle control and minimize leaks

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  muscle stretches: deep breathing and relaxation exercises can relax the muscles

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  diet changes: avoiding alcohol or caffeine may help with urinary problems

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  self-care techniques: taking medication, avoiding activities that can cause pain in your pelvic floor, and drinking enough water can aid in treating pelvic floor problems

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  soft-tissue massage: this massage can help stretch tight pelvic floor muscles

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  vaginal dilator: plastic or silicone devices may be able to gently stretch vaginal tissue to reduce pain during sex

Biofeedback is the most common type of pelvic floor therapy that can retrain your pelvic floor. “Biofeedback is a process that provides people with information about their [body], such as their heart rate, brain waves, or muscle tension, to help them learn how to control and regulate these functions,”  Gelman says. 

Sensors are placed on or inside your pelvic area during a biofeedback session. These sensors detect muscle activity in your pelvic floor. The monitor displays the sensor data, showing the movement of your pelvic floor muscles. 

You and your therapist will use this feedback to ensure you do your pelvic floor exercises correctly. "A trained pelvic therapist guides the sessions and shares the data with you," Jenkins says. “The data can be compared as improvement occurs.”

There are two other ways to perform biofeedback: with a mirror or by hand. "[A mirror gives] visual feedback of what your muscles are doing,” Gelman says. “Or it can be done manually, in which the provider feels your muscles and gives you feedback.”

A good start is to ask your doctor. This can be your primary care physician or oncologist. They can offer recommendations or provide a referral on your behalf. 

You can also contact your local outpatient physical therapy clinic and ask if they have any pelvic floor therapists. 

The PT Locator from the American Physical Therapy Association or Pelvic Rehab’s search tool are also good resources.

According to Jenkins, most health insurance plans cover pelvic floor therapy. But double-check with your insurance provider first. You'll want to know what to expect for co-pays or co-insurance for your sessions if you have to pay out of pocket or if you need a referral or pre-approval beforehand. Some insurance companies may require a referral or pre-approval from your healthcare provider to determine if pelvic floor therapy is medically necessary. 

Before your first session, you’ll also need to ask the physical therapist if they take insurance. Some don’t.  

While you can eventually build up to doing pelvic floor exercises from the comfort of your home, it’s best to start by getting an evaluation from a licensed pelvic floor therapist.

At-home pelvic floor exercises are not a one-size-fits-all approach. Jenkins says doing these exercises alone may be hard and even dangerous.

"If a person has pelvic floor spasms or tight muscles and starts a strength program, this could worsen the spasm," Jenkins says. Another issue may arise if you have pain from nerve compression in your pelvis, she added, “as certain stretches may make this pain worse.”

If you want to do pelvic floor therapy, work with a licensed professional. They can help you to make sure that you’re doing the right exercises to retrain your pelvic floor and get the results you want.