Pelvic Health after Breast Cancer: The conversations we need to have

Breast cancer treatment can affect so many aspects of life. But what happens when changes to your bladder, bowel or sexual health become part of that journey? Let's open up the conversation.

When you think about breast cancer treatment, pelvic health might not be the first thing that comes to mind.

There may be appointments to attend, treatments to navigate, medication to take, physical changes to adjust to and the emotional impact of everything you have been through. You might be thinking about your family, your work, your relationships, or simply finding your way back to a sense of normality.

There can be so much to process.

And amongst all of this, you might notice changes to your bladder, bowel or sexual health that you aren't quite sure how to talk about.

Perhaps you are rushing to the toilet more frequently. Maybe your bowel habits have changed, intimacy feels different, or you are experiencing vaginal dryness or discomfort.

You might wonder whether these changes are connected to your treatment, whether they are something you simply have to accept, or whether they are even important enough to ask for help.

I want you to know that they are worth talking about.

At Wildflower Physiotherapy, I believe that looking after your health means looking at the whole person. Your pelvic health is just one part of that picture, but it is an important part of your comfort, confidence and quality of life.

Why can pelvic health change after breast cancer treatment?

Some breast cancer treatments can affect hormone levels, sometimes bringing on or worsening menopausal symptoms. These hormonal changes can affect the vaginal and vulval tissues, bladder symptoms, sexual comfort and desire.

Other factors, including medication, fatigue, changes in activity, emotional wellbeing and the experience of treatment itself, may also influence how you feel.

Every woman's experience is different. You may experience several changes, just one, or none at all.

The important thing is that you shouldn't have to navigate these concerns alone.

Let's talk about your bladder

Have you noticed that you need to go to the toilet more often? Perhaps you experience a sudden urge to pass urine, wake during the night to use the toilet, or notice a little leakage when you cough, sneeze or exercise.

Bladder symptoms can have a real impact on everyday life. You might find yourself planning outings around toilet facilities, avoiding exercise or worrying about getting caught short.

These changes can sometimes be overlooked when there are other health concerns to manage, but they deserve attention.

A pelvic health assessment can help explore your symptoms, bladder habits and pelvic floor function, where appropriate, to identify possible contributing factors and discuss suitable support.

You do not have to simply put up with symptoms that are affecting your daily life.

What about your bowel health?

Bowel health is another subject that can feel difficult to discuss, even with a healthcare professional.

Constipation, changes in bowel habits, difficulty emptying your bowels or discomfort can be frustrating and may affect your confidence and wellbeing.

There can be many reasons for these changes, including medication, changes in routine, hydration, movement and pelvic floor function.

Understanding what is contributing to your symptoms is an important first step towards finding the right support.

If you notice a new or persistent change in your bowel habits, speak to your healthcare team rather than assuming it is simply a consequence of treatment.

Intimacy, vaginal changes and sexual wellbeing

This is perhaps one of the conversations we need to make more space for.

For some women, breast cancer treatment can bring changes that affect intimacy and sexual wellbeing. Hormonal changes may contribute to vaginal dryness, irritation or discomfort during sex. Fatigue, body image, emotional wellbeing and changes in relationships can also influence how you feel.

You may find that your body feels different, that intimacy is no longer comfortable, or that your interest in sex has changed.

You may not feel ready for intimacy at all.

Whatever your experience, there is no right timeline and no expectation that things should return to how they were before.

Sexual wellbeing is personal. It is about your comfort, your choices, your relationships and how you feel in your own body.

There are ways to explore support for these concerns, and you deserve the opportunity to discuss them openly, without embarrassment or pressure.

If you are considering treatments for vaginal symptoms, particularly hormonal products, speak with your breast cancer team or an appropriate healthcare professional about what is suitable for your individual circumstances.

How can pelvic health physiotherapy help?

Pelvic health physiotherapy can be one part of your wider support following breast cancer treatment.

Depending on your symptoms and individual needs, an assessment may explore bladder and bowel function, pelvic floor muscle coordination, movement, comfort and strategies to help manage your concerns.

It is important to remember that pelvic health physiotherapy isn't always about strengthening your pelvic floor. Sometimes the muscles need help relaxing, coordinating or working differently.

Support should be tailored to you, with your comfort, consent and preferences at the centre of every decision.

You can ask questions, talk through your concerns and discuss what you feel ready for. You do not have to do everything at once.

You have enough to think about already

One of the things I feel passionately about is recognising that women affected by breast cancer are navigating so much more than a diagnosis or a course of treatment.

There may be physical changes, emotional adjustments, family responsibilities, work, relationships and the challenge of finding a new sense of normality.

Pelvic health may not feel like your priority right now, and that is okay.

But if bladder, bowel or sexual health symptoms are affecting your everyday life, you deserve to know that support is available.

You do not have to wait until things become unbearable. You do not have to feel embarrassed. And you do not have to feel that your concerns are somehow less important than everything else you have been through.

Sometimes, simply having the space to talk, understand what is happening and explore your options can be an important first step.

Opening up the conversation

This is why I am delighted to be supporting an evening with Lady McAdden Breast Cancer Trust, focusing on pelvic health after breast cancer treatment.

We will explore bladder health, bowel function and sexual wellbeing, creating space for conversations that can sometimes feel difficult to start.

My hope is that women leave feeling more informed, reassured and empowered to seek support when they need it.

Because pelvic health is not just about muscles, symptoms or treatments. It is about how you feel, how you live and what matters to you.

I am truly passionate about improving quality of life through pelvic health discussions and treatments. From experience with my patients, I know that our pelvic health is often forgotten about during periods of treatment whislt priorities are at different stages. Priorities are allowed to be different, but once you are ready to understand and establish how you can improve your symptoms, reach out!

And whilst there may be so much else to think about, your wellbeing matters, too.

If you have concerns about changes to your bladder, bowel or sexual health, speak with an appropriate healthcare professional for advice tailored to your circumstances.

Stacey Xx

Wildflower Physiotherapy