Physiotherapists regularly work with patients with breast cancer, assisting them with surgical recovery and with lymphoedema and other side effects of the cancer treatment. 

New research now suggests that improving pelvic floor health can be added to the care offered by physiotherapists, says Dr Udari Colombage APAM, a physiotherapy researcher at the University of Melbourne and a lecturer at Monash University.

Her research field focuses on incontinence in women with breast cancer, an interest that grew out of her experiences working at breast cancer clinics as a graduate physiotherapist.

‘I used to run post-surgery group exercise classes for women with breast cancer and a number of these patients had incontinence issues. 

‘They came to me for advice because they’d heard that physios have a role in managing incontinence,’ Udari says.

She quickly realised that there was not much research evidence about treating incontinence in breast cancer survivors.

‘Considering that we have great care pathways set up for treating incontinence in Australia, it was really strange that there was nothing about this in the breast cancer literature or in the breast cancer clinical practice guidelines,’ Udari says.

With the guidance of Associate Professor Helena Frawley, Dr Sze-Ee Soh and Dr Kuan-Yin Lin, Udari embarked on a PhD project to investigate pelvic floor dysfunction in women with breast cancer.

It has turned out to be a remarkably fruitful project, with several papers published as a result of her research to date.

Initially, she looked at the experiences of women with breast cancer, including the prevalence of pelvic floor dysfunction, therapies offered to them during their recovery and potential barriers to receiving adequate care for pelvic floor dysfunction during breast cancer treatment and recovery.

Udari discovered that pelvic floor dysfunction, especially urinary incontinence, was prevalent in women with breast cancer, particularly in older women with more advanced disease. 

However, there was a lack of awareness about pelvic floor dysfunction in women undergoing breast cancer treatment.

Following the initial studies, Udari completed a study funded by a Physiotherapy Research Foundation Seeding Grant (awarded in 2019) that compared pelvic floor muscle function in women with and without breast cancer. 

The results of the study were published earlier this year in the journal Continence (Colombage et al 2023).

In this study, the research team measured pelvic muscle strength using a variety of assessment techniques, including intravaginal pressure manometry, to determine maximum squeeze pressure.

‘The study found that women with breast cancer had weaker pelvic floor muscles and poorer pelvic floor relaxation ability compared to women without breast cancer. 

‘This finding suggests that therapies such as pelvic floor muscle training or relaxation techniques may be therapeutic targets to improve pelvic floor muscle function in women with breast cancer,’ Udari says.

A follow-up study looking at the feasibility of delivering pelvic floor muscle training (PFMT) by telehealth to treat urinary continence in women with breast cancer has indicated that PFMT is both feasible and potentially beneficial for this cohort (Colombage et al 2022).

Udari says that a striking aspect of the PFMT feasibility study was the high level of engagement shown by the participants.

Recruitment of the 54 women who took part in the study took a fortnight rather than the three months that Udari expected and very few of the trial participants dropped out.

‘We had a 100 per cent consent rate, which means that all the women who were eligible to participate agreed. 

‘They were all very enthusiastic. 

‘We had a high attendance rate for the physiotherapy sessions during the 12-week program,’ she says.

The results look very promising, with a statistically significant decline in the prevalence of urinary incontinence and a corresponding increase in pelvic floor muscle strength after completing the 12- week PFMT course.

‘At the start of the feasibility trial, 100 per cent of the participants had stress urinary incontinence, while only 29 per cent still had incontinence after the intervention,’ Udari says.

The next step is to do a randomised controlled clinical trial to confirm the results of the study in a larger cohort of women with breast cancer. 

In the meantime, she hopes to raise awareness both among women undergoing breast cancer treatment and among physiotherapists working with this patient group about pelvic floor dysfunction and the potential for improvement through PFMT.

‘One of the most important messages that I want to get out there to physios is that women with breast cancer can experience pelvic floor dysfunction after having breast cancer treatment. 

‘And if they do, there are fantastic pathways for treating incontinence in Australia, so please direct them to the existing pathways,’ Udari says.

‘I found that women don’t prioritise these symptoms at the time and then, after they’ve completed all the cancer treatment and they have to continue to live with this, they think, “I’ve just gone through a life- threatening illness; I can deal with a bit of incontinence.” 

‘But when you ask them how it affects their life, they have had to make a lot of changes because of this incontinence. 

‘It’s stopping them from moving on from breast cancer and its treatments.’

Udari says she is inspired by something one of the participants in her studies told her.

‘I’ve spent the past three years surviving and I don’t want to just survive for the next 25 years. 

‘Incontinence is such a big part of that. It’s not about survivorship, but thrive-rship.’

>> Udari will present the results of her feasibility study at the APA’s IGNITE 2023 national conference in October. Visit ignite2023.physio for more details.

>> Click here for an infographic summarising the pelvic floor training study and its results.

References

Colombage, Udari & Soh, Sze-Ee & Lin, Kuan-Yin & Kruger, Jennifer & Frawley, Helena. (2022). The feasibility of pelvic floor training to treat urinary incontinence in women with breast cancer: a telehealth intervention trial. Breast Cancer. 30. 1-10. 10.1007/s12282-022-01405-6.

Colombage, Udari & Soh, Sze-Ee & Lin, Kuan-Yin & Frawley, Helena. (2023). Pelvic floor muscle function in women with and without breast cancer: A cross-sectional study. Continence. 5. 100580. 10.1016/j.cont.2023.100580.