Study design, materials and methods
A transversal study was conducted through the usage of a structured questionnaire administered in interviews between January and March 2024 to women undergoing treatment for breast cancer. The sample was recruited from women undergoing post-surgical treatment for breast cancer in the physical medicine and rehabilitation department of a secondary hospital. The questionnaire consists of 51 questions and is divided into 5 parts: characterization of the sample (sociodemographic data); types of treatment and stage of diagnosis (medical data); urinary function; bowel function and sexual function.
Results
Information was collected from 52 women with an average age of 58.9 ± 12.1 years. The entire sample had undergone surgery for breast cancer, 80% radiotherapy, 75% chemotherapy, 30% immunotherapy and 23% hormone therapy. 56% of our sample reported having some kind of involuntary loss of urine, and 21% of them reported that it had started after the start of breast cancer treatment. 72% of the women said that the leakage occurred in urgent situations and 65% reported leakage on exertion. Looking at age groups, we found that in the 25 to 39 age range, there was a 25% increase in women complaining of urinary incontinence (UI) after starting treatment. Women aged between 40 and 59 saw a 47% increase in the same rate, and in the case of women over 60, there was a 19% increase.
With regard to fecal incontinence (FI), 42% of the women surveyed reported involuntary leakage of feces and/or gas, and 65% of these reported that it started after treatment (30% of whom reported leakage more than 3 times a week). Evaluating by age group, it was found that in the 25-39 age range, there was a 25% increase in women complaining of FI after treatment. There was a 27% increase in women aged between 40 and 59, and a 22% increase in women over 60.
With regard to Sexual Dysfunction (SD), 62% of the sample referred they had some kind of complaint during sex after starting treatment, 68% said that they didn't lubricate enough and 41% said that sex was painful. Analyzing by age range, it was found that women aged between 25 and 39 had a 50% increase in the DS rate. For the group of women aged between 40 and 59, the rate increased by 40%. For women over 60, there was a 16% increase.
62% of the sample reported that their complaints of pelvic floor dysfunction caused a negative impact on their sexual relationship. 82% of the women reported that at no time were they asked about possible complaints associated with Pelvic Floor Dysfunction (PFD) by any health professionals who had accompanied them since the beginning of their diagnosis.
Interpretation of results
Several recent studies report that women undergoing treatment for breast cancer experience complaints of pelvic floor dysfunction (PFD), such as urinary incontinence (UI), fecal incontinence (FI) and sexual dysfunction. Evidence shows that women undergoing treatment for breast cancer have a prevalence of UI of over 38% and FI of over 18% (1), corroborating our findings. By interpreting the numbers, there is a trend towards the appearance and possible worsening of symptoms in women undergoing breast cancer therapy, regardless of age group, which suggests that age alone is not a risk factor for UI.
It is also important to note that, according to our sample, we found much higher rates of FI, suggesting an emerging need for these women to be monitored by a professional specializing in the pelvic floor.
The literature suggests that the prevalence of SD in women who have undergone breast cancer is over 65% (2), confirming the results of our study and indicating that the most prevalent dysfunction in our study is SD. Although breast cancer treatments are not directly associated with the pelvic floor, it is estimated that the appearance of these symptoms is related to the reduction in oestrogen (which leads to vaginal atrophy and dryness) resulting from ovarian suppression after chemotherapy and/or hormone therapy (1). Considering that 68% of the sample reported difficulty with lubrication during sexual intercourse, it is important to recommend lubricants in order to alleviate their complaints.
Although the most up-to-date guidelines do give importance to monitoring and supporting these women with regard to sexual dysfunction, the assessment and referral of other pelvic floor dysfunctions in women undergoing breast cancer treatment does not belong yet as part of the various clinical guidelines.
Concluding message
Although our study does not relate the different types of treatment and stages of breast cancer with appearance of pelvic floor dysfunction, it is clear that in this sample the prevalence of PFD is high and has a significant impact on these women's sexual lives. However, it is important to consider the small size of the sample used, which we believe to be a study limitation, due to the poor representativeness of the results, especially in the younger age groups.
The women reported they would appreciate to receive more information about pelvic floor dysfunctions during their follow-up treatment for breast cancer.
It is therefore essential to include pelvic floor specialize health professionals in the guidelines for monitoring these women, not only regarding to SD, but also regarding to UI and FI.