Pelvic floor physiotherapy after cancer treatment

The pelvic floor is a group of muscles at the base of the pelvis that supports the bladder, bowel and vagina, and plays a role in sexual function and continence. After breast cancer treatment, many women experience changes that affect these muscles and surrounding tissues. Low oestrogen from chemotherapy, ovarian suppression or hormone therapy can make vaginal tissues thin and dry, and if sex becomes painful, the pelvic floor muscles often tighten protectively. Over time, this tension can itself cause pain, making intimacy, gynaecological examinations and even inserting a tampon difficult. Some women also notice bladder leakage, urgency or constipation. Pelvic floor physiotherapy, sometimes called pelvic health physiotherapy, is a specialised treatment delivered by a trained physiotherapist. It usually starts with a private discussion and, with your consent, an assessment of muscle strength, tension and tenderness. Treatment may include breathing and relaxation techniques, gentle stretching, exercises to relax or strengthen muscles, education about bladder and bowel habits, and guidance on using vaginal dilators. Many women find that physiotherapy reduces pain, improves comfort and confidence, and helps them return to intimacy at their own pace.

It is not only about strengthening

For many women after breast cancer, the aim is to relax overactive muscles, not tighten them.

It is private and consent-based

You choose what is assessed, and you can stop at any time.

Ask for a referral

Your breast care team or gynaecologist can refer you to a pelvic health physiotherapist.

Dilators are smooth, graded devices that help stretch tissues gently and build confidence.

Start small

Begin with the smallest size that feels comfortable, using plenty of lubricant.

Relax first

Lie in a comfortable position, practise slow breathing and relax the pelvic floor before gentle insertion.

Short, regular sessions

A few minutes several times a week is usually more helpful than occasional long sessions.

Move up gradually

Progress to the next size only when the current one feels comfortable.

Keep them clean

Wash dilators with mild soap and warm water after each use.

A physiotherapist will tailor exercises to you, but these general relaxation techniques are often a starting point. Stop if anything causes pain.

Belly breathing

Lie on your back with knees bent and a hand on your tummy. Breathe in slowly through your nose, letting your tummy rise and your pelvic floor gently soften and drop. Breathe out slowly. Repeat for a few minutes each day.

Noticing tension

Many people hold tension in the pelvic floor without realising. Throughout the day, check whether you are clenching, and consciously let the muscles relax.

Gentle stretches

Positions such as lying with the soles of the feet together and knees falling apart, or the child's pose in yoga, can help the pelvic floor relax.

Warmth

A warm bath before relaxation or dilator practice can help muscles loosen.

Combine with dilator use

Practising relaxation breathing before and during dilator use often makes insertion more comfortable.

Be patient

Learning to relax the pelvic floor is a skill that improves with regular practice over weeks.