Beyond surviving: What to know about bladder, bowel, sexual health & menopause before pelvic cancer treatment

When you are diagnosed with cancer, the immediate goal is understandably clear: treat the cancer.

Appointments, scans, surgery, radiation and chemotherapy can quickly take over. There is an enormous amount of information to absorb, often at a time when simply getting through the next day feels like enough.

But eventually, treatment ends.

And for many people who have been treated for a gynecological or pelvic cancer, another set of questions begins:

Why am I suddenly going to the bathroom all the time?
Why does sex hurt?
Why does my vagina feel different?
Why am I leaking urine or stool?
Why am I so exhausted?
Is it safe to exercise?
Will I ever feel like myself again?

As a pelvic health physiotherapist, I often meet people at this stage — sometimes months after treatment and sometimes years later.

They are incredibly grateful to be cancer-free, but they are also realizing that cancer treatment can have lasting effects on bladder health, bowel function, sexual health, hormones, physical activity and even the way they feel about their body.

In Episode 129 of The Pelvic Floor Project, I spoke with Kayla Switlishoff, a nurse practitioner with BC Cancer in Kelowna, who works primarily with people undergoing treatment for gynecological and genitourinary cancers.

We talked about something that deserves much more attention:

What happens after cancer treatment — and how can we help people not just survive, but recover and live well?

Cancer treatment can affect more than the cancer

The pelvis is an important place.

The bladder, bowel, reproductive organs, vagina, pelvic floor muscles, nerves and blood vessels all live in a relatively small area. Treatments aimed at cancer in this region can therefore affect other structures and systems as well.

Radiation, surgery and other cancer treatments may contribute to changes such as:

urinary urgency or frequency
burning or discomfort with urination
bowel urgency or changes in stool consistency
bladder or bowel leakage
vaginal dryness
pain or discomfort with penetration
vaginal tissue changes or scarring
fatigue
changes in sexual desire or pleasure
treatment-induced menopause
fertility changes
fear or uncertainty around exercise
changes in body image and confidence

Not everyone will experience these symptoms, and recovery looks different for every person.

But knowing that these changes can happen — and that there may be options to help — is important.

“I don't remember anyone telling me this.”

This is something both Kayla and I hear frequently.

The interesting part is that patients may actually have been given information about potential side effects before treatment.

They just couldn't absorb it.

And that makes complete sense.

Imagine you've just been told you have cancer. You're trying to understand your diagnosis, what treatment you'll need, whether it will work and what the next several months of your life are going to look like.

Then someone starts explaining what might happen to your sex life six months from now.

Your brain may simply say:

Not today.

Kayla pointed out that patients are dealing with an enormous amount of information during their initial cancer consultations. Side effects discussed toward the end of those conversations may simply not register.

That doesn't necessarily mean we need to give people more information all at once.

Instead, we need to make information available at the time people are ready to receive it.

For one person, that might be before treatment.

For another, it might be several weeks afterward.

And sometimes a partner or family member may be ready to learn about the next stage before the person undergoing treatment is.

There isn't one right way to navigate cancer.

A new focus on survivorship

This recognition helped lead to the development of the GLOW Clinic — Gynecological Life and Ongoing Wellness — a survivorship initiative at BC Cancer Kelowna co-developed by nurse practitioner Kayla Switlishoff and radiation oncologist Dr. Hamid Raziee.

The clinic was developed as a quality-improvement initiative for people who have undergone treatment for gynecological cancers.

Rather than focusing solely on whether the cancer has been successfully treated, the program looks at several areas that can significantly affect quality of life afterward, including sexual health, hormone/endocrine health, physical concerns and mental health.

This fills an important gap.

As Kayla described during our conversation, some patients have told her that this was the piece that had been missing from their recovery.

Because being cancer-free and feeling well are not necessarily the same thing.

Your bladder and bowel may behave differently

Radiation to the pelvis can irritate structures that sit close to the treatment area.

The bladder, for example, may become irritated, contributing to symptoms such as urinary frequency, urgency or burning.

The bowel can also be affected, and some people experience looser or more frequent bowel movements or increased urgency during treatment.

These symptoms do not automatically mean that your pelvic floor is weak.

This is an important distinction because one of the most common pieces of advice people encounter online for almost any pelvic symptom is:

Do Kegels. Strengthen your pelvic floor.

But pelvic floor symptoms are much more complicated than that.

After cancer treatment, tissues may be irritated and the nervous system may be more protective. Some people actually develop more pelvic floor tension, not less.

Trying to repeatedly tighten muscles that are already tense may make some symptoms worse.

Sometimes rehabilitation involves strengthening.

Sometimes it involves learning how to relax.

Often it involves understanding how your pelvic floor interacts with your breathing, abdominal muscles, bladder, bowel and nervous system.

There is no universal pelvic floor exercise prescription.

Dilators aren't simply about “stretching the vagina”

People who undergo pelvic radiation may also be advised to use vaginal dilators after treatment.

Radiation can contribute to fibrosis and scarring, which can cause the vagina to narrow or shorten. Dilators may therefore be recommended to help preserve vaginal length and tissue mobility and allow for future medical examinations.

But here's something I think is frequently missed:

Putting a dilator into the vagina isn't simply a tissue-stretching exercise.

The pelvic floor muscles surround the vagina, and these muscles are highly influenced by the nervous system.

If your body has spent months experiencing examinations, procedures, pain or invasive cancer treatments, your nervous system may understandably become protective of this area.

You can have the perfect dilator and follow every stretching recommendation, but if your brain is saying this isn't safe, your pelvic floor may tighten.

That is where rehabilitation becomes much more nuanced.

We may work on breathing, positioning, pelvic floor relaxation, education, gradual exposure and finding ways to make the experience feel less clinical.

For some people, incorporating pleasure or sexual touch may eventually become part of that process.

For others, it won't.

The goal is not simply to “get the dilator in.”

It is to help you regain comfort, confidence and agency over your body.

Sexual health is health

Sex can become complicated after pelvic cancer treatment.

There may be vaginal dryness or tissue changes. Penetration may hurt. Desire may change.

But there can also be fear.

You may be afraid that sex will hurt.

Your partner may be afraid of hurting you.

And after months of having your pelvis examined and treated medically, it may begin to feel less like an intimate part of your body and more like something clinical.

Kayla described this beautifully in our conversation: part of recovery can involve taking ownership of that part of your body again.

And intimacy doesn't have to immediately mean penetrative sex.

Touching, kissing, massage, closeness and other forms of intimacy can be ways of slowly rebuilding comfort and connection without making intercourse the goal.

Lubricants and vaginal moisturizers are not the same thing

Another very practical point we discussed was vaginal dryness.

Many people know about lubricant, but fewer realize that vaginal moisturizers are different.

Lubricant is generally used during sexual activity or dilator use to decrease friction.

A vaginal moisturizer is used regularly to help manage ongoing vaginal dryness and support the vaginal tissues.

For someone experiencing tissue changes after pelvic cancer treatment or treatment-induced menopause, both may have a role.

And there should be no embarrassment around using either.

Comfort matters.

Cancer treatment can cause sudden menopause

For younger people undergoing pelvic radiation, another significant consideration is the effect treatment can have on the ovaries.

Radiation can cause ovarian function to stop, resulting in a treatment-induced menopause.

Unlike natural menopause, which often develops gradually through perimenopause, this hormonal change can happen very quickly.

That may mean suddenly experiencing symptoms such as:

hot flashes
sleep disturbance
vaginal dryness
changes in sexual function
other symptoms associated with menopause

Depending on the cancer and individual circumstances, hormonal treatment may be one option to discuss with the medical team.

Fertility can also be affected, making conversations about fertility preservation particularly important for younger patients before treatment begins.

These are enormous decisions to make while simultaneously processing a cancer diagnosis — another reason compassionate, ongoing support is so important.

“I'm scared to exercise.”

This is another statement I hear frequently in my clinic.

After cancer treatment, people can lose trust in their bodies.

Something feels different.

They're exhausted.

They may have been relatively inactive for months.

And suddenly the exercise they used to do feels impossible.

That can create a feeling of fragility:

What if I hurt myself?

What if exercise makes something worse?

Where am I supposed to start?

Fatigue is extremely common with radiation treatment and can continue after treatment has finished.

The answer isn't necessarily to force yourself back into your previous exercise routine.

It may mean starting much smaller.

A short walk is movement.

Gentle mobility is movement.

A few minutes of exercise is still exercise.

I often talk to patients about finding their threshold — the amount of activity their body can tolerate without leaving them completely depleted — and gradually working from there.

The goal isn't to prove that your body can do what it used to do.

The goal is to help your body progressively build capacity and confidence again.

Pelvic health physiotherapy after cancer is about much more than Kegels

The term pelvic floor physiotherapist can be misleading because it makes it sound as though we only treat one group of muscles.

In reality, rehabilitation after pelvic cancer may involve much more.

We might talk about:

bladder and bowel function
urinary or bowel urgency
pelvic floor tension
vaginal or pelvic pain
dilator use
painful sex
breathing and nervous-system regulation
scar and tissue mobility
returning to exercise
rebuilding strength and endurance
understanding your anatomy
rebuilding confidence in your body

Often, one of the most powerful things I can do is simply show someone how their body works.

I'll use pelvic models, diagrams and images to explain how the bladder fills, how the pelvic floor interacts with it, what happens during bowel movements or sexual arousal, and how someone's particular cancer treatment may have affected those systems.

Once you understand why something may be happening, it can feel much less frightening.

Then we can talk about options.

And importantly, you get to decide which problems matter to you.

One person may desperately want to return to intercourse.

Another couldn't care less about sex but wants to stop running to the bathroom.

Someone else just wants to get back to hiking.

Rehabilitation should reflect your goals, not someone else's idea of what recovery should look like.

You don't have to suffer in silence

Perhaps the biggest message from my conversation with Kayla was this:

You are allowed to care about quality of life after cancer.

You can be incredibly grateful that your cancer has been treated and still be frustrated that you leak urine.

You can be relieved to be cancer-free and still grieve changes to your sexual health.

You can celebrate finishing treatment and still need help figuring out how to exercise again.

Those things can exist at the same time.

And if something isn't working well, ask.

Talk to your oncology team, nurse practitioner, family doctor or another healthcare provider. If appropriate, seek out a pelvic health physiotherapist — ideally someone with experience working with people after pelvic cancer treatment.

There may not always be a quick fix.

But there are often far more options than people realize.

Cancer treatment is about survival.

Cancer recovery should also be about helping you get back to living.

This blog is intended for educational purposes only and does not replace individualized medical advice.