Pelvic pain and cancer (SPARC)
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Sometimes, the cancer itself might cause pain within the abdomen or pelvis, however occasionally cancer treatment side effects can cause pelvic pain.
Scar tissue, nerve damage, and muscle weakness from treatments such as surgery, radiation, and chemotherapy can all contribute to pain around the pelvis.
This may present as pain in the pelvis e.g. lower abdomen, bladder, or buttocks, or it might present as genital pain e.g. the perineum (space just in front of the anus), vagina or vaginal entrance, tip or shaft of the penis, or scrotum. It can present differently for everyone.
Persistent pelvic pain is when someone has had pain in their pelvis for longer than three to six months.
When pain has persisted for this long, people often notice that many factors can influence it such as hormonal fluctuations, bowel habits, reduced physical fitness or activity levels, sleep levels, mood, or stress.
It can be helpful to try and understand your pain and what impacts it – speaking with a health professional can be a good way to help explore this.
Communication
The fluctuating nature of pain can be confusing for the person experiencing it as well as their friends and family. It can initially be difficult to make sense of how you can do certain things on some days and not on others.
It can be helpful to set aside some time to have a conversation with those that are close to you so they can understand a little more about what you are experiencing and how they may be helpful to you.
Similarly, when speaking to your healthcare team, it can be helpful to plan out in advance what you would like to discuss. Have a look at ‘Communication – Live Well with Pain’ or ‘talking about pelvic and abdominal concerns’ for more advice on communication.
Bladder, bowel, and sexual function
Those who experience pelvic pain may also have experienced bladder symptoms, bowel symptoms, or concerns around sexual function.
Having pelvic pain can reduce sexual desire or make sex and intimacy feel difficult, embarrassing, or less pleasurable. Have a look at our page on sex, intimacy and cancer for more support with this.
Tips for managing pelvic pain
- Heat, ice, and TENS (Transcutaneous Electrical Nerve Stimualtion) machines – these all offer non-medical pain relief which can be used as much as you like! You can place these over your abdomen, pelvis, lower back, or buttocks for short-term pain relief.
If you are using ice then only place on the skin for 10–20-minute intervals at a time. Also make sure that you are careful with using any of these options over areas with reduced sensation. Seek advice from a healthcare professional if you are unsure.
- Managing constipation – Constipation or diarrhoea can worsen pelvic pain, see our section on ‘bowel symptoms and ‘pelvic health’ for further advice on this.
- Sleep – it is common to have disrupted sleep when you have pain, especially if you are still going through cancer treatments. There are often multiple reasons why your sleep might be disrupted. Click on our ‘sleep page’ for more information on how to get a better nights sleep.
- Relaxation strategies – there is lots of evidence to show that relaxation strategies can help people with persistent pelvic pain.This might include taking part in activities that help you to feel relaxed e.g. yoga, walking the dog, listening to calming music, or taking a warm bath. Guided relaxation can also be helpful which might involve ‘progressive muscle relaxation’ of different body parts, which you can use alongside breathing techniques.
Apps such as Headspace or Calm have lots of options available. Relaxation and mindfulness – Live Well with Pain.
- Pelvic Floor Muscle relaxation – like any other muscle in the body, the pelvic floor muscles can become tight or overactive. Whilst pelvic and abdominal pain can cause these muscles to become overactive, overactive pelvic floor muscles can also cause pelvic pain.If you have received cancer treatment impacting the abdominal and pelvic area, your pelvic floor muscles are likely to have been impacted by this. There are simple exercises you can do to help to relax these muscles, including breathing exercises (see below).
- Deep breathing exercises – taking three deep breaths in and out can have multiple positive influences on our pain:
- This can help to slow the heart rate down and activate the ‘rest and digest’ system which helps the body to feel calm and relaxed
- It can help to focus on the current moment, rather than worrying about the past or future
- It can help to relax our pelvic floor muscles as these muscles work in coordination with our breathing muscles.When we take a breath in, the diaphragm contracts and moves downward and the pelvic floor gently relaxes and lengthens. When we breath out, the diaphragm lifts up and the pelvic floor recoils and also lifts.
Practicing taking some deep tummy breaths (sometimes called diaphragmatic breathing) and visualising the pelvic floor muscles dropping or melting away can help with relaxation of the pelvis.
Have a look at our ‘overactive pelvic floor muscle page’ for more information on making sure you have good movement and relaxation of the pelvic floor muscles
- Stretches – pelvic pain is often accompanied by tight pelvic, lower back, or hip muscles. Gently completing some of the below pelvic stretches can help to reduce tension within the pelvis:
Easy Stretches to Relax the Pelvis
These stretches are designed to loosen the muscles inside and around the pelvis. Take the movements to a point of increased tension but never pain. Hold an easy stretch for 30 seconds and breathe mindfully into your:
- Massage – gentle massage to the tummy, pelvis, lower back, or buttock muscles can help to relax and reduce pain in the pelvis. A pelvic health physiotherapist can offer more guidance on specific types of massage that may be beneficial.
- Pain medication – pain medication can be a useful aid to managing your pelvic pain to enable you to be more active. Talk to your cancer team or GP about what pain relief medication is available to help manage your pain.
The 5 P’s for managing activities with persistent pain
- Plan your activities or daily routine in advance so that you can spread activities out across the day or week
- Prioritise activities that are important to you (don’t just focus on chores and work) and try to include activities that bring you joy, hobbies, or social events
- Problem solving – can you make something easier e.g. light weight vacuum
- Pacing – this means modifying your daily routine so that you are getting a balance between staying active and not trying to do too much too soon. Pacing activities means that over time you can slowly build up your activity levels
- Pausing for breaks – when pacing yourself try to take regular breaks in activities, rather than keeping on going until pain or fatigue stops you completely. By taking a break, you will likely be able to return to the activity again that day or week and slowly find that you can increase the amount of time on each activity
Seeing a change often takes a consistent approach over several months. Try having a weekly planner that includes self-care (looking after your health with physical activity, rest and sleep, good nutrition), work or household chores, socialising, hobbies and enjoyable activities. This can help to track your activity levels and what changes you are making.
Manging Flare-ups
“Flare-ups” describes times when your pain levels are at their worst. Sometimes you know what has triggered a flare-up and at other times they seem to just happen.
It is normal to experience flare-ups or set-backs with pelvic pain (or any persistent pain), especially if you are still living with cancer or going through treatment.
It is also common to feel frustrated or anxious when we experience a flare-up, but this is a common factor in manging persistent pain, so try not to blame yourself or your body when this happens! It can be useful to have a plan in place, so that you feel prepared.
Tips for managing flare-ups:
- Communicate with your support network – communicate your needs and what you are experiencing with loved ones and your healthcare team – they can offer support, empathy, and advice
- Go back to the 5 P’s: plan, prioritise, problem solve, pace, and pause for breaks
- Find a pain management strategy that works for you: ice, heat, TENS, positions of ease – it can be helpful to try this before a flare-up to know what feels good for you
- Gentle movement e.g. yoga or going for a walk – this helps to reduce stiffness, improve blood flow and increase feel-good brain chemicals like endorphins. Having some pain with activities does not necessarily mean is it bad for you, use this pain level traffic light to guide your activity levels during a flare-up
- Ensure you are keeping good bladder and bowel habits, see ‘pelvic health’ for more information on this
When to seek help
It is common to worry about pain and people often worry that it might be a sign of their health worsening or that they are doing something wrong. We would recommend that you seek further support from your cancer team or GP if:
- You have ongoing pelvic pain that is impacting your ability to engage in your daily activities or hobbies
- The pain is a new symptom for you
- The pain has changed or is getting worse
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