Pelvic Physical Therapy for Oncology Patients

Treatment for cancer can cause a number of general side effects such as fatigue, changes in appetite, and pain. Patients who have cancers in the pelvis or abdomen can experience side effects that affect the bladder, bowel, and sexual function. These cancers include endometrial, cervical, ovarian, vaginal and vulvar in women, prostate cancer in men, and bladder, anal or colorectal cancers. Pelvic floor therapy may be used to help manage some of these side effects.

What is the pelvic floor?

The pelvic floor is a group of muscles that surrounds the vagina (only in women), anus and urethra (where urine comes out of). As the name suggests, the muscles make up the bottom of your pelvis. They act like a sling to support your rectum and other pelvic organs. If you are lacking strength, coordination, or the ability to relax any of these muscles, it can lead to:

• Back or pelvic pain.
• Urine or stool leakage (incontinence).
• Constipation or difficulty emptying your bladder.
• Pain with intercourse in women.
• Erectile dysfunction in men.

You can see these muscles in action by inserting a finger into the vagina or anus and feeling how the muscles squeeze around your finger. You can also try to stop your urine mid-stream or prevent gas from coming out. Relaxing these muscles allows for a bowel movement or emptying your bladder. Your pelvic muscles let you do all these things.

What causes pelvic floor problems in people with abdominal or pelvic cancers?

The pelvic floor muscles can be affected by:

• Scar tissue that forms after surgery for cancer.
• Surgery can cause tissues or muscles to shift or move.
• Radiation can cause scar tissue, hardening, or shrinking of muscles.
• In some cases, the tumor itself can be affecting the muscles.

What is pelvic physical therapy (PT)?

Different from traditional PT, pelvic PT takes place in a private treatment room to allow the therapist to address your needs with privacy. The therapist will ask about your health history and bowel, bladder, and sexual issues that might have come up since receiving cancer treatment. Just like traditional PT, pelvic health physical therapists will also assess upper extremity, lower extremity, and core strength, range of motion, gait and functional stability, and posture. Pelvic floor PT focuses on the muscles of the pelvic floor. The best way to examine the pelvic floor is through an internal vaginal or rectal examination. If you are not comfortable with this, your PT can also view the muscles from the outside, or feel the muscles working over clothes.

What treatments are used in pelvic floor therapy?

After your physical therapist evaluates your pelvic muscles, they will suggest things to help improve your pelvic muscle function. This can include:

• Soft tissue mobilization (massage) and stretching of tight muscles.
• Exercises to strengthen your core and pelvic floor muscles.
• Recommending dietary changes such as avoiding alcohol or caffeinated beverages if you are experiencing urinary symptoms.
• Relaxation and deep breathing to relax the muscles.
• Biofeedback techniques.
• Vaginal dilators for women with pain during intercourse.
• Your therapist will teach you self-care techniques to promote your quality of life.

What is biofeedback?

One tool that many therapists use with traditional exercise, breathing, and massage is biofeedback. Biofeedback measures the electrical activity of your muscles using either external stickers or internal probes and displays this on a computer screen. This helps you see your muscles work, strengthens them, and improves your overall control of these muscles.

Your physical therapist’s goal is to help you return to life after cancer. Whether that means having the energy to golf again, returning to work without fear of having accidents, or returning to intimacy with your partner. Treatment could involve one screening session before, after, or during your cancer treatment, or you can be followed closely to help you reach your goals.