As medicine has continued to improve, survival rates following gynecological cancers have also increased. This is all around a GOOD thing! However, it has brought to light the importance of looking at an individual’s quality of life AFTER the cancer is gone as the struggle often doesn’t stop there. When it comes to gynecological cancers, side-effects such dyspareunia (pain during urination), urinary incontinence, and fecal incontinence are often reported. Not only are these dysfunctions higher among cancer survivors, but they are reported to remain significant and even increase in severity in the long term. 1As a physical therapist who specializes in the treatment of pelvic health conditions, this is extremely relevant and important to me!
Physical therapists are skilled in the assessment and treatment of muscular and soft tissue function—both of which can be extremely compromised from surgery, radiotherapy, and/or chemotherapy. Currently, radical hysterectomy is the standard treatment for early-stage cervical cancer.2 While this procedure has many benefits in regards to patient safety and post-operative pain, there is a high associated risk of lower urinary tract dysfunction, such as stress urinary incontinence and overactive bladder, following. 2 This is due in part to the cutting and resection of important ligaments and tissues within the pelvic cavity. Direct injury to the parasympathetic nerves and ligaments of the uterus is responsible for post-hysterectomy constipation as well.2 Post-operative side-effects are often more bothersome for those also undergoing radiotherapy and chemotherapy.
Radiotherapy can cause lesions to the pelvic floor muscles, changing the structure and functional capabilities of the muscles as well as the adjacent tissues. The muscles are unable to generate as much force and demonstrate with less squeeze pressure and maximum strength compared to those having not undergone radiotherapy. The pelvic floor muscles play a large role in pelvic organ support, continence, and sexual function. If the muscles are not able to function properly, these roles are not able to be carried out effectively. Chemotherapy can cause neurotoxicity to sensory nerve fibers, leading to numbness, tingling, pain, and burning sensations. However, this usually presents in more of a glove and stocking (hand and feet) pattern as opposed to directly impacting the pelvic floor tissues.3
“It’s been deemed important that more opportunities are found for both screening and managing pelvic floor symptoms throughout the cancer journey.“
With all of these factors considered, it’s been deemed important that more opportunities are found for both screening and managing pelvic floor symptoms throughout the cancer journey.4 Screening should take place both prior to cancer treatments as well as following as those that are already experiencing symptoms of pelvic floor dysfunction are more likely to be at risk post treatment as well. Physical therapists, specifically those certified in the treatment of pelvic health, are an appropriate specialty to seek out for these services. Not only are we skilled in the assessment of these tissues, but we are educated in the techniques required to retrain the muscles and promote healing of the involved tissues. Vaginal dilator therapy is recommended to prevent and/or treat severe scarring or stenosis that is associated with pelvic radiotherapy. The pelvic health team at Apex is skilled in the use of dilator training and can assist in teaching techniques to be utilized for home care as well. Studies have found, with good evidence, that pelvic floor therapy (including dilator training), along with counseling, and yoga (or core strengthening) may improve patient quality of life and sexual function in survivors of cervical cancer. 1
Just because you have had cancer and undergone the appropriate (and very necessary) treatment protocols, this does not mean that you must accept resulting long-standing pelvic floor dysfunction. Please reach out to the team at Apex (feel free to request speaking with a pelvic health provider) with any questions in how we may be able to assist you in a higher quality of life!
1 http://academic.oup.com/ptj/article/100/8/1357/5828396
2 http://karger.com/goi/article-pdf/86/4/353/3759433/000517995.pdf
3 https://doi.ord/10.1371/jounral.pone.0234389
4 http://doi.org/10/1016/j.gore.2022.101007