Pelvic Health Therapy

Pelvic health therapy is part of our cancer rehabilitation services at The University of Kansas Cancer Center. It is designed for people who develop pelvic health issues related to cancer treatment or who have pre-existing pelvic health issues prior to starting treatment.

Cancer treatments, including hormone deprivation therapy, radiation, surgery and sometimes chemotherapy, can affect your pelvic health causing urinary incontinence, constipation or painful intercourse.

Pelvic health symptoms may also arise from treatment for cancers outside the pelvis, such as breast cancer. These conditions can affect people of all genders.

Pelvic health conditions related to cancer treatment affect both men and women.

What is pelvic health therapy?

Pelvic health therapy, also sometimes referred to as pelvic floor therapy, is a specialized form of treatment to improve the overall health of your pelvic floor. The pelvic floor is a group of multilayered muscles at the base of the pelvis that can be affected by cancer treatment. The pelvic floor muscle group supports the pelvic organs, sphincteric function, sexual function and helps to move lymphatic material.

The goal of pelvic health therapy is to maximize your function and quality of life related to your pelvic health conditions. We review your medical history and current challenges specifically related to bowel, bladder and pelvic pain or dysfunction associated with cancer treatment. We perform a comprehensive musculoskeletal exam including core, hip and, if indicated, internal pelvic floor muscle assessment. 

Pelvic health therapy related to cancer care most often involves urinary, bowel and sexual health issues associated with treatment for prostate, bladder, colorectal, bowel and gynecologic cancers.

Common pelvic health diagnoses include, but are not limited to: 

• Bowel urgency and frequency
• Constipation and difficulty with voiding
• Diastasis recti (abdominal separation)
• Fecal incontinence
• Interstitial cystitis (painful bladder syndrome or bladder pain syndrome)
• Numerous pregnancy and postpartum conditions
• Pain with medical pelvic exams, with or without a speculum
• Pain throughout the abdomen, pelvis, genitals, lower back, hips and coccyx
• Pain with sexual activity
• Pelvic floor dyssynergia (functional bowl disorder)
• Pelvic organ prolapse
• Penile curvature (also known as Peyronie’s disease)
• Sexual dysfunction
• Urinary incontinence
• Urinary retention and difficulty with voiding
• Urinary urgency and frequency (overactive bladder)

Pelvic health symptoms and risks

Cancer care can cause a variety of changes to pelvic health. Changes depend on the type of cancer and stage, forms of treatment you receive and where you are on the timeline of survivorship. These changes can involve the bladder, bowel and sexual function if you’ve had surgery, as well as radiation and hormone deprivation therapy related to cancer treatment. If lymph nodes were removed during surgery, you may also have a higher risk of developing genital lymphedema.

If you are currently receiving cancer treatment, discuss with your care team the best time for you to begin pelvic rehabilitation.

Cancer patients may experience the following pelvic health symptoms:

• Bladder cancer
  Bladder surgery or bladder removal can significantly alter bladder function and may require changes in daily habits to improve control. If you also receive radiation, you may experience urinary urgency, frequency, incontinence or difficulty emptying. Depending on the radiation field, people of all genders may notice changes in bowel function, and females may additionally experience vaginal changes.
• Breast cancer
  If your breast cancer treatment involves estrogen deprivation, you may experience chemically induced menopause. This can lead to genitourinary symptoms associated with menopause such as urinary urgency, urinary frequency, incontinence, nocturia, as well as vaginal dryness, vaginal atrophy and vaginal pain.
• Colon cancer
  Surgery can help speed stool movement through the large intestine, especially if combined with radiation treatment. You may experience fecal urgency, fecal frequency and fecal incontinence. Females may also see vaginal changes.
• Gynecologic cancers (uterine, cervical, ovarian)
  You may experience pelvic pain following surgery or radiation treatment. You are more likely to develop pelvic health symptoms with pelvic radiation associated with gynecologic cancers. 
• Prostate cancer
  If you’ve had a prostatectomy, you may experience urinary incontinence, erectile dysfunction and have an increased risk of developing Peyronie’s disease, a condition that results in curvature of the penis that may cause pain and difficulties with erectile function and sexual activity. Pelvic radiation may lead to urinary and fecal urgency, frequency and incontinence, difficulty emptying the bladder and rectal pain.
• Rectal and anal cancers
  Surgery can lead to the formation of scar tissue at the operative site. Radiation can result in the development of proctitis (inflammation of the rectum lining) and tissue fibrosis in all patients, and vaginal changes in women. Both treatments may lead to changes in bowel function and cause bladder symptoms, difficulty with anoreceptive intercourse and erectile dysfunction.

Surgery can create scar tissue that impacts your tolerance for wearing underwear, sitting, penetrative intercourse and medical examinations. Radiation treatment can compound these symptoms, further aggravating your bladder and bowel function.

In addition, pelvic radiation can lead to tissue scarring and thickening, which is known as radiation fibrosis. If this condition develops and advances, patients may experience:

• Anal fissures
• Constipation
• Dysuria
• Fecal incontinence
• Gas incontinence
• Tissue irritation externally
• Urinary frequency
• Urinary incontinence
• Urinary retention
• Urinary urgency
• Pain and/or difficulty with vaginal and/or rectal penetration secondary to stenosis, which can impact sexual function and participation in medical examinations
• Sexual dysfunction in male patients

Hormone deprivation therapies can also alter pelvic function and cause systemic symptoms in men and women, including:

Men:

• Bone density loss
• Fatigue
• Hot flashes
• Metabolic changes
• Mood changes
• Muscle atrophy
• Sexual dysfunction

Women:

• Bone density loss
• Fatigue
• Hot flashes
• Joint pain
• Mood changes
• Nocturia (waking up 1 or more times at night to urinate)
• Painful intercourse
• Urinary frequency, incontinence or urgency
• Vaginal atrophy
• Vaginal dryness and irritation

Chemotherapy is less likely to impact the pelvis alone, as its effects are more systemic with fatigue, neuropathy and cognitive changes.

Pelvic health diagnosis and screening

You will receive pelvic health therapy from licensed physical therapists and occupational therapists who have had additional training to manage pelvic health concerns. Our team has extensive and specialized training to treat all genders for pelvic health issues related to the prostate, bladder, bowel and sexual health systems. We also have physical therapists who specialize in lymphedema and general cancer rehabilitation.

Our role as pelvic health therapists varies depending on the type of cancer you’ve been diagnosed with, the forms of treatment you’ve received and your personal needs. If you’re having surgery that is likely to affect pelvic function, we can evaluate and educate you prior to and after your surgery to aid your rehabilitation. If you’re having pelvic radiation treatment, we can inform you about tissue changes associated with radiation and self-management options to decrease the impact of radiation to your pelvic health systems. We can also actively treat you with manual therapy and exercise.

We work with your interdisciplinary cancer team to ensure you receive the highest quality care. Our clinical facilities have the latest equipment to meet the holistic needs of cancer patients.

During your first visit, a licensed specialist will perform your pelvic health examination in a private treatment room. Depending on your medical history and needs, we may require multiple visits to complete your examination. We will also ask you questions about your diagnosis, medical care, lifestyle and current pelvic health symptoms.

Based on the information you provide, we will perform a detailed musculoskeletal assessment of your pelvic floor muscles, abdomen, lumbar spine and hips and functional movement patterns. To evaluate the pelvic floor musculature, we typically perform an external assessment and internal digital assessment.

Cancers with the highest risk for developing pelvic health conditions include:

• Anal cancer
• Bladder cancer
• Breast cancer
• Colon cancer
• Gynecologic cancers (uterine, cervical, ovarian)
• Prostate cancer
• Rectal cancer
• Vulvar cancer

While these are the main cancers that contribute to pelvic health conditions, patients undergoing treatment or surveillance for other types of cancers can also experience pelvic health symptoms impacting mobility, safety and overall quality of life.

Pelvic health treatment

Our pelvic health therapists offer a variety of modalities and equipment for therapy if necessary. We have gym equipment for strengthening the muscles associated with pelvic health issues, blood flow restriction cuffs, electrical stimulation, real-time ultrasound and biofeedback.

We prescribe exercises based on your individual symptoms and musculoskeletal presentation. Based on our assessment, your treatment may include strengthening, coordination and/or flexibility training.

We work with you to develop a treatment plan and requisite education. Subsequent visits may include exercises, breathing techniques, nutrition review and biofeedback. We will determine your individual care plan, including frequency and number of visits, after your assessment.

Services we offer

• Education on bladder and bowel health
• Education on sexual health
• Coordination training for emptying bowel and bladder
• Manual therapy to address tissue tension and pain
• Therapeutic exercise to address strength, coordination and flexibility deficits
• Functional training
• Endurance training
• Modalities as needed, including biofeedback therapy or real-time ultrasound

If you are experiencing symptoms with bladder function, bowel function, sexual health function and/or pelvic pain due to cancer treatment, talk to your physician or healthcare provider about a referral to pelvic health physical therapy for musculoskeletal evaluation.