Written by Dr. Charlotte Singletary, PT, DPT
As a cancer survivor, you persevered through hardship and trauma. While that is definitely something worth celebrating, part of you may feel like something is still “off”. You may not feel like the same person you once were. You may be experiencing lingering side effects from treatment – effects that may have you avoiding social activities, feeling tired all the time, or uncertain of your relationship status.
In this blog, we will focus on post-cancer effects to the pelvic floor. Several cancers can affect the pelvic floor, including the:
- Bladder
- Cervix
- Rectum
- Ovaries
- Prostate
- Uterus
The common treatments for cancers in these areas are radiation therapy and surgery. However, after radiation therapy and surgery, additional issues can develop, like soft tissue dysfunction, spasms, trigger points, adhesions or scarring.
These changes can lead to:
- Pain
- Pelvic floor muscle weakness
- Nerve damage
- Urinary or fecal incontinence
- Constipation
- Sexual dysfunction
Physical therapists that receive additional training in pelvic floor anatomy and the treatment of pelvic floor dysfunctions have multiple tools in their chest to treat your post-cancer pain symptoms. While the following treatment options are not exclusive to treating the pelvic floor, they can be especially effective in post-cancer recovery.
Manual Therapy
Manual therapy is a treatment that involves direct, individualized planning and care by your therapist. The specific techniques require skilled, passive movements. These hands-on treatments utilize mobilization, kneading, and stretching of soft tissues to increase range of motion and decrease pain. Skin, muscles and joints can all be manipulated during manual therapy.
Specific manual therapy techniques include:
- Theile’s Massage
- Trigger point therapy
- Dry needling
- Myofascial release
- Scar tissue mobilization
The decision to utilize one approach over the other will depend on the result you and your physical therapist are seeking.
Exercise
While manual therapy is a passive modality, exercise is active. Your level and intensity of prescribed exercises will depend on what your therapist finds during a pelvic floor evaluation.
If you have difficulty eliciting a pelvic floor contraction, or are extremely weak, you may start with exercises on your back or sides. In these positions, you do not have gravity to contend with, and some even use gravity to help your contractions.
You will likely not spend your life flat on your back, so throughout the course of treatment, you will need to progress to more functional activities. Exercises targeting your pelvic floor muscles and your core will move to active contractions in sitting and standing positions, and finally, to practical activities you find yourself frequently performing.
Biofeedback
Sometimes, it’s hard to know which muscle is contracting. Biofeedback is simply the principle of aligning your brain to your body, and your body to your brain, to help make the connection. Touching yourself is a form of biofeedback. For instance, if you carry tension in your neck, you may connect your mind and body by rubbing your neck with your hands to encourage your muscles to relax.
When hands-on biofeedback is not enough, or when muscles are harder to knowingly engage, like those in our pelvic floors, there are several tools in the marketplace to assist in reconnecting with yourself. They may be simple, solid plastic instruments or use complex, electrical circuitry and computers. Outside signals, such as pictures, lights or sounds, coincide with muscle contraction and relaxation. With the right kind of cueing and training, you will begin to develop more control over your pelvic floor. With more control, you can learn to develop strength or relax tight muscles.
A physical therapist trained in pelvic floor muscle rehabilitation can help relieve your pelvic pain after surgery or radiation therapy. You can learn more from our knowledgeable and trained pelvic floor rehabilitation therapists. Contact the Smart Body Physical Therapy team for an appointment at (904) 296-4140.