Content Warning: This article discusses topics surrounding cancer, cancer treatments, and their effects on the body.

Cancer survivorship is an experience that varies greatly from person to person. There are many different types of cancer, symptoms, and conventional treatments that a person may experience during survivorship.

Treatment and support during this time can often require a very multidimensional approach, as cancer and its related treatments can affect the body in many ways.

One form of treatment that may often be forgotten is pelvic floor physical therapy. The pelvic floor is something every person has. It is a group of muscles found in the pelvis that are essential for a variety of bodily functions.

The pelvic floor supports the pelvic organs (uterus, bladder, colon, etc.) and provides the body with stability.

Additionally, the pelvic floor controls continence of both the bladder and bowels, and even plays a role in sexual function and appreciation!

When the pelvic floor experiences dysfunction—such as having weakness, tightness, inflexibility, or poor coordination—it fails to provide the above-mentioned functions effectively.

This results in a variety of painful or uncomfortable symptoms that interrupt health and significantly impact a person’s quality of life. So, what does this have to do with cancer?

Cancer, as well as the conventional treatments used to treat it, can have a huge impact on the pelvic floor and its surrounding structures. This is especially so in the case of cancers affecting the urinary, gastrointestinal, or reproductive systems.

Therefore, many individuals may benefit from pelvic floor-focused care, which can address the many unideal side effects of pelvic floor dysfunction.

There are a very wide range of symptoms that fall under the umbrella of pelvic floor dysfunction. Below, we’ve outlined some common pelvic floor related symptoms that are experienced during survivorship:

• Pelvic pain
• Urinary urgency
• Painful urination 
• Painful bowel movements
• Frequent urination
• Incomplete emptying of the bladder or bowels
• Abdominal pain
• Constipation
• Bladder or bowel incontinence
• Sexual dysfunctions
• Pelvic organ prolapse of the uterus, rectum, or bladder
• Scar tissue or adhesions
• General pain of the hips, lower back, or abdominals
• And more

Physical therapy helps manage these side effects by maintaining pelvic floor health, reducing pain, and managing symptoms of pelvic floor dysfunction.

These treatments are incredibly important for supporting a better quality of life and the overall well-being for individuals experiencing survivorship.

We’ll get into the specifics of cancer-related pelvic floor care soon, but first let’s look at what type of cancers are more likely to cause pelvic floor dysfunction.

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As mentioned before, certain cancers are more likely to create pelvic floor dysfunction.

These often occur within or near the pelvic region, and conventional treatments used to target cancer can often have direct effects or side effects that impact pelvic health, too.

Below, we’ve outlined some common types of cancers that contribute to pelvic floor dysfunction, as well as some common symptoms experienced with these cancers.

In many cases, cancer-related pelvic floor care can play a major role in maintaining comfort and function for individuals experiencing the symptoms described below.

Gynecological Cancers

Gynecological cancers are those that affect the reproductive system for individuals born with a vagina.

These cancers can affect areas such as the uterus, ovaries, cervix, vagina, or vulva. These cancers and the treatments used for them can create significant side effects or symptoms, such as the following:

• Scar tissue or adhesions
• Vaginal shortening
• Vaginal dryness
• Sexual dysfunction
• Incontinence
• Pelvic organ prolapse
• Pelvic pain
• And more

Urological Cancers

Urological cancers affect the urinary system, such as the bladder, kidneys, or urethra.

These cancers are a more common type, and can significantly affect urinary function either directly or due to treatment. Symptoms experienced as a result of these cancers can include:

• Incontinence
• Pelvic pain
• Back pain
• Painful urination
• Frequent urination
• And more

Urological cancers can also refer to cancers that affect the reproductive system of those born with a penis. This can include prostate cancers, testicular cancers, and penile cancers.

These can affect many structures of the reproductive and urinary systems, and may cause symptoms such as:

• Urinary incontinence
• Erectile dysfunction
• Pelvic pain
• Sexual dysfunction
• Scar tissue
• And more 

Gastrointestinal Cancers

Gastrointestinal cancers are those that occur in any part of the digestive system, including the esophagus, stomach, intestines, and the anus.

While not all types of gastrointestinal cancers affect the pelvis or pelvic floor, some that are in closer proximity do—such as colorectal cancers.

Colorectal cancers are those that occur in the large intestine, such as the colon or rectum. Additionally, anal cancer (a type of gastrointestinal cancer) can also contribute to pelvic floor dysfunction.

Some symptoms one may experience from these types of cancers include:

• Bowel dysfunction
• Fecal incontinence
• Pelvic pain
• Scar tissue
• Constipation
• Abdominal pain
• Nerve damage
• And more

Breast Cancer

Breast cancer does not directly affect the pelvis, but those with this type of cancer may undergo hormonal therapies that can affect structures of the pelvis.

These therapies may contribute to pelvic floor dysfunction and vaginal atrophy (thinness, dryness, and a loss of elasticity) for those born with a uterus.

For those who are born with a penis and undergo hormone therapy for breast cancer, side effects can include low sex drive and erectile dysfunction.

Cancer-related pelvic floor care such as pelvic floor physical therapy looks to improve the quality of life for those experiencing side effects of cancer or cancer treatment.

Physical therapy can provide support by restoring pelvic function, managing side effects, and reducing pain. These goals will be achieved through a comprehensive and individualized care plan that is unique to each individual and their symptoms.

Hive’s physical therapists will consider their patient’s medical history, severity and type of cancer, as well as their comfort level when it comes to treatment and the discussion of their survivorship experience.

At Hive Therapy and Wellness, the patient’s comfort is the most important aspect of treatment.

Our providers understand that survivorship can be a difficult and emotional topic, and that receiving treatment for pelvic-related symptoms can be intimidating or confusing.

That is why our providers make it their top priority to create an understanding, safe, and supportive environment for each and every person who receives treatment.

Begin treatment with confidence knowing that Hive’s physical therapists have the knowledge, training, and sincerity needed to provide trauma-informed care for any individual with a cancer diagnosis.

Evaluation and Examination

To begin treatment, your physical therapist will need to better understand your symptoms, and your unique survivorship situation. It’s important to remember that at Hive, you are always in control during treatment.

If you ever feel uncomfortable discussing details of your experience, or do not feel comfortable with certain types of treatment, you have the right to refuse.

Our providers genuinely care about your comfort, and want to support you with methods you are comfortable with.

At any point during treatment, even midway, you can choose to refuse a treatment method. No worries—our providers will do their best to work with your needs and comfort level even without specific treatments.

With that being said, treatment begins with an evaluation, which may include discussing medical histories and details of your symptoms.

The evaluation portion will also include a physical examination to evaluate the health of the pelvic floor and surrounding structures.

This can include assessing muscle tone, flexibility, tightness, weakness, and coordination. Your physical therapist will also look for scar tissue, mobility restrictions, swelling, discomfort, and other physical aspects that can contribute to symptoms.

Physical examination in regards to the pelvic floor can be both external and internal, as are certain forms of pelvic floor treatment. However, as mentioned before, our physical therapists will work with your comfort level and only perform treatment or examination that you consent to.

Your physical therapist will also assess other areas that are closely interconnected with the pelvic floor, such as the core, lower back, hips, and other areas.

These structures will need to be strong and healthy, so that they can properly coordinate with the pelvic floor to provide function.

Issues with mobility, muscle balance, or posture in these areas can contribute to pain and dysfunction, so your physical therapist won’t ignore these important parts of the body!

Once they have a better understanding of your unique needs, symptoms, and survivorship experience, your physical therapist will formulate a curated treatment plan based on their findings.

This treatment plan can include any of the following treatment methods:

Manual Therapy 

Manual therapy is a physical technique that provides a lot of benefits for treating pelvic floor dysfunction. Manual therapy techniques can relieve muscle tightness, improve mobility and blood flow, and reduce pain.

It can even help address adhesions or restrictive scar tissue, both of which impact mobility and contribute to pain.

Manual therapy can be used on many areas of the body, and can be performed with the provider’s hands or a variety of tools.

The pelvic floor can benefit from internal manual therapy (using tools such as pelvic wands), and areas such as the pelvis, hips, lower back, and abdominals can benefit from external methods.

Pelvic Floor Training

Pelvic floor training is an important part of treatment for pelvic floor dysfunction.

Cancer treatments can significantly affect the muscles and ligaments of the pelvis and pelvic floor, often causing weakness, tightness, and immobility of these soft tissues.

These problems are what lead to symptoms like painful sex, prolapse, or incontinence.

Pelvic floor training looks to correct these dysfunctions by retraining the patient’s awareness and control of their pelvic floor muscles.

This can involve treatments and activities that help a patient feel and see the contraction and relaxation of their muscles in real time, as well as exercises for strengthening or relaxing these important muscles.

These activities may differ from person to person, as each person’s survivorship experience and pelvic floor dysfunction can vary.

Dilator Therapy

Another useful technique that can be used for pelvic floor training is dilator therapy. Dilator therapy is a form of treatment that utilizes tools called dilators to gently stretch tissues via insertion.

This can be done vaginally or rectally, and can be extremely beneficial for those who have experienced any of the following as a result of cancer treatment:

• Vaginal stenosis
• Vaginismus
• Dyspareunia
• Anal or colorectal surgeries
• Vaginectomy
• Hysterectomy
• And more

Dilator therapy is a progressive process that allows patients to improve at their own pace.

They can begin insertion with very small sizes, and slowly work their way up to larger sizes to meet their individual health goals.

These tools gently stretch tissues to improve elasticity, reduce pain, and provide desensitization to those who struggle with penetration due to fear or anxiety.

While this treatment may seem intimidating for some, rest assured that the providers at Hive Therapy and Wellness will always prioritize your comfort.

As mentioned before, they will never perform a treatment without your consent, and can stop treatment at any time if you feel the need.

Don’t hesitate to ask your provider for more information or explanation of treatments as needed—Hive is here to help!

Strengthening

While strengthening your pelvic floor muscles can be very important, there are also other parts of the body that can contribute to pelvic floor dysfunction and are affected by cancer treatments.

Your hips, lower back, core, and other areas of the body all coordinate and support your pelvis. These areas must all be in good health in order to properly support each other, and so your physical therapist will be sure to rebalance any areas of muscle weakness or tightness.

Strengthening and stretching these areas can help improve your stability, support better posture, reduce overall stiffness, and improve your body’s flexibility.

Not only is this great for pelvic health, but it can help counteract aspects of general weakness or fatigue.

Your physical therapist will curate an exercise routine for your needs, taking into account both your current physical abilities and health goals in order to create a safe and individualized plan.

Behavioral Modifications

The providers at Hive Therapy and Wellness value holistic care. Therefore, your physical therapist will be sure to address any behaviors or factors that could contribute to your pelvic floor dysfunction or pain.

This can include any of the following:

• Avoiding or altering activities that can put stress on the pelvic floor, such as heavy lifting.
• Correcting posture, spinal misalignment, or harmful movement mechanics. 
• Teaching toileting techniques such as proper toilet posture, how to reduce straining, and reducing phone use in the restroom.
• Bladder retraining techniques to manage urgency, incontinence, and other bladder dysfunctions.
• If necessary, physical therapists can provide support for the use of pessaries, which are supportive devices used for individuals with prolapse.
• Providing education or suggestions to improve sexual comfort, such as positioning, lubricants, tools or other supportive aids.

Collaboration

The physical therapists at Hive Therapy and Wellness understand that treatment during cancer survivorship can require a multidimensional approach.

Therefore, they are always ready to collaborate with other health professionals, such as oncologists, urologists, gynecologists, mental health professionals, and more.

This allows our physical therapists to provide treatment that best aligns with your health needs, goals, and other treatments experienced outside of the physical therapy clinic.

The treatments listed above are just a few examples of how physical therapy can address pelvic floor dysfunction and related side effects during cancer survivorship.

However, they are not the only methods you may experience when receiving pelvic floor care for survivorship.

At Hive, our providers are committed to comprehensive treatment, meaning they may utilize a variety of other useful methods to best meet your health goals and needs. This can include any of the following:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Cupping 
• Tissue scraping 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Spinal manipulation 
• Therapeutic modalities 
• Biofeedback