Pelvic Floor Rehabilitation After Cancer Treatment

The pelvic floor is a group of muscles, ligaments and tissues. Together they form a sling at the base of your pelvis. The American Cancer Society describes its job simply. It supports the bladder, vagina, uterus and rectum. It controls bladder and bowel function. And it supports sexual health. Treatment aimed at the pelvis passes straight through it.

Several cancers can lead to pelvic floor damage. The American Cancer Society lists cervical, prostate, bladder, ovarian and endometrial cancer. It names two treatments as the cause: surgery and radiation therapy.

The National Cancer Institute covers the same ground from the symptom side. Radiation therapy to the pelvis can cause bladder problems. That includes radiation to the reproductive organs, the bladder, the colon and the rectum. Some types of chemotherapy and immunotherapy can do the same. So can surgery. That includes prostatectomy (removal of the prostate), bladder cancer surgery, and radical hysterectomy (removal of the uterus and nearby tissue). After surgery, NCI names two specific problems: "leaking urine" and "trouble emptying your bladder completely."

The American Cancer Society lists what the damage can lead to. Bladder incontinence and leaking urine. Constipation, or difficulty with bowel control. Erectile dysfunction and pain during sex. Bladder, bowel or pelvic pain. Pelvic organ prolapse, which means a pelvic organ slips out of its normal place.

Incontinence is not one thing. The American Cancer Society separates several kinds. Stress incontinence means "leaking urine when you cough, laugh, sneeze, or do physical activity." Urge incontinence means "a strong or sudden need to urinate; or have trouble holding in urine long enough to get to a toilet." Overflow incontinence means "leaking urine when your bladder is full." Complete incontinence means "lacking any control over when you pee." The difference matters, because it changes what a therapist works on.

Federal cancer information covers this thinly. The National Cancer Institute's page on urinary and bladder problems names the treatments and the symptoms accurately. But it does not mention pelvic floor exercises or pelvic floor therapy at all. That gap is not evidence that therapy fails to help. But you are unlikely to be handed a referral just by reading the standard patient materials. Do not expect anyone to quote you published success rates either.

What a trusted cancer organization does say is modest. It is still worth knowing. The American Cancer Society states that pelvic therapy done with biofeedback often works better than exercises alone. Beyond that, be skeptical of anyone promising a set recovery percentage or a fixed number of sessions.

The American Cancer Society describes the process. A pelvic floor therapist assesses you, and may do an internal pelvic exam. Treatment can include Kegel exercises and stretching. It can include teaching about bladder and bowel habits. It can also include biofeedback. And it can include vaginal dilators, or electrostimulation, which uses a low electrical current.

This is the practical part. Ask your oncologist, surgeon or nurse to refer you to a pelvic floor physical therapist. Use that exact phrase. It is a recognized specialty. A vague request for "help with leaking" often ends with a pad recommendation instead.

Cancer treatment centers often employ pelvic floor therapists. Raise pelvic problems with your doctor before or during treatment. Do not wait. The American Cancer Society is direct about the cost of delay. Dr. Lan Coffman is quoted saying that "if a patient doesn't seek help from a pelvic floor therapist, the symptoms are unlikely to improve and can get worse."

Some changes need a call, not an exercise plan. One of them cannot wait: if you suddenly cannot pass urine at all, especially with lower-belly pain or a bladder that feels full and will not empty, go to an emergency department now. NIDDK describes acute urinary retention as a medical emergency — the 24-hour figure some checklists use is about producing no urine over a day, not about being unable to pass it. The American Cancer Society also says to get help right away for new or worsening confusion or blood in your urine.

The CDC lists the signs of a urinary tract infection, also called a UTI. Pain or a burning feeling when you urinate. Urine that is cloudy or red. A fever of 100.4 °F (38 °C) or higher. CDC warns that "in people being treated for cancer, a UTI can turn into a serious condition that needs immediate medical care." CDC also advises you to talk with your doctor or nurse. Learn what symptoms you may experience, and ask which ones to call about. Other sources put that fever threshold at 100.4 °F (38 °C), so use the number your own team gave you.

• American Cancer Society, How Pelvic Floor Therapy Can Help During Cancer: https://www.cancer.org/cancer/latest-news/how-pelvic-floor-therapy-can-help-during-cancer.html
• American Cancer Society, Bladder Incontinence: https://www.cancer.org/cancer/managing-cancer/side-effects/stool-or-urine-changes/bladder-incontinence.html
• National Cancer Institute, Urinary and Bladder Problems: https://www.cancer.gov/about-cancer/treatment/side-effects/urination-changes