Pelvic Floor Physical Therapy for Cancer: My Perspective as a PT (and a Patient)

February 19, 2022

MY PERSONAL PERSPECTIVE

While only a part of my life’s story, I had breast cancer in 2017. I am grateful to report I’ve been in remission since October of the same year. I was lucky enough to have already been accepted to PT school and knew the need to have PT to prepare for surgery, regain function and strength after my surgeries, and combat the horrid fatigue that was associated with chemotherapy. Prior to my double mastectomy, I was a very flexible yoga practitioner. After my double mastectomy, I could not lift my arm above my shoulder. If not for the work I did with Adrienne Jensen PT, DPT and breast cancer rehab specialist, as soon as my surgeons gave me the go-ahead, my arm would still be stuck below my shoulder. As a result of both my personal and clinical experience, here’s why I believe every patient with a confirmed cancer diagnosis would benefit from a pelvic floor physical therapy evaluation.



MY CLINICAL PERSPECTIVE

Impact of scars. Cancer treatments, including surgeries, such as a mastectomy, or radiation, can cause scarring to the superficial tissues of the body. As I wrote about in my previous blog post, based on the connections of myofascial lines of the body, pelvic physical therapy is indicated for anyone who has undergone a surgery, sustained an injury, or experienced a change to their torso.


Tumor impact on your body structure and function. Many cancer surgeries include partial or full removal of the organ or body structure affected by tumors. Even if the scar that we can see on the skin is really small, tumors and their subsequent removal can cause changes to our internal alignment which impacts our intra-abdominal pressure, posture, and how we move through space. These changes can then influence strength, pain, and sensation at the site of surgery as well as above and below it. 


Pelvic floor tension and nerve innervation. Surgeries, such as prostatectomies or hysterectomies, also can have a direct negative influence on pelvic floor function. For example, in a prostatectomy, surgeons try to preserve innervation to the penis, prostate, and seminal vesicles. Sometimes, due to the location of the cancer, it isn’t possible to perform nerve sparing surgery. Some of the side effects of this include urinary incontinence and erectile dysfunction. Similarly, hysterectomy side effects may negatively impact the fascial tension of the pelvic floor and nerve innervation, resulting in pelvic floor weakness and sensation changes. All of these conditions can improve with pelvic floor PT.


Skin tissue changes. During and following chemotherapy or while using hormone blockers, such as tamoxifen, the texture of your skin can change. For those with a vagina, these changes affect vulvar tissues, resulting in potential vaginal dryness, bowel and bladder incontinence, increased bleeding, and/or pain with sexual intercourse.


Pelvic pain and emotions.
Lastly, cancer, of any type or stage, is often deeply traumatic, depressive, stressful and scary. More and more research is emerging that links pelvic pain to our mood and life experiences. There are many techniques and tools a pelvic floor physical therapist can perform and teach you on how to manage pelvic pain.

The farther I get away from my own diagnosis, the more of a bird’s eye view I am beginning to have for the wider breast cancer community.  We often say that we are in the “sorority we never wanted to join.” Many others in my breast cancer community weren’t as lucky as me. No one told them to go get PT at any point in their treatment. Or, the physical therapist, while well-meaning did not clarify, “What could you do before? What do you want to do now? Let’s figure out how to get you there.” Patients with cancer diagnoses are often treated like we are fragile, that we will break at any moment. However, our lives are at risk- breaking is not an option! 

The farther I advance into my physical therapy career, the more I learn clinically about what cancers do to the body from the site of the tumor and systemically. My personal experience influences what I wish to create in my treatment sessions. I wish everyone had had the knowledge and life circumstances I did to seek out physical therapy early in their treatment. As a result, I am passionate about supporting patients to return to or improve a state of pelvic well-being throughout their cancer journey. If you have recently been diagnosed, are undergoing treatment, are a cancer survivor, or a cancer thriver, my colleagues at Activcore would be honored to treat you. We offer specialized physical therapy treatment for pelvic floor conditions, lymphedema, and orthopedic rehabilitation. We will ask you, “What could you do before? What do you want to do now? Let’s figure out how to get you there.”

Learn more by visiting our breast cancer rehab page. You can also contact us to speak with a physical therapist who can help.

REFERENCE:

Till SR, As-Sanie S, Schrepf A. Psychology of Chronic Pelvic Pain: Prevalence, Neurobiological Vulnerabilities, and Treatment. Clin Obstet Gynecol. 2019;62(1):22-36. doi:10.1097/GRF.0000000000000412

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

Dr. Molly Weingart

Physical Therapist
Molly Weingart is a Doctor of Physical Therapy (DPT) who specializes in pelvic health, women's health, lymphedema treatment, and general orthopedics. She works at Activcore in Princeton, New Jersey, located just 2 miles from Princeton University. Molly believes in tailoring each patient’s treatment to fit that individual’s goals and lifestyle.
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