Navigating Gynecologic Cancer: Understanding its Impact on the Pelvic Floor

Gynecologic cancer, a complex and often challenging journey, is a topic that demands our attention and understanding. It's a battle against the growth and spread of abnormal cells that can affect the delicate pelvic organs and the pelvic floor muscles, which can significantly impact one’s quality of life.

In this blog post, we aim to shed light on the often overlooked aspects of gynecologic cancer and the critical role pelvic floor physical therapy plays in the journey towards recovery. Join us as we navigate through the complexities of this battle and explore the paths to healing and restoration.

What is Gynecologic Cancer?

Gynecologic Cancers are the growth and spread of abnormal cells that can affect the pelvic organs. The most common types are cervical, uterine, ovarian, vulvar, and vaginal.

Signs and symptoms of gynecologic cancer may include:

• Abnormal discharge

• Bleeding

• Spotting

• Pain in or around the pelvis, abdomen, or back

• Quickly feeling full after small amounts of food

• Difficulty eating

• Pelvic pressure

• Bloating

Reminder! PAP smears can help detect some of these cancers so it is important to stay on top of your health and attend your regularly scheduled exams.

How Does Gynecologic Cancer Impact the Pelvic Floor?

Pelvic floor dysfunction is fairly common among people with or recovering from gynecologic cancer because treatment pathways may include surgery, radiation, and/or chemotherapy–all of which can alter the physical function of the pelvic floor muscles. 

For example, surgery may impact the pelvic floor through scar tissue restriction and swelling; radiation in the pelvic region can lead to fibrosis (hardening of the tissue), stenosis of the vagina, and narrowing of the vaginal canal; even chemotherapy (and radiation, actually!) can cause hormonal changes that may result in vaginal dryness and discomfort. Individually and combined, these physical changes can impact the contractility of the pelvic floor, the strength, the muscle tone, and the sensitivity of the pelvic tissue which may result in dyspareunia (painful intercourse), urinary or fecal incontinence, anorgasmia, and pelvic pain.

But because our physical health and our emotional health are often very closely intertwined, gynecologic cancer can also impact the pelvic floor muscles through psychological pathways. Receiving a cancer diagnosis can be devastating and often drastically changes the life that someone is living, which may result in dysfunction across several areas including pelvic floor function. For example, up to 50% of women who have undergone treatment for gynecologic cancer report experiencing stress surrounding diagnosis and treatment along with associated difficulty relaxing their pelvic floor muscles and, as a result, painful sex.

What Can Be Done in Therapy to Help with These Changes?

Pelvic floor physical therapists are trained to assess and treat the whole person by identifying the different influences that may be contributing to the physical changes occurring in the body. 

To aid in pelvic floor recovery after cancer and to optimize function so that the person can experience their fullest life possible, pelvic floor PTs can:

• Work with the patient on relaxation techniques and breathwork to release tension in the pelvic floor

• Provide home exercise programs to strengthen pelvic floor muscles after treatment

• Perform manual therapy such as scar tissue desensitization, mobilization, and stretching to help regain control of pelvic floor function

• Refer to additional providers, such as mental health clinicians, that may support the patient in other areas

Are These Changes Sustained Over Time?

Research has shown that women who have undergone treatment for gynecologic cancer followed by pelvic floor physical therapy have demonstrated a reduction of pain, improved urinary symptoms and improved sexual function. Pelvic floor physical therapy provides survivors of gynecological cancers with the tools to empower and educate them for an improved quality of life. 

A Lifeline in Pelvic Floor Physical Therapy

The journey to recovery after gynecologic cancer is challenging, but pelvic floor physical therapists are there to provide support and guidance. Through relaxation techniques, breathwork, and tailored exercise programs, they help survivors regain control of their pelvic floor function. They also perform manual therapy, such as scar tissue desensitization and mobilization. Additionally, pelvic floor PTs can refer patients to mental health clinicians to address emotional aspects.

Research has shown that survivors of gynecologic cancer who undergo pelvic floor physical therapy experience a reduction in pain, improved urinary symptoms, and enhanced sexual function. These therapies empower survivors, providing them with the tools and knowledge to improve their quality of life.

Written by: Dr. Felice Gebhardt, PT, DPT 

Edited by: The Empower Physical Therapy Team

References:

Cyr MP, Dostie R, Camden C, Dumoulin C, Bessette P, Pina A, Gotlieb WH, Lapointe-Milot K, Mayrand MH, Morin M. Improvements following multimodal pelvic floor physical therapy in gynecological cancer survivors suffering from pain during sexual intercourse: Results from a one-year follow-up mixed-method study. PLoS One. 2022 Jan 25;17(1):e0262844. doi: 10.1371/journal.pone.0262844. PMID: 35077479; PMCID: PMC8789131. 

“How to regain intimacy during and after your cancer treatment”, City of Hope. 2022 Jan 4.