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Providing Hope After Cancer Treatment.

Every year nearly 98,000 American women are diagnosed with gynecological cancer, according to the American Cancer Society. Although nearly 30,000 of these new cases will die from the disease, more women are surviving. Many survivors are left with poor quality of life due to pain, functional limitations and fatigue among other effects from treatment. It is very common for women who have been treated for gynecological cancer to report issues with urinary dysfunction, bowel dysfunction, sexual impairments, pelvic pain, cancer related fatigue, and lymphedema. What is most devastating is that many of them don’t know that help is out there. In fact, many healthcare providers do not realize these impairments can be treated by a physical therapist.

Gynecological cancer encompasses cancers of the female reproductive system. Primary types are vulvar, vaginal, cervical, uterine, and ovarian. The signs and symptoms for each are different, but common symptoms among all are abnormal vaginal bleeding or discharge. The chart below explains the different symptoms for different cancers. Treatment for these cancers may include surgery, radiation therapy, chemotherapy, and/or hormonal therapy. These treatments have shown to have adverse side effects on the pelvic floor (Hazewinkel). Physical Therapy can address these effects of gynecological cancer treatment, and give women a full and active life beyond cancer, beyond survival. 

Often gynecological cancer treatment pushes women in to early menopause through surgical removal of reproductive organs.  This impacts hormone levels, as do the medications that follow.  Many times women have decreased desire, arousal, and painful intercourse due to the tissue changes that ensue.  It is important to address these issues sooner rather than later.  When tissues remain unhappy and painful, the surrounding connective structures and muscles become tense, further feeding into the cycle of pain and tension. A pelvic physical therapist is trained to assess vulvar tissue changes, and educate patients in how to manage.

Scar tissue is also a common side effect of cancer treatment. Scar tissue forms as the body’s response to injury, it is a physiological response and is designed to repair broken tissue. Surgery, as in hysterectomy, creates scar tissue. Scar tissue is a common cause of pain because it lacks mobility and is often hypersensitive. Pelvic radiation therapy can also create scar tissue. Radiation therapy affects all tissues within the area, and often women experience vaginal stenosis (narrowing of the vaginal canal) because of this. Obviously, this can cause pain with sexual intercourse. Manual physical therapy helps to stretch, mobilize and desensitize tissues. 

Gynecological cancers affect women in an area that is central to our emotions and intimate relationships. Naturally, muscle guarding in the pelvis and abdomen as a result of treatment is common. Muscle guarding is a natural response to pain, but when it lingers it can increase pain and discomfort. This further causes increased muscle tension and spasms. After cancer treatment is over, muscle guarding can continue. Radiation therapy changes the elasticity of the muscles causing further tissue immobility and tension. Women often complain of tightness in the pelvis, abdomen, inner thighs, hips, and buttock muscles.  When these side effects are present, there are effects to the urinary, gastrointestinal, and reproductive systems. This often is seen as urinary incontinence or incomplete bladder emptying, Constipation, painful intercourse, pain with sitting or activities. A Pelvic Physical Therapist can help with these side effects from cancer treatment. Foundational Concepts, Specialty Physical Therapy addresses muscle tension and tissue tightness with manual physical therapy.  This works to release myofascial trigger points, and ease pain.

Cancer-related fatigue is a feeling of exhaustion greater than expected for the given activity or exertion level. It is not relieved by rest or sleep. Managing cancer-related fatigue is important to improving quality of life. Patients need education in energy management, rest breaks, and an exercise program that fits their individual needs.  Research supports exercise for reducing risk of cancer recurrence. However, exercise is also vital in improving strength and mobility, pain management and in preventing osteoporosis. Bone density is decreased as we go into menopause, which is the case often with these women.  A women’s health physical therapist is able to develop an exercise program to improve bone density, while also taking into account fatigue and pain.

Last but certainly not least in our list of cancer treatment side effects is lymphedema.  Depending on the stage of cancer, patients often have lymph nodes surgically removed.  This reduces the lymphatic system’s capacity and puts women at risk for lymphedema.  This occurs when excess lymphatic fluid collects, typically in a limb because the system is not able to move that fluid through the body as it used to.  In gynecological cancers nodes are removed from the inguinal (groin) region which causes lymphedema of the leg. Physical therapy for lymphedema involves complete decongestive therapy to reduce edema and provide patients with tools to manage this condition independently.

Ask about Pelvic Physical Therapy if you or a loved one has been through treatment for gynecological cancer.  There are many side effects that you do not have to trade quality of life for.  You can lead a happy, healthy life after cancer and a Women’s Health Physical Therapist can help you achieve this.

– Sarah Dominguez, PT, MSPT, CPT, WCS

This blog is here for your help. It is the opinion of a Licensed Physical Therapist. If you experience the symptoms addressed you should seek the help of a medical professional who can diagnose and develop a treatment plan that is individualized for you.  If you enjoyed this blog, check out our website at foundationalconcepts.com for more blog entries and to learn more about our specialty PT practice, Foundational Concepts.  Follow us on Twitter @SarahpelvicPT or @Jenn_pelvic_PT or @AmandaFisherPT and like us on Facebook/Foundational Concepts for updates. 

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