By Allison Romero
At PHRC we treat a wide variety of patient populations. One population that we’re beginning to see more often is patients undergoing treatment for anal cancer.
Recent research has shown that the incidence of anal cancer, which is linked to the human papillomavirus (HPV), is on the rise, especially among men and women under the age of 45.
Although we’re seeing more of these patients, they remain highly underserved when it comes to physical therapy. That’s because many physicians and patients simply are not aware of the help that physical therapists, specifically pelvic floor physical therapists, can offer.
Thus, I’ve decided to write this blog, which gives a complete overview of how pelvic floor PT can help anal cancer patients.
Anal cancer is a malignancy that starts in the anus, the opening at the end of the rectum. The American Cancer Society estimates that 7,210 cases will be diagnosed in 2014. The good news is that when detected early, anal cancer is usually curable. This page on the website of the Anal Cancer Foundation is one of the best sources of information on the disease.
Anal cancer is typically treated with combined chemoradiation therapy, and even in early diagnoses, treatment can often have serious and difficult side effects.
Patients who receive local radiation to their pelvis and anus, for example, may suffer from long-term fatigue, gastrointestinal, and sexual health dysfunction. In addition, in women, treatment may result in vaginal stenosis, which is the narrowing of the vagina due to scar tissue formation, and anal stenosis, often rendering sexual activity extremely painful. For men, it cause erectile dysfunction and anal stenosis.
Fortunately, pelvic floor PT can help with these side effects, as well as with the following:
- hip pain and/or pelvic pain, patients will often say that they feel as though they’ve lost range of motion in their hip/pelvis;
- surgical pain if there is a surgery;
- fatigue, which can be a short-term or long-term effect;
- lymphedema, which is localized fluid retention due to a compromised lymphatic system;
- general musculoskeletal impairments, such as overall weakness, neuropathy or just general deconditioning;
- pelvic floor dysfunction, which includes, in addition to the above-mentioned issues, gas and fecal incontinence, urinary symptoms, such as hesitancy or a weak urine stream;
- and scar tissue due to radiation burns.
PT can Help
I believe there is a big role that physical therapy can play in the management of the above-mentioned side effects. While there is not much research literature to support this, we’ve seen very good clinical evidence that indicates pelvic PT is worth the time and resources for patients.
So exactly how can PT help?
For one thing, many patients experience musculoskeletal pain as a result of treatment, typically in the pelvic area. Even areas of the pelvis that haven’t been radiated can be affected due to radiation of nearby tissue. To be sure, the pelvic floor can act as a veritable house of cards, where one problematic area can cause issues to adjacent areas. Thus, manual therapy techniques such as myofascial trigger point release, connective tissue manipulation, scar mobilization, and joint mobilization can treat the affected tissues.
For pelvic floor dysfunction caused by stenosis of the anus and/or vagina, manual therapy can help to maintain the openness of the organ. Patients with stenosis also need to be placed on a dilator program that ensures progress continues outside of treatment. A PT can help patients learn how to use dilators, and monitor their progress.
Another pelvic floor-related issue that can occur as a result of cancer treatment, is gas and/or fecal incontinence. This is because radiation therapy can damage the integrity of pelvic floor tissues, which can in turn cause a laxity in the muscles that results in uncontrollable gas, or a loss of bowels. There may also be a situation where tissue such as the external sphincter, must be removed.
For its part, pelvic floor rehab can help to strengthen any affected muscles by using techniques such as biofeedback, patient education, and/or neuromuscular electrical stimulation. That said, although gas and fecal incontinence are dysfunctions that pelvic physical therapy can help to decrease, I should make it clear that we can’t always completely cure these issues.
When it comes to overall function, patients often feel that their body has significantly changed as a result of having endured incessant pain or fatigue. Many patients that I have treated feel as though they’ve lost mobility, strength, or their muscles have been deconditioned as a result of lack of use. As PTs, we can help to recondition patients by working to correct their posture, sitting position, gait and walking, and by treating any lower back or hip impairments with manual therapy, neuromuscular reeducation, and patient-specific exercises.
Fatigue is a big issue for patients going through cancer treatment. And there is evidence to support that PT is a great tool that can help combat chronic fatigue. A therapist can help patients pace out their daily activities, and whenever possible, help them to resume physical activity. When it comes to a body in motion, we want to place patients on a program that combines aerobic, strengthening, stretching, and balance activities.
A final point that I’d like to mention pertains to lymphedema caused by cancer treatment. If for instance, lymphedema occurs in the groin area, pelvic floor rehab can manually drain the lymphatic system, and decrease symptoms like pain and swelling.
For any patient who is considering pelvic floor rehab, please be aware that it’s a good idea to receive clearance by your physician in order to start therapy. Additionally, like all other forms of therapy, it’s important to give PT a fair chance to make a difference. Meaning, this type of therapy requires at least a three to twelve month patient commitment. However, patients may not be required to come on a weekly basis.
If you have any questions about pelvic floor rehabilitation in the case of anal cancer treatment, please do not hesitate to leave them in the comment section below.
All my best,
Allison Romero, DPT