The Intersection of Pelvic Health and Oncology Optimizes Sexual Symptom Management
Both a patient’s cancer and their subsequent treatment plan can affect (https://doi.org/10.1016/j.soncn.2019.150981) their bodies, including pelvic health and sexual functioning. A pelvic health physical therapist can help combat—or even prevent—those issues as a member of the interprofessional cancer care team.
Pelvic health physical therapists work closely with the cancer care team, including oncology nurses, to provide comprehensive education, deliver treatments, and identify precautions and other considerations involving pelvic health throughout a patient’s cancer journey. We rely on ongoing communication with the oncology team to determine a pelvic health care plan. Physical therapists, especially those who specialize in pelvic health, should be integrated as early as possible into the cancer care continuum, ideally between the time of diagnosis and the start of treatment, so we can evaluate patients and identify optimal interventions.
Once a patient is referred for pelvic health physical therapy, we begin by evaluating their situation. Pelvic health physical therapy assessments include:
- Musculoskeletal examinations to assess patients’ functional movements, posture, range of motion, strength, sensation, reflexes, balance, circumferential measurements, skin assessment, and gait.
- Pelvic examinations to evaluate patients’ pelvic floor muscle tone and functioning, sensation, reflexes, and tissue health.
We base our treatment plan on those examination findings and other patient-reported symptoms. We may provide prescription exercises, manual therapy, pelvic floor muscle training, balance training, gait training, and dilator training after pelvic radiation, depending on each patient’s situation, needs, and desired outcomes.
Pelvic health physical therapists work mainly in rehabilitation clinics, but we also often consult in cancer centers or inpatient care. Appointments typically last 45–60 minutes and are individually tailored to each patient. We document and share all of our findings with the cancer care team, vendors, and patients or their caregivers. Depending on a therapist’s background, we may also incorporate research, teaching, or administrative work.
Our patient interactions also involve comprehensive pelvic health education throughout the cancer journey, including bowel, bladder, and sexual function. We are specially trained to discuss sensitive topics appropriately. We also focus on teaching patients about how pelvic health physical therapy can address potential side effects and the behavioral modifications and precautions they can take prevent any treatment complications. Because the pelvic floor is often unfamiliar to many patients, pelvic health physical therapists will use resources such as three-dimensional pelvic models and images during patient education. If a patient’s situation warrants, we may also refer them to other healthcare providers, such as dieticians and sex therapists.
Oncology nurses should consider pelvic health and the benefits of physical therapy when assessing patients. Pelvic health physical therapy can mitigate and resolve many bowel, bladder, and sexual dysfunction side effects of cancer and cancer treatment, and as general physical therapists, we can also address pain, cancer-related fatigue, balance, weakness, and more.
Nurses and other healthcare providers have an essential role in opening and continuing conversations with their patients about pelvic health. Although the topic is sometimes uncomfortable, patients must understand how pelvic health physical therapy services can help prevent or manage distressing symptoms. The more oncology nurses can educate their patients on pelvic health physical therapy, the more likely patients are to follow up with those important appointments.