Life After Cancer: The Role of Pelvic Physical Therapy

In Female Pelvic Pain by pelv_admin3 Comments

Every year over 70,000 American women are diagnosed with gynecological cancer, according to the CDC. A diagnosis of gynecological cancer can be devastating, but, as medical technology and research advances, more and more women with this diagnosis are becoming cancer survivors. Although surviving cancer is an amazing feat, many of these women are left with a decreased quality of life due to adverse side effects of the cancer treatment. It is common for gynecological cancer survivors to report one or more of the following: urinary dysfunction, bowel dysfunction, sexual impairments, pelvic pain, cancer related fatigue, and lymphedema. What many women – and sometimes their medical practitioners – do not realize is that their pelvic floor impairments and lymphedema can often be treated by a physical therapist.

Before we dive into physical therapy treatment, I want to first talk about what gynecological cancer is. Gynecological cancer refers to cancer within the female reproductive system. There are 5 main types of gynecological cancer: vulvar, vaginal, cervical, uterine, and ovarian. The signs and symptoms for each of these cancers differ; the CDC has put together an information booklet to help distinguish them. Medical treatment for gynecological cancer may include surgery, radiation therapy, chemotherapy, and/or hormonal therapy. Studies have shown that these treatments can have an adverse side effect on the pelvic floor. However, research has also shown that physical therapy can help ease these adverse side effects.1

One of the things we treat most often here at PHRC is muscle tension. Since gynecological cancer assaults our most private and vulnerable areas, muscle guarding during medical treatment is very common. Guarding occur when we tense up, and when we draw everything in to protect ourselves. Although it is a natural response to pain, guarding can increase pain and discomfort  over time by causing muscle tension and spasms, as well as myofascial trigger points. Additionally, even after medical treatment has ended, muscle guarding may still continue as a response to discomfort such as with post-op surgical pain. Radiation therapy can also contribute towards muscle tightness, as there can be changes to the  elasticity of the muscles that have been exposed to radiation. If these complications occur, patients may complain of tightness within the pelvis, abdomen, inner thighs, hips, and buttock muscles. Once present, the increased muscle tone and myofascial trigger points can also contribute towards pain with sexual intercourse, urinary and bowel impairments such as difficulty emptying the bladder, urinary and bowel frequency and urgency, and constipation. This is where therapy comes in. At PHRC, we can treat muscle tension by using manual physical therapy to release any muscle tightness and myofascial trigger points, and thus help ease discomfort within the pelvic region.

Another adverse side effect common with gynecological cancer treatment is scar tissue restriction. The development of scar tissue is a biologic response; scar tissue forms to heal the body from a wound. Surgery, such as hysterectomy or vulvectomy, naturally creates scar tissue as a part of the healing process after the surgical procedure. Scar tissue can commonly cause pain and discomfort due to lack of mobility or hypersensitivity along the scar. Pelvic radiation therapy can also create scar tissue. Radiation therapy, such as external beam radiation and brachytherapy, affects all tissues within the field of treatment, including muscles, tendons, ligaments, and skin. It is not uncommon for women to experience vaginal stenosis, narrowing of the vaginal canal, due to scar tissue forming from pelvic radiation. This can cause pain with sexual intercourse. Manual physical therapy helps to stretch, mobilize and desensitize the scar tissue, making the patient feel better.

Chemotherapy and radiation therapy are gruelling ordeals, inducing cancer-related fatigue in the vast majority of cases. Cancer-related fatigue can be described as extraordinary exhaustion disproportionate to one’s activity or exertion. It is not relieved by rest or sleep and disrupts quality of life. The keys to managing cancer-related fatigue are energy management, frequent rest breaks, and a well-designed and individualized exercise program. It may be hard for patients with cancer-related fatigue to be motivated to exercises, however research shows that physical activity is important with reducing the risk of cancer recurrence and mortality.2 Exercise is important for increasing strength and mobility, reducing pain and helping to prevent osteoporosis. Bone density can decrease when we go through menopause and many gynecological cancer patients go through abrupt menopause due to having their ovaries removed. A decrease in bone density can lead to osteoporosis and an increased risk of fractures. Physical therapy helps patients to maintain strong bones, mobility, balance, and everyday function all the while being cognitious of cancer-related fatigue.

Another risk to be mindful of is lymphedema. Lymphedema is when excess fluid collects in tissue causing swelling, also known as edema. Depending on the stage of the cancer, some gynecological cancer patients may have lymph nodes removed, mainly from the groin area. Lymph nodes are important for carrying lymph fluid, nutrients and waste. When lymph nodes have been removed from the groin, fluid may collect and cause swelling in the pelvis, abdomen, and/or leg. This swelling is called lymphedema. Not all gynecological patients develop lymphedema, however if lymph nodes have been removed, then the patient has a lifetime risk of developing lymphedema. Physical therapy intervention consists of patient education on how to prevent lymphedema and to decrease lymphedema if it has occurred through manual lymphatic drainage therapy.

Accepting a decreased quality of life after surviving gynecological cancer is not obligatory. Physical therapy treatment is available to ease the discomfort commonly associated with cancer treatment. Surviving cancer warrants a happy and celebratory life.

If you have any questions or comments regarding this topic, please do not hesitate to leave them in the comment section below.



  1. Yang, E.J., et al. Effect of a pelvic floor muscle training program on gynecological cancer survivors with pelvic floor dysfunction: A randomized controlled trial. Gynecology Oncology 2012; 125:705-711.


What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.


  1. It is good to hear that pelvic physical therapy can help relieve pain and tightness. I can only imagine the discomfort after going through surgery or radiation therapy. Technology and our understanding of the body truly have made way for great care for those who are recovering.

  2. Hello. I am 28 years old and had a LEEP done exactly a month ago. My doctor told me to wait 2 weeks to have sex. I saw him and he told me I was healed and cleared me for sex at the two week mark. I tried to have sex with my fiance and it was painful. It felt weird – like a burning but also numbing sensation that was uncomfortable. The doctor told me my symptoms are abnormal and he has never heard of such a thing. I waited 2 more weeks, but even being aroused gives me that burning/numbing sensation. I got a second opinion and she told me that there can be permanent nerve damage – which might mean at 28, I may never be able to enjoy (or even have sex) again. I refuse to accept this poor quality of life. Do you think pelvic physical therapy can help my situation?

    1. Author Malinda Wright says:

      Hi Amber,
      Yes, absolutely physical therapy can help! The pain you’re feeling could be from muscle tension and trigger points from guarding during the LEEP procedure. I highly recommend you see a pelvic floor physical therapist.
      Best Wishes,

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