Pelvic Floor Therapy for the Oncology Patient

Transcription

1 Therapy for the Oncology Patient CARINA SIRACUSA, PT, DPT, WCS OHIOHEALTH PELVIC FLOOR PHYSICAL THERAPIST ONCOLOGY REHABILITATION PROGRAM COORDINATOR What does a pelvic floor therapist treat? Muscles Muscles Muscles Therapy: Not Just Kegels! Common misconception that pelvic floor therapists only treat incontinence Pelvic floor therapists treat a variety of different disorders that can arise as a consequence of cancer treatment or side effects of different types of cancers 1

2 Therapy: Not Just Kegels! Therapy: Not Just Kegels! Diagnoses commonly treated by a pelvic floor therapist Urinary and fecal incontinence Pelvic pain Constipation/obstructed defecation Irritable bowel syndrome Abdominal scar tissue Urinary retention Neurogenic bladder Pelvic peripheral neuropathy Treatment techniques used by pelvic floor therapists Pelvic floor muscle exercise Myofascial release techniques Dietary recommendations Behavioral retraining techniques Modalities General exercise Posture and body mechanics Common Side Effects Pelvic floor therapy after GYN cancers Pelvic pain Scar tissue from surgery Estrogen deficiency Vaginal narrowing Urinary retention Hormonal imbalances/decreased sexual drive Dysfunction due to pain Inability to have intercourse Research Posture and body mechanics Patients who have abdominal/pelvic surgery tend to have chronic pelvic pain posture and develop muscle imbalances Pelvic floor muscle balancing Pelvic floor muscle relaxation Abdominal scar massage Urinary retention management Rutledge et al 2014 showed that pelvic floor muscle therapy improved urinary incontinence and quality of life after surgery and chemotherapy for gynecologic cancers Yang et al 2012 showed that pelvic floor muscle training could improve urinary continence and sexual functioning of survivors of gynecologic cancers 2

3 Prostate Cancer Surgery Prostate Cancer Prostate Cancer Surgery Pelvic Complications from Prostate Cancer Surgery Urinary incontinence Fecal incontinence Abdominal pain of Complications Research for pelvic floor muscle exercise Urinary Incontinence Dietary modifications Behavioral modifications Posture and body mechanics Zhang et al 2015 showed that patients completing pelvic floor muscle exercise with biofeedback with or without formalized instruction improved urinary incontinence symptoms better than patients who received traditional care Wang et al 2014 showed that preoperative strengthening prior to radical prostatectomy improved overall urinary incontinence symptoms after surgery 3

4 of Complications Sexual Dysfunction Studies have shown that strengthening the pelvic floor muscles can improve blood flow to penis, and increase ability to maintain an erection May also counsel on positioning and behavioral modifications Colorectal Cancer Common Complications Abdominal pain Fecal incontinence Pelvic pain Abdominal Pain Scar tissue massage Exercise Colon massage Visceral mobilization Dietary recommendations Colon Massage Visceral Mobilization 4

5 Fecal Incontinence Dietary recommendations Behavioral modifications Sexual Dysfunction Abdominal pain/pelvic pain treatment Resolution of incontinence issues Research for pelvic floor muscle exercise after colorectal surgery Pelvic Pain Internal and external pelvic floor muscle myofascial release Abdominal release Pelvic floor muscle relaxation Constipation care Lin et al 2015 showed that patients undergoing rectal surgery had a significant decrease in the incidence of fecal incontinence if they performed a supervised pelvic floor exercise program Bartlett et al 2011 showed that a biofeedback pelvic floor exercise program can improve both quality of life, lifestyle, coping and embarassment Complications after Surgery Lung Cancer Urinary/Fecal Incontinence Due to chronic cough prior to surgery, pelvic floor is weakened and unable to resist intraabdominal pressure Urinary/Fecal Retention Due to thoracotomy, patients are unable to exert the necessary intraabdominal pressure needed for normal urination/defecation Patients become constipated or have difficulty with urination and defication 5

6 Increases in intra abdominal pressure Pelvic floor muscle retraining/balancing Toileting posture Constipation control General posture and body mechanics Reconditioning Physical Therapy Complications Neurologic Cancers Neurogenic bladder Urinary retention Urinary/fecal incontinence Poor bowel habits Neurogenic bladder Education for catheterization Pelvic floor muscle rebalancing Toileting postures Retention control Urinary Retention Bowel and Bladder diary Double voiding Avoiding post void residual Possible pessary Estim Possible TENS to sacral dermatomes 6

7 Bowel and Bladder Diary Urinary/fecal incontinence Constipation management Toileting Posture Poor bowel habits Fiber management Toileting posture Bowel program Summary Almost every type of cancer has bowel or bladder complications that accompany it Complications may be from surgery or continued cancer treatment such as chemotherapy or radiation Patients may not need to see a pelvic floor physical therapist more than 1-2 times, but all will benefit from a pelvic floor therapy referral Carina Siracusa, PT, DPT, WCS OhioHealth carina.siracusamajzun@ohiohealth.com