Why Pelvic Rehab Should Be Part Of Your Cancer Recovery

Colorectal and urogynecological cancers may be on the rise, especially among young people, but thanks to early detection and better treatments, more people are surviving these cancers than ever. While this is great news, we know survivorship can come with its own set of challenges. Pelvic pain, incontinence, fatigue, changes in sexual function, and adjusting to life with an ostomy are just some of the issues people face after treatment for these cancers. Unfortunately, not enough survivors are being told about their physical therapy options after cancer treatment. 

Pelvic rehab is one of the most effective tools for addressing any and all of these symptoms. While surviving cancer is a huge milestone, we know that it marks just the beginning of your recovery. Physical therapy can help you address any uncomfortable symptoms after treatment and help you navigate the complex emotions that come with finding a new normal. You don’t have to navigate your cancer recovery alone. 

At Origin, we believe pelvic rehab should be an essential part of your healing process, not an afterthought. That’s why this National Cancer Survivor Month we’re highlighting the importance of pelvic rehab for cancer survivors. Read on to learn how this type of physical therapy can help you rebuild strength, restore function, and reclaim your life after cancer.

One woman’s recovery journey

When Marisa Peters, founder of Be Seen and host of From Carpools To Chemo, was diagnosed with early-onset colorectal cancer four years ago, she was shocked. As a young mom who had just birthed her third child, she had been told that her symptoms were just a normal part of recovery after childbirth. But her gut prompted her to seek more answers as her symptoms grew more concerning. Unfortunately, after over five years of voicing concerns she was diagnosed with stage 3 colorectal cancer. She underwent 11 months of chemotherapy, radiation, multiple surgeries and more, and we’re happy to share that she reached a complete response.

But her recovery wasn’t passive. Marisa took an active role from the beginning. Having worked with Origin for postpartum PT after each of her three children, she knew firsthand how powerful specialized physical therapy could be. 

Throughout her treatment and recovery, Marisa worked with a specialized cancer treatment physical therapist who provided in-home sessions. She and her therapist set clear goals and worked on building up muscle mass and endurance, all while managing fatigue, nausea and treatment-induced menopause at age 39. 

Marisa also leaned on a tailored estrogen therapy, a customized exercise program, and a multidisciplinary care team to help her manage the physical and emotional impact of treatment. Now, she wants more women to know how helpful holistic treatment can be during recovery, even if it takes more self-advocacy to assemble your team. 

Marisa believes that rehab should begin early and be part of standard cancer care, not something survivors have to fight for as they are fighting to regain their quality of life. We couldn’t agree more. According to Marisa, too many people only realize the impact on their pelvic or sexual health months after treatment ends, when symptoms are already disruptive and in some cases, irrevocable. 

Marisa’s story is proof that pelvic rehab for cancer survivors can be life-changing. In her words: 

"It wasn’t just about saving my life," she says. "It was about helping me feel and be alive." 

Our goal is to make sure you are aware of your options and know that, even though you’re amazing for surviving cancer, you don’t have to “just accept” when there are uncomfortable symptoms after.

Why prehab is important

For many, a colorectal or urogynecological cancer diagnosis comes with little time to prepare, and when possible, starting physical therapy before treatment (also known as “prehab”) can help build strength and stamina for what’s ahead. Building stamina before treatment can better support recovery and potentially reduce side effects from surgery, chemo, and/or radiation accompanied by the mental and emotional load. 

Engaging in prehab before cancer surgery can improve mobility, strength, and pelvic floor awareness, laying the foundation for a smoother recovery. Check with your doctor to see if prehab before cancer surgery is a good option for you.

What is pelvic rehab for cancer survivors?

While prehab is a great option, most people experience rehab after treatment. As empowering and relieving as completing cancer treatment is, your body might feel different than it once did. Whether you’ve undergone surgery, radiation, chemotherapy, or hormone therapy, the effects of these treatments can include muscle weakness, scar tissue, nerve damage, tissue tightness, and inflammation. These changes can lead to symptoms like incontinence, pelvic pain, constipation, painful sex, and more. But rather than accept these as par for the course establishing a new life norm, we want you to know you have options.

This is where pelvic rehab comes in. Pelvic rehab for cancer survivors is a specialized type of physical therapy that addresses pelvic floor dysfunction after cancer treatment. Just like you’d rehab a knee after ACL surgery, pelvic rehab helps you target and retrain your pelvic floor muscles if they’ve become weak or impaired by treatment. 

Pelvic floor therapy after cancer focuses on retraining and reconditioning these muscles to support daily function and long-term health. A typical pelvic rehab session can include:

• Evaluation: A thorough intake conversation and physical assessment to learn about your history, symptoms, and goals.
• Pelvic floor muscle training (PFMT): Targeted exercises to help strengthen or relax the pelvic floor muscles, depending on your symptoms.
• Manual therapy: Hands-on techniques may be performed internally or externally to reduce scar tissue, improve tissue mobility, and relieve pain. These techniques can be applied by a therapist in-person, or can be taught to you and/or your partner by a virtual provider. 
• Biofeedback: Technology that gives you real-time feedback on how your pelvic muscles are working, helping you build better control.
• Education: Clear, compassionate guidance on how your body works and what tools you can use to feel better.

Common post-treatment issues 

As any survivor knows, fighting cancer is a physically and emotionally taxing experience that can have a significant impact on your life and your body, including your pelvic floor. Treatment often leads to decreased strength and endurance and can affect how well your tissues function. You may notice new aches and pains, movement restrictions, or even permanent anatomical changes that require adjustment, such as the partial or complete removal of organs or the addition of a stoma. These changes are common, but they shouldn’t be ignored. Staying proactive in your recovery after treatment ends is key to preventing long-term issues and supporting your overall well-being.

Here are some common issues that can be addressed with pelvic rehabilitation:​

• Urinary incontinence: Loss of bladder control is common after pelvic surgeries or radiation, but that doesn’t mean you should leave it unaddressed. Research shows that pelvic floor muscle training can improve urinary symptoms in gynecological cancer survivors. 
• Fecal incontinence: In addition to bladder leakage, damage to nerves and muscles during treatment can lead to bowel control issues, or fecal incontinence. A 2018 randomized controlled study reported that supervised pelvic floor muscle training in combination with conservative treatment helps improve fecal incontinence.
• Pelvic pain: Radiation and surgery can cause scarring and muscle tension, which can contribute to joint restrictions or limitations in ease of movement. Manual therapy combined with neuromuscular training techniques can help reduce pain and improve muscle function.​
• Sexual dysfunction: Pain during intercourse, reduced libido, and vaginal dryness are prevalent among survivors. Holistic pelvic floor physical therapy has demonstrated sustained improvements in sexual function and reduced distress.
• Scar tissue and adhesions: Post-surgical or post-radiation adhesions can restrict movement and cause discomfort. Manual therapy helps mobilize scar tissue, enhancing flexibility and reducing pain and tension.
• Fatigue and weakness: Deconditioning is one of the most common effects of cancer treatment. A personalized, progressive exercise program can help restore strength and endurance.​
• Body image concerns: It’s important to acknowledge that changes in bodily function and appearance can affect both self-esteem and a person’s mental health. Education and counseling within pelvic rehabilitation can address some of these concerns, and help you identify if another specialist may be appropriate during your recovery.

Addressing these issues through pelvic rehabilitation not only can improve physical function but can offer some much needed support as you navigate life after treatment, and all the changes that can come with it. 

Can physical therapy help with incontinence after cancer surgery?

Absolutely!  Physical therapy is one of the most effective tools for managing and improving bladder and bowel control after cancer. A 2024 umbrella review highlighted the therapeutic potential of pelvic floor rehabilitation in cancer survivorship, emphasizing its role in improving bladder, bowel, and sexual function, as well as overall quality of life. Multiple other recent studies have found that pelvic floor muscle interventions significantly benefited gynecological cancer survivors, reducing pain, enhancing sexual function and improving health-related quality of life.

Incontinence is a common side effect of cancer treatment, especially after pelvic surgeries or radiation which are often part of the treatment for colorectal and urogynecological cancers, but that doesn’t mean you need to just accept it. We can teach you exercises to improve muscle coordination, strategies to reduce leakage, and ways to manage your pelvic floor health for life. Whether you’re dealing with leakage, urgency, or frequent nighttime trips to the bathroom, physical therapy after cancer treatment can be life-changing.

Can pelvic floor therapy help with bowel problems after colorectal cancer?

Yes! Pelvic floor dysfunction after colorectal or urogynecological cancer can include bowel habit changes like increased constipation, urgency, or fecal incontinence. As with urinary incontinence, pelvic floor therapy can teach you how to coordinate your muscles more effectively for bowel movements and help you feel more comfortable leaving your home without fear of an accident. 

Managing pelvic pain after cancer

Pelvic pain can show up days, months or even years after cancer treatment. It may stem from scar tissue, nerve changes, muscle tension, or even postural patterns. This kind of pain can interfere with everything from sitting comfortably in a chair to intimacy. 

Pelvic floor therapy is a great tool to help reduce pelvic pain and improve quality of life after cancer. Techniques like myofascial release, breathwork, mobility exercises, and gentle internal work can ease muscle tension, improve circulation, and promote healing.

Unfortunately, so many people experience pelvic pain long after their cancer treatment is complete. This can be due in part to not receiving the tools to prevent pain early on. Regardless of how long it’s been since your treatment, we’re always here to help you address any issues – even years later.

Intimacy after cancer

This is one of the most common issues we see, but for many, it’s not an easy one to discuss. Becoming intimate again after cancer is deeply personal and can take time and patience. Many survivors report changes in desire, comfort, or body image as a result of their cancer and cancer treatment. Others experience physical symptoms like vaginal dryness or pain with penetration, especially those whose treatment propels them into early menopause like Marisa experienced beginning at age 39. “While these issues are common, we want to scream from the rooftops that they are treatable”, shared Marisa.

Pelvic rehab provides a safe and supportive setting to address these concerns and provide you with the tools you need to feel comfortable and happy to return to intimacy after cancer treatment.

What exercises help with sexual function after cancer treatment?

There are a number of different exercises and tools that can be used for this type of treatment, but it’s important to remember that restoring comfort with intimacy after cancer is about more than just exercise. Your physical therapist will be the best person to guide you through the best exercises for your body, but a holistic approach often includes:

• Pelvic floor muscle training, which helps support arousal and orgasm while improving blood flow.
• Stretching and mobility work to reduce tension and pain.
• Dilator therapy, which consists of gradual, guided use of dilators to help restore comfort and reduce pain during penetration.
• Relaxation and breathwork to encourage full-body relaxation and reduce anxiety around intimacy.

In addition to these rehab tools, honest communication with your partner can help with reclaiming intimacy after cancer. Make sure you talk about any anxiety or emotions you have around sex and intimacy. Be patient and kind with yourself. And remember that reconnecting with your body and your partner after cancer treatment is a journey, and we’re here to support you through it.

How long does it take to recover from pelvic floor dysfunction after cancer?

Recovery depends on so many different variables and looks different for everyone. Some people notice improvement within a few weeks, while others may need several months of consistent care. Factors such as the type and intensity of your cancer treatment, your baseline health and fitness, and the specific symptoms you're managing can all impact your recovery timeline. It’s important to just be patient, and focus on your own recovery. But one thing is for sure: It’s never too late to start, and progress is always possible.

Building a better future for cancer survivors

Like Marisa, we are determined to help cancer survivors know what the types of support that exist. Marisa encourages women to speak up, even when it feels hard. "The stigmas start around us, and they also live inside us," she says. "If we’re not mindful, they can stop us from living our fullest life."

So here’s our reminder to you: Physical therapy exists to support you throughout your cancer recovery, from diagnosis to treatment and beyond. If you’re experiencing any pelvic floor symptoms that feel unusual or disruptive, don’t wait to seek help. While physical therapy is often seen as a follow-up to a diagnosis, our pelvic floor physical therapists are often the first to diagnose an issue when something isn’t right. Then, we can either treat it or help you get the care you need. If your doctor hasn’t brought it up, you can. Advocate for yourself. You deserve to feel like you.

Our physical therapy team is here for you

“Recovery after cancer treatment takes a village. And it takes using your voice, starting first by listening to your body,” shares Marisa. Whether you’re newly diagnosed, currently in treatment, or years out from your last session, our pelvic floor specialists are ready to support you. Schedule your first visit today. 

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Sources Cited

1. Siegel, Rebecca L., et al. "Cancer Statistics, 2024." CA: A Cancer Journal for Clinicians, vol. 74, no. 1, 2024, pp. 12–49. Wiley Online Library, https://doi.org/10.3322/caac.21820.acsjournals.onlinelibrary.wiley.com
2. Kraus, Sarah, et al. "Pelvic Floor Dysfunction in Gynecologic Cancer Survivors: A Systematic Review." Journal of Cancer Survivorship, vol. 15, no. 4, 2021, pp. 456–467. PMC8267161.
3. Ussing, Anja, et al. "Efficacy of Supervised Pelvic Floor Muscle Training and Biofeedback vs Attention-Control Treatment in Adults With Fecal Incontinence." Clinical Gastroenterology and Hepatology, vol. 17, no. 11, Dec. 2018, pp. 2253–2261. Elsevier, https://doi.org/10.1016/j.cgh.2018.12.015.
4. Nakashima, Yuki, et al. "Efficacy of Pelvic Floor Muscle Training for Postoperative Patients with Rectal Cancer: A Systematic Review and Meta-Analysis." Cureus, vol. 15, no. 12, 2023, e50287. PMC10776499.
5. Cyr, Marie-Pierre, et al. "Improvements Following Multimodal Pelvic Floor Physical Therapy in Gynecological Cancer Survivors Suffering from Pain During Sexual Intercourse: Results from a One-Year Follow-Up Mixed-Method Study." PLOS ONE, vol. 17, no. 1, 2022, e0262844.
6. Hao, Jie, et al. "Pelvic Floor Rehabilitation in Cancer Survivorship: An Umbrella Review." Journal of Cancer Survivorship, 25 Nov. 2024, doi:10.1007/s11764-024-01713-0.