This is the first of a three-part series regarding the benefits of physical therapy after treatment for anal cancer. The HPV and Anal Cancer Foundation is thrilled to have licensed physical therapist Dr. Allison Palandrani lend her expertise on this subject matter.

Featured Contributor: Allison Palandrani, PT, DPT

At the pelvic rehabilitation center where I work as a licensed physical therapist, we treat a wide variety of patient populations. One population that we’re beginning to see more often is individuals diagnosed with and treated for anal cancer.

This population remains highly underserved when it comes to physical therapy (PT). That’s because many physicians and patients simply are not aware of the help that physical therapists, specifically pelvic floor physical therapists, can offer to people that have been through treatment for anal cancer.

Thus, the HPV and Anal Cancer Foundation invited me to write this blog, which gives an overview of how pelvic floor PT can help people who have undergone treatment for anal cancer.

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 the U.S. in 2014.

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 discomfort, anal and vaginal canal stenosis, and sexual dysfunction. Fortunately, pelvic floor PT can help with these, as well as with the following, side effects:

  • hip pain and/or pelvic pain;
  • loss of hip and pelvis range of motion;
  • surgical pain if there is a surgery;
  • fatigue, which can be short-term or long-term;
  • lymphedema, which is localized fluid retention due to a compromised lymphatic system;
  • general musculoskeletal impairments, such as overall weakness, neuropathy or deconditioning as a result of lack of use;
  • 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

There is a role that physical therapy can play in the management of the above-mentioned side effects. While there is not much research literature yet regarding this issue, we’ve seen very good clinical evidence that indicates pelvic PT is worth the time and resources for patients. This is a good time to mention that while I am a licensed physical therapist, and treat a large number of people with these symptoms, it is necessary to speak with your physician before initiating any type of physical therapy treatment.

So exactly how can PT help?

Musculoskeletal pain.  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; 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.

Vaginal and anal stenosis. For pelvic floor dysfunction caused by stenosis of the anus and/or vagina, manual therapy can help to maintain the patency or openness of the canal. Patients with vaginal and/or anal canal stenosis may 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. This will be discussed in more detail in a future post.

Gas and/or fecal incontinence. 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 functional weakness 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 anal 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.

Pelvic strength and mobility. 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 re-education, and patient-specific exercises.

  1. Fatigue is a big issue for patients going through cancer treatment and there isevidence to support that PT in general 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.
  2. 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, it is recommended to speak to your doctor 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.

Part 2 and Part 3 of the series are now available!

Allison-head-shot-150x150Allison received a bachelor’s degree in exercise science from Sonoma State University and a clinical doctorate in physical therapy from the University of Southern California. She is a physical therapist specializing in pelvic floor dysfunction and treatment at the Pelvic Health and Rehabilitation Center in San Francisco, CA.  Allison is an active member of the International Pelvic Pain Society and is involved with community outreach and education in the Bay Area. She has been specifically involved in treating issues related to treatment for anal cancer and was recently given the opportunity to speak at the Educational Forum for Anal Cancer Survivors at the University of California, San Francisco.