On Anal Cancer Awareness Day, Sunday March 21st 2021, Anal Cancer Foundation co-founder Justine Almada and board-certified physical therapist Dr. Allison Romero, PT, DPT of Reclaim Pelvic Therapy hosted a webinar to discuss Taking Care of You: Tips and Exercises to Restore Your Pelvic Health after Anal Cancer Chemoradiation.
This hour-long webinar includes an overview of the impacts of anal cancer treatment as well as a plan to care for the nerves, muscles, and fascia that are affected by chemoradiation. It ends with an audience-led Q & A.
Resources we discuss and the physical therapy exercises Dr. Romero demonstrates and recommends for daily practice are included below.
Daily home practice, from Dr. Allison Romero:
These exercises can be done in your own home, with just a mat and some optional pillows for comfort. While Dr. Romero suggests practicing these daily, taking time to practice them even twice a week will still be helpful for most thrivers.
For visual demonstration, make sure to view the video above. The exact points in the video are provided for each exercise.
Exercise 1: Breathwork [35:14-40:11]
- 5 minutes of diaphragmatic breathing per day (breathing into the abdomen, not the chest):
- Put one hand on the abdomen, and one hand on the chest.
- Breathe in through the nose, and out through the mouth.
- Feel the ribcage expand: front to back, and then side to side, and then up and down.
Exercise 2: Fascial lengthening/mobility sequence [40:14-45:43]
- Lying on your back or side with knees bent (sitting is also fine):
- Bring both knees to the chest, and take 2 breaths.
- Extend one leg down to the floor and straighten the knee. Take 2 breaths and bring knee back to chest.
- Repeat with other leg.
- Straighten one leg. Bring bent knee across body toward the opposite shoulder.
- Rest the ankle of your bent knee on the opposite leg. Gently rest your hand on the raised knee to press toward feet and feel a back pocket (piriformis) stretch. Take 2 breaths.
- Keeping ankle on the knee, bring knee of raised leg across to opposite shoulder and back to feel a piriformis stretch. Do this 2-3 times.
- Bring raised leg back down to the floor and repeat on the opposite leg.
- Take 2-5 breaths in each position and feel free to modify as needed.
- Finish by bringing knees to chest one more time. Take 2 more breaths.
Exercise 3: Pelvic floor muscle activation [46:09-47:49]
- Draw pubic bone to tailbone.
- Draw sitz bones toward each other.
- Focus on squeezing just the anus closed and lifting up.
- Repeat the above exercises 10x.
Exercise 4: Quadrant circles [47:51-49:32]
- Bring pubic bone to right sitz bone.
- Bring right sitz bone to tailbone.
- Bring left sitz bone to tailbone.
- Bring pubic bone to left sitz bone.
- Repeat going the opposite direction.
Exercise 5: Engage anal sphincter [49:33-50:19]
- Bring the mind to the anal sphincter.
- Inhale once.
- As you exhale, imagine closing the anal sphincter, and lifting it up.
Finding a Pelvic floor physical therapist:
We recommend first checking with your oncologist for a referral to a physical therapist who is knowledgeable in pelvic floor physical therapy. If they are unable to give you a referral, the following websites may help you find a therapist in your area:
Addressing the cost of Physical Therapy and associated products:
We received several questions and comments about how expensive physical therapy and products such as dilators are. We know how frustrating this can be.
A referral from your oncologist to a pelvic floor physical therapist as well as a prescription for products will make insurance coverage most likely. Another option that has proven successful for some thrivers is calling insurance providers and asking them to make gap exception coverage for pelvic floor specialists.
If insurance is unavailable, Dr. Romero's advice is to encourage thrivers to think about investing in a one-time visit with someone in the pelvic floor field. The goal of this visit would be to develop an individualized plan that can be done daily at home without the need for continued visits.
Thank you again for your interest in this webinar and we hope you find this information useful. Some other resources to support you on your anal cancer journey are:
- See Dr. Romero's series on our blog about pelvic floor physical therapy.
- Learn about the side effects of radiation and other tools to manage them.
- Connect with a peer: our peer-to-peer support program matches thrivers and their caregivers with volunteers who have also been through treatment for knowledgeable support and connection.
Do you have other questions or feedback? Please contact us!