Spotlight On: Pelvic Physical Therapists in Cancer Care

March 31, 2021
Brielle Gregory Collins, ASCO staff

If you’ve been diagnosed with cancer, you will interact with a number of different members of the health care team at various times during treatment. When you walk into a doctor’s office, hospital, or cancer center, you may encounter nurses, physician assistants, social workers, doctors—the list goes on. In the Spotlight On series, we talk with some of these health care professionals to learn more about their jobs and the role they play in providing high-quality cancer care.

Lucia Miller, PT, MPT, PRPC, is a physical therapist who specializes in pelvic physical therapy. After graduating with her MPT, she worked in dance medicine, neurology rehabilitation, and outpatient orthopedics for 27 years. Her focus for the past 13 years has been in the specialty practice of pelvic physical therapy. Lucia launched the Pelvic Health Physical Therapy program at Sutter Novato Community Hospital in Novato, California, and at the Stanford Pelvic Health Center in Redwood City, California. She has no relationships relevant to this content to disclose.

People with certain types of cancer, including bladder cancer, cervical cancer, colorectal cancer, ovarian cancer, prostate cancer, and uterine cancer, may experience changes in how their pelvic organs function during or after cancer and its treatment. A person’s pelvic organs include the bladder, bowel, cervix, prostate, rectum, uterus, and vagina. Changes to the function of these organs caused by cancer and its treatment can lead to pain, discomfort, and problems with sexual function.

To help, a pelvic physical therapist, who may also be referred to as a pelvic floor therapist, may become part of the cancer care team. A pelvic physical therapist helps address issues related to the pelvic organs and pelvic floor, or core muscles, that people with cancer may experience.

Here, pelvic physical therapist Lucia Miller describes the role a pelvic physical therapist plays on the cancer care team and the impact pelvic health has on quality of life for people with cancer.

Why did you become a pelvic physical therapist?

Lucia Miller (LM): I had been working for 14 years primarily in orthopedic physical therapy as a manual therapist and Pilates-based rehabilitation specialist, integrating my background in professional dance. Pelvic anatomy had intrigued me in grad school, but it was only very briefly covered. I was exploring this subspecialty of orthopedic physical therapy when, serendipitously, a pelvic physical therapist called asking if I would study, get certified, and train with her to work in her busy pelvic physical therapy practice. In my 13 years now in pelvic health physical therapy, I see patients with a broad range of diagnoses, including people with cancer and cancer survivors. As patients were referred to us for pelvic and pelvic floor issues, we were able to explore and address how cancer, surgery, chemotherapy, and radiation therapy affect the pelvic region and how pelvic physical therapy can help.

What role does a pelvic physical therapist play on the cancer care team?

LM: In general, pelvic physical therapists and physical therapists are part of the glue connecting the multidisciplinary team treating each person with cancer. This is because physical therapists treat the patients of each specialist and care provider on the medical care team. We are able to take the time to listen, support, educate, and advocate for these patients in addressing their complex needs. People with cancer have many concerns and fears that we can help allay through education, interventions, and exercise. We also provide reassurance that we will address their care plan across body, mind, and spirit.

Pelvic physical therapists focus on the anatomy and function of the pelvis, including the pelvic floor muscle, pelvic organs, and lymphatic system. We use practices such as soft tissue mobilization (manual therapy aimed to help reduce tight muscles, heal scar tissue, and improve circulation), visceral manipulation therapy (to help your body release organ restrictions), biofeedback therapy (for muscle coordination training), electric stimulation, ultrasound, dilator and pelvic wand therapy, and rectal balloon sensory therapy to help patients. We also advise people on the use of supplements, tools, and products for self-care and home exercise.

What are some of the most important things you do for people with cancer in your role?

LM: The most important thing we do as pelvic physical therapists is listen. People with cancer are navigating unknown territory and can have tremendous anxiety and questions regarding their symptoms and changes in bodily function. When patients feel heard, we can often uncover some of the hidden components of their current condition and experience that they may not readily share with other health care providers. Establishing this trust is key to moving toward a return to full restoration of organ and muscle function.

The other side of the therapeutic relationship is empowerment. We challenge patients to take responsibility for their self-care and home exercise practices. We are there to help them help themselves and become independent in their self-care of their body, mind, and spirit. We instruct them in the use of manual therapy, stretches, mindfulness practices, stress management tools, pain management interventions, exercise protocols, dietary and nutritional information, behavioral management, and supportive services, which include using books, apps, and podcasts.

What are some common concerns your patients have, and how do you help address them?

LM: Many people with cancer have concerns about the changes in the function of their bladder and bowel, sexual function, development of scar tissue, lymphedema, and soft tissue stenosis (also called fibrosis). Concerns about fatigue, weight loss or weight gain, and cognitive or emotional changes are common.

During cancer, people may develop incontinence of the bladder or bowel, changes in the urge to pass urine or have a bowel movement, or pain of the bladder, rectum, or sexual organs. Scar tissue adhesions and soft tissue stenosis may also cause pain and problems with the function of pelvic organs and circulatory system, including the lymphatic system. Pelvic physical therapy helps retrain organ function and reduces pain by using biofeedback therapy, manual therapy, exercise, and educational tools to help reduce symptoms and restore function. Changes in energy level or chronic fatigue can be addressed with individualized exercise programs as well as with recommendations and resources addressing weight goals, pain management, improved cognitive function, and emotional support.

What is 1 thing that people should be aware of when it comes to pelvic physical therapy and cancer?

LM: People should be aware that the body is complex and very plastic, which means it is capable of changing and healing. No matter where they are in their cancer experience, pelvic physical therapists take a holistic, multimodal approach because there is never just 1 symptom or 1 complaint. All signs, symptoms, and functions must be addressed holistically through the body, mind, and spirit, which is known as the biopsychosocial model of medical care.

How can people with cancer better communicate with their pelvic physical therapist?

LM: Honesty is the best policy. The best way we can help is for you to communicate your thoughts, insights, and concerns. I always ask my patients, “What do you think your body is telling you through this symptom?” People usually have an intuitive sense of what is going on in their body that can be helpful in the therapeutic process. Many people feel embarrassed or ashamed to share their concerns. We can assure them that, while in our society people do not freely talk about these very private aspects of themselves, they are not alone in their experience, and nothing will shock us. We have heard and seen it all, and we can provide a safe space for sharing of their intimate concerns.

What are some of the most rewarding parts of your job?

LM: The most rewarding aspect of my work is seeing patients regain function and functional mobility; develop a newfound body awareness; restore the pelvic functions of their bladder, bowel, and pelvic floor muscles; restore their sexual function; and experience less pain. Being able to help people regain these vital, intimate, and fundamental aspects of themselves is deeply rewarding.

How can someone with cancer find a pelvic physical therapist for their care team? 

LM: The American Physical Therapy Association (APTA) website has a Physical Therapist Locator tool to find a pelvic physical therapist in your geographic area. Herman and Wallace’s website also has a tool that allows you to find a physical therapist with a Pelvic Rehab Professional Certification near you.

Share your thoughts on this blog post on Cancer.Net's Facebook and Twitter.