Integrating Pelvic Health Into Cancer Rehab: A Step-by-Step Clinical Framework
If you work in oncology rehabilitation, you’ve likely encountered this moment: a patient mentions bladder leakage, difficulty with bowel movements, pain with intimacy, or a sense of pelvic heaviness they don’t quite have words for.
You pause, wondering whether this is something you should address, whether it’s within your scope, or whether you’re opening a door you don’t yet know how to walk through.
Many highly skilled clinicians share this hesitation because pelvic health has rarely been integrated into traditional oncology rehabilitation education. At the same time, cancer survivorship is evolving rapidly, with more people living longer and managing long-term effects that significantly impact pelvic health. Despite this shift, most rehab clinicians lack a clear, practical framework for how to integrate pelvic health into oncology care.
This post outlines an actionable, clinically grounded guide for oncology rehab professionals so pelvic health is no longer avoided in the care of People Living With and Beyond Cancer (PLWBC).
Why Pelvic Health Belongs in Cancer Rehabilitation
Cancer survivorship is no longer a niche population. In the United States alone, over 18 million people are currently living as cancer survivors, with projections exceeding 22 million within the next decade. Survivors are living longer and increasingly managing long- and late-term effects of surgery, radiation, chemotherapy, and endocrine therapies — many of which directly or indirectly affect pelvic health.
Research consistently demonstrates that PLWBC experience elevated rates of urinary and bowel dysfunction, pelvic pain, and sexual dysfunction following treatments for cancers such as breast, prostate, colorectal, gynecologic, and bladder cancers. These issues are not rare complications; they meaningfully affect activity participation, quality of life, mental health, and the ability to return to valued roles and routines.
Financial realities also matter. Many cancer survivors delay or avoid specialty care due to cost or access barriers, making early screening and basic rehabilitation interventions essential. If we do not screen for pelvic health concerns within oncology rehab, patients may wait until symptoms are severe, or never seek help at all.
What “Integrating Pelvic Health” Actually Means (and What It Doesn’t)
Pelvic health integration should be viewed as part of comprehensive survivorship care rather than as a separate or siloed specialty.
Integrating pelvic health into cancer rehabilitation does not mean performing internal pelvic examinations or specialized pelvic assessments without appropriate training, treating pelvic conditions beyond your competency, or replacing pelvic health specialists. Instead, it means normalizing pelvic health as part of whole-person cancer care, consistently screening for common pelvic floor–related symptoms, providing education and basic interventions within general rehabilitation scope, and knowing when and how to refer appropriately.
This approach allows clinicians to ethically expand their impact without overstepping professional boundaries.
A Step-by-Step Clinical Framework for Integration
Step 1: Normalize Pelvic Health Early
Patients often do not bring up pelvic concerns because they assume symptoms are normal after cancer, believe nothing can be done, worry it is inappropriate to discuss, or simply feel embarrassed. Clinicians can change this dynamic with simple, welcoming language that removes stigma and signals safety.
For example: “As part of cancer treatment and recovery, many people notice changes in bladder, bowel, or pelvic function. I like to ask everyone about this because help is available. Is it okay if I ask you a couple of questions about your pelvic health?”
This approach does not require solving the problem immediately. It simply opens the door and communicates that pelvic health is a valid and expected part of cancer rehabilitation.
Step 2: Screen Consistently
You do not need an extensive pelvic intake to screen effectively. Every oncology rehab patient should be screened for pelvic health concerns, with particular attention given to those with a history of pelvic cancers or hormone therapy, regardless of tumor location.
Key symptoms to ask about include urinary leakage, urgency, frequency, or difficulty emptying; constipation, fecal urgency, or leakage; pelvic pain or pressure; and sexual concerns. While red flags such as acute bleeding or new neurologic changes warrant immediate medical referral, many pelvic symptoms can be triaged and addressed conservatively within rehabilitation.
Consistent screening ensures that symptoms are identified early rather than emerging later as crises.
Step 3: Address What Is Within Your Professional and State Scope
There is a great deal you can safely and ethically address without specialized pelvic certification. This includes breathing and pressure management strategies, pain science education, postural and mobility interventions, core and trunk strengthening and coordination, and education on fiber, hydration, bowel habits, and voiding strategies. Activity modification and graded return to function are also well within the scope of oncology rehabilitation practice.
Even acknowledging pelvic health concerns and validating that help exists can significantly reduce distress and isolation for PLWBC. Patients often feel relief simply knowing their symptoms are recognized and legitimate.
Step 4: Refer to a Pelvic Health Specialist When Appropriate
Beyond screening and early intervention, it is critical to recognize when referral is indicated and to have a clear pathway for doing so. Even symptoms often labeled as “simple,” such as stress urinary incontinence, frequently involve more complexity than pelvic floor strengthening alone can address.
A reasonable clinical approach is to initiate behavioral, lifestyle, and general therapeutic interventions while referring out for persistent bladder and bowel dysfunction, suspected prolapse, pelvic pain, and sexual dysfunction.
How referrals are framed matters. Patients are far more likely to follow through when referrals are normalized as part of comprehensive care and when they understand what to expect from pelvic health physical therapy.
If you need a better understanding of what pelvic health physical therapy involves, check out my YouTube Pelvic Health Playlist with videos that break down everything from what patients can expect at a pelvic health PT visit to choosing (or referring to) the right pelvic PT.
Common Barriers Clinicians Face — and How to Move Past Them
Many clinicians express concerns such as, “I don’t feel qualified,” “I don’t want to open something I can’t treat,” or “I don’t know how to bring this up.” These fears are understandable, especially given how underrepresented pelvic health is in oncology training.
However, competence does not require mastery. It is built on foundational knowledge, safe practice, and knowing when to collaborate. Avoidance, on the other hand, leaves patients without guidance during a particularly vulnerable phase of recovery.
Trying to piece together pelvic health knowledge from brief webinars or social media alone is often insufficient, particularly given the complexity of oncology populations.
This gap is precisely why I created Pelvic Health Foundations for the Oncology Rehab Provider: to give rehabilitation clinicians a clear, oncology-informed framework for screening, education, and early intervention, without overstepping scope or requiring advanced pelvic specialization.
Ready to Build Confidence in Integrating Pelvic Health Into Cancer Rehab?
If you want to improve your skills and confidence in addressing pelvic health as part of oncology rehabilitation, consider enrolling in the on-demand course, Pelvic Health Foundations for the Oncology Rehab Provider. In this course, you’ll learn how pelvic health conditions commonly present among PLWBC, what screening questions to ask and how to ask them, evidence-based education and therapeutic exercise interventions with clinical rationale, and specific considerations for oncology rehabilitation providers. Real-world case examples will help you integrate this knowledge seamlessly into your clinical practice.
Pelvic health does not need to be a separate conversation from what you are already addressing with your oncology patients. It belongs in cancer rehab, front and center. With the right foundation, you can better support your patients, reduce long-term morbidity, and practice with greater confidence.
By integrating pelvic health into oncology rehabilitation, you help ensure every survivor receives comprehensive, compassionate care — empowering both yourself and your patients for the road ahead.
