Managing the Effects of Pelvic Radiation
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Radiation therapy is a common treatment for people who have pelvic cancers, including gynecologic, prostate, and colorectal cancer.
Radiation damages the pelvic structures which can lead to bladder, bowel, and sexual dysfunction, as well as pain, but treatment is available!
Keep reading to learn more about common effects to expect from pelvic radiation therapy and how to manage them.
Work with a pelvic health physical therapist
If you’re having bladder, bowel, or sexual dysfunction, a pelvic health physical therapist can help you address these concerns. Pelvic health physical therapists have additional specialized training to treat conditions affecting the pelvic floor muscles. The first visit will include the physical therapist asking many questions about your symptoms and cancer history including what treatment you’ve had. A physical exam, including a pelvic exam, will also be performed. This allows the physical therapist to get a clear picture of what is contributing to your symptoms and what types of interventions are needed. The end of the first visit should include a recap of what their exam findings were, what to expect at upcoming visits, and some homework.
Tip: If you’re not comfortable with pelvic exams or have questions, talk to your physical therapist! There are other options besides a vaginal or rectal pelvic exam.
Start a dilator program
If you’ve had pelvic radiation to treat cancer and you are a woman / vulva-owner, then you will need to use dilators. Dilators can help with reducing fibrosis, improving tissue mobility, and allowing for comfortable penetration for sexual activities and/or for pelvic exams. Dilators are typically started 4 to 6 weeks after radiation therapy is finished, but make sure to talk to your radiation oncologist and your pelvic health physical therapist about when it’s appropriate for you to start.
For general instructions on using dilators as well as different brand options, check out my previous blog post.
Always check with your oncologist and pelvic health physical therapist on what your dilator program should look like.
Perform pelvic floor muscle exercises
Regardless of your gender, you should be performing pelvic floor muscle exercises after pelvic radiation. This doesn’t necessarily mean doing a bunch of Kegel exercises to make the muscles stronger; you may need to work on lengthening and relaxing the pelvic floor muscles, especially if you have radiation fibrosis and pain. An assessment by a pelvic health physical therapist will help you figure out the type of pelvic floor exercises that you need to do.
If you have radiation fibrosis and pain, try this exercise: gently contract the pelvic floor muscles for 3-5 seconds, then gently bulge the pelvic floor as if passing gas for 3-5 seconds. Do not strain or push very hard with this exercise. Bulging helps to lengthen the pelvic floor muscles and tissues and helps them become more mobile. Repeat this exercise 5 times and perform several times throughout the day.
Stretch
I often recommend stretches after radiation therapy to help decrease any pain and tightness at the pelvic floor muscles. Happy baby is a great stretch to help lengthen and relax the pelvic floor muscles..
Happy Baby stretch
Lie on your back and bring your knees up towards your chest
Slowly bring your knees out and support them with your hands either at the knees or at the ankles like in the picture
Hold this stretch for 1 minute and perform deep belly breathing
You should not have any pain with this stretch! If you do, stop.
Additionally, people often experience tight hips and hip and low back pain after radiation therapy. Gentle stretches, resistance training, and staying active can help address any hip or low back problems you may have. An oncologic physical therapist can assess you from head to toe and provide you with different exercises to help you feel and move better.
Monitor for lymphedema
Finally, an often-overlooked side effect of pelvic radiation therapy is lymphedema. This is an abnormal accumulation of lymphatic fluid as a result of damage to the lymphatic system. For those who have had pelvic radiation, you may experience lymphedema in the genitals (scrotum, penis, vulva, vagina), the lower abdomen, and/or the legs. If you develop lymphedema, work with a Certified Lymphedema Therapist (CLT or CLT-LANA) to reduce the swelling and improve your function. Some indications that you may have lymphedema include:
Swelling
Skin firmness
Heaviness or achiness in the legs or genital region
Indentations (pitting) across waistband
Underwear band and pants/shorts feel tighter
If you had radiation to the pelvic area for cancer treatment, work with a physical therapist for the best outcomes. It can be daunting finding someone to address your needs, so check out my previous blog posts about pelvic health physical therapy and oncologic physical therapy to learn more about what to expect and how to find a provider.
