UNC Health Care
Woman doing hip bridge on exercise mat, using elastic band

Relieving Pain After Pelvic Cancers

Improvements in cancer therapy have led to an increase in life expectancy and cure rates in most types of cancers. While this is great news for anyone diagnosed with cancer, survivors sometimes experience ongoing pain as a result of their cancer treatment.

This often occurs in cancers that affect the pelvic floor, such as anal cancer, cervical cancer, uterine cancer and cancer of the vulva. But there is hope. While treatment such as radiation and surgery can cause uncomfortable side effects, pelvic physical and occupational therapy can help alleviate the pain.

We talked to UNC physical therapist Erika Johnson, PT, to learn more.

Treatment of Cancers in the Pelvic Region

Your pelvis is located below your bellybutton and above your thighs and includes your hipbones, sacrum (the bone at the base of the spine, between the hipbones), tailbone, bladder, rectum and reproductive organs.

Pelvic cancers that affect both men and women include bladder cancer, anal cancer, rectal cancer and cancer of the bone, which is called osteosarcoma. Male-specific pelvic cancers include prostate and testicular cancer, and in women, cervical, ovarian, uterine, endometrial, vaginal and vulvar cancers are possible.

If caught early, most pelvic cancers are curable. Treatment of pelvic cancer varies depending on the type and stage of cancer. Most often, it includes surgery and radiation, which can cause debilitating side effects that can affect long-term quality of life if not addressed.

For women who have had radiation, the tissues around the pelvic floor can change, which may narrow the vaginal canal. That can result in pain when pressure is applied, such as during intercourse or a bowel movement.

Side Effects of Cancer Treatment in the Pelvic Region

Side effects from cancer treatment to the pelvic region include:

  • Diarrhea
  • Incontinence (involuntary loss of urine or bowel control)
  • Pain during intercourse, gynecological exams and defecation
  • Bladder dysfunction (not emptying, or increased frequency or urgency)

Retraining the Pelvic Floor Muscles

Pelvic floor physical and occupational therapy can help alleviate these problems. Pelvic floor therapy is performed by a physical therapist who will work on your pelvic floor muscles externally or internally. Pelvic floor physical therapy varies depending on a patient’s symptoms, and each person’s physical and occupational therapy sessions will be unique. Treatment options include:

  1. Hands-on manual therapy techniques

Similar to massage, hands-on therapy helps to loosen the tissue and improve blood flow so that there’s better tolerance of penetration or bowel movements. This helps to “desensitize (the affected area) to some degree because they’ve been through trauma in that area,” Johnson says.

  1. Coaching on techniques patients can do at home

Therapists work with patients to learn techniques they can do at home to retrain their pelvic floor muscles, such as Kegel exercises, which are pelvic floor contractions. They also teach patients self-massage to alleviate their pain. Sometimes, therapists will teach their patients to use a dilator to gradually make the vagina more elastic.

“We work on strengthening and endurance and how to coordinate that with their day-to-day activities,” Johnson says.

So if a patient is leaking urine with sneezing, “we’re going to teach them how to use their pelvic floor when they sneeze,” Johnson says.

  1. Setting a schedule

If a patient struggles with increased or decreased bowel frequency and urgency or pain with bowel movements, therapists teach him or her how to establish a bowel routine during the day because a schedule helps regulate bowel movements.

“Bowels love a schedule, so go to bed roughly at the same time, get up around the same time and eat roughly at the same time,” Johnson says.

Physical therapists can also provide some general education on how diet, exercise and water can help bowel movements. For example, if a person is dehydrated, the muscles in the bowel region can cramp. Water helps with this muscle function and provides lubrication.

“We’ll help them determine if they are getting enough water and help them determine if they’re ingesting a lot of bladder and bowel irritants such as caffeine,” Johnson says. “These irritants could be contributing to their symptoms.”

Seek Help Soon After Cancer Treatment

Johnson says that too often patients don’t come for physical therapy until several years after cancer treatment.

“Many tell us they wish they had come soon after treatment instead of just living with what they thought was their new norm,” Johnson says. “Muscles that don’t work after eight years are harder to treat than those that don’t work after eight months, so we encourage them to come in soon after their cancer treatment ends. We want to help them have the best quality of life possible after treatment.”


Talk to your doctor if you have concerns about side effects from cancer treatment. If you need a doctor, find one near you.