Pelvic floor dysfunction is a common side effect of cancer treatment. Disruption to the pelvic musculature through surgery, radiation or hormonal treatment can cause associated challenges with bladder control, sexual dysfunction and pelvic instability for both men and women. Other trauma and stress can create a cumulative effect contributing to a weakened pelvic floor, such as:
- child birth,
- surgery to remove the prostate,
- other pelvic surgeries,
- chronic cough,
- being overweight,
- lack of general fitness,
- repeated heavy lifting without contracting the pelvic floor first, or
- repeated straining to empty the bowels.
What is the Pelvic Floor?
The pelvic floor consists of several layers of muscles that reach from the tail bone (coccyx) to the pubic bone. It acts like a sling to support the bladder and bowel.
Symptoms of a weakened pelvic floor include:
- accidental leakage of urine,
- unintentional passing of wind, and/or
- leakage of bowel contents.
When triggered by laughing, coughing, or sneezing, these symptoms are referred to as stress incontinence.
Hormonal treatments for men and women can lead to a significant dysfunction in pelvic floor function. For women, estrogen deprivation that occurs after menopause and as a result of hormonal therapies will thin the lining of the bladder which can lead to “the urge to void” referred to as urge incontinence. Therefore strengthening these muscles is essential.
When speaking to groups of people with a cancer diagnosis we ask the question, “who has heard of Kegels”? Most often the women will nod their heads and the men will look at us with a puzzled expression. This is because women are commonly prescribed this type of exercise when preparing for childbirth. Men typically are not comfortable discussing “their equipment”. Speaking frankly is important, as it opens the door to learning and information on how to reduce symptoms and move towards healing.
Performing isolated special exercises for the pelvic floor is important for both men and women. These exercises, known as Kegels, help strengthen the muscular sling in the pelvic area. Stronger muscles reduce the symptoms of stress incontinence, urge incontinence and sexual dysfunction.
Finding Those Muscles
We like to have a little fun with this important topic in order to evoke discussion and to encourage engagement in exercises that may alleviate some of the uncomfortable and embarrassing symptoms listed above. Now, to the fun part, how do we engage, stimulate, and find these muscles?
The best way is to think about the times when you have wanted to avoid expelling gas, or when you need to stop the flow of urine. Or, for the men, pull the testicles up. Imagine what would happen if you put something cold under the testicles. For the women, squeeze vaginal wall and gently pull up. These are some common examples but unfortunately it is not that simple. It is really important to find and engage the muscles without recruiting gluteal, leg and or abdomen muscles. On top of that, remember to breathe!
Once you can engage these muscles, try holding the contraction for 3 seconds then releasing slowly. These muscles are small and the movement is subtle and there bigger muscle groups that want to help and take over. There are many other techniques to consider and fortunately there are a number of physiotherapists that can offer further treatment and help.
As Kinesiologists and Exercise Physiologists, we have had a lot of success helping individuals who suffer from pelvic floor dysfunction. In the cases where further, more specialized treatment is required, we have a number of excellent therapists to refer to.
Above all, we invite you to discuss this topic with your doctor, your partner, your exercise or physical therapist. Don’t be shy, help is available.
The Science Behind It
A number of studies support the benefits of pelvic floor exercises before and after surgical removal of the prostrate (radical prostatectomy). The incidence of incontinence after radical prostatectomy ranges from .5 to 87 percent according to an article written by Parekh in the Journal of Urology in 2003. Continence returns within the first year after surgery in the majority prostate cancer patients who perform pelvic floor exercises. However in cases of extreme incontinence, the benefit was limited. A study performed by Sueppel in 2001 showed improved continence outcomes when patients performed pelvic floor exercises prior to surgery. This is because the muscles are going in to surgery in a better condition, therefore come out in better condition.
Wille in 2003 found that pelvic floor exercises were just as effective alone as when combined with electrical stimulation and biofeedback in improving continence post radical prostatectomy.
A randomised controlled trial performed by Dorey in 2005 found pelvic floor exercises given to men who had erectile dysfunction for 6 months or less, either regained normal erectile function or improved erectile function after 6 months of the intervention.
About the Authors – Joanne Morgan, BHK & Dale Ischia, CSEP
Joanne is a certified Cancer Exercise Specialist and trained at the Mind Body Medicine Institute in Washington DC as a Cancer Guide. She works with InspireHealth members who inspire her with their courage and strength as they travel through their cancer journey.
Dale is an Accredited Exercise Physiologist specializes in exercise rehabilitation for cancer survivors.