If you have been diagnosed with a digestive cancer (such as colorectal, anal, stomach, pancreatic, liver, or esophageal cancer) and are about to start or are currently undergoing treatment, having the right support can make a meaningful difference. Cancer treatments can affect your body in complex and often unexpected ways, particularly digestion, bowel function, and pelvic health. A physiotherapist with specialized training can help you understand and manage these changes with care and confidence.

Working with a pelvic health physiotherapist with advanced training in oncology is crucial for achieving the best outcomes. Treatments for digestive cancers (including surgery, chemotherapy, and radiation) can profoundly affect the abdomen, pelvic floor, bowel function, lymphatic system, and overall quality of life. Therefore, a therapist who understands both pelvic rehabilitation and cancer care is essential for comprehensive treatment.

Common Symptoms Associated with Digestive Cancer Care/Treatment

• Urinary and/or Fecal Urgency and Frequency
• Altered stool consistency
• Incontinence
• Evacutory Dysfunction (urinary and fecal)
• Gas-Stool discrimination dysfunction
• Radiation can lead to fibrosis, resulting in the tightening of internal structures and hollow organs. This can cause symptoms such as painful bowel movements, bladder urgency and frequency, discomfort during urination, and painful intercourse for women.
• Chemotherapy often causes GI inflammation & acute gastrointestinal symptoms as well as painful intercourse, painful urination
• Scar tissue and radiation fibrosis leading to reduced abdominal mobility
• Lower extremity Lymphedeama
• Cancer related fatigue
• Chemo-induced peripheral neuropathy (CIPN)
• Weakness and muscle loss
• Abrupt onset of menopause

How Rehabilitation at Cornerstone Works for Digestive System Cancers

At Cornerstone, our pelvic physiotherapists possess specialized training in oncology rehabilitation. This expertise enables them to address not only the physical aspects of pelvic and abdominal recovery but also the specific ways digestive cancer treatments can impact your body. They understand and treat common side effects such as changes in bowel function (urgency, incontinence, constipation), pelvic pain, sexual health issues, lymphatic swelling, scar tissue, fatigue, and overall recovery.

Our therapists are committed to staying current with the latest evidence-based research to provide comprehensive support for your symptoms, including:

• Bowel urgency or incontinence
• Constipation
• Abdominal or pelvic pain
• Gas and bloating
• Nerve symptoms
• Lymphatic swelling
• Changes in daily function

You don’t have to face this journey alone. We are dedicated to providing the knowledge, support, and empowerment you need every step of the way.

Initial Assessment (Approx. 60 Minutes)

Your first visit is a private, one-on-one session that allows your therapist to:

1. Gather a thorough medical history
2. Conduct a comprehensive physical examination

The physical examination often includes an internal pelvic floor assessment (vaginal and/or rectal). This is considered the gold standard for evaluating issues related to the pelvic floor and bowel, as these structures are located internally. The examination is always performed gently, using a gloved finger (not a speculum), and allows us to safely assess tissue mobility, pain, coordination, and strength while being mindful of any sensitivities, tissue fragility, narrowing, or post-treatment changes.

At the conclusion of the assessment, your therapist will clearly explain the findings, discuss how physiotherapy can help your specific symptoms, and outline a personalized treatment plan.

Follow-up Treatment Sessions (30 or 60 Minutes)

Subsequent treatment sessions are tailored to your needs, lasting 30 or 60 minutes as recommended by your therapist. To help you achieve the best possible outcomes, every session includes education, practical strategies, and home exercises to support your progress between visits.

Colorectal Cancer Rehabilitation

Approximately 6% of Canadians will develop colorectal (colon) cancer during their lifetime, making it the fourth most common cancer in Canada. While overall incidence rates are declining, diagnoses are increasing among adults under 50, likely due to environmental and lifestyle factors. As a result, more colorectal cancer survivors are living longer and managing the lasting physical effects of treatment, often without the rehabilitation support they need. That’s where we come in. Our specialized cancer rehabilitation program can help you recover, rebuild strength, and improve quality of life at every stage of survivorship.

What is Colorectal Cancer?

Colorectal cancer is characterized by a malignant tumor originating in the cells of the colon or rectum. These two organs, which make up the large intestine and are part of the digestive system, are often grouped together because they share the same tissue composition and lack a distinct boundary. However, despite their similarity in cell type, the specific location within the digestive system means that the treatment for colon cancer and rectal cancer can sometimes differ.

Common Symptoms of Colorectal Cancer

• Change in bowel habits (constipation, diarrhea, change in consistency)
• Rectal bleeding
• Blood in stool
• Abdominal discomfort (cramps, gas or pain)
• Feeling that bowel doesn’t empty
• Weakness/fatigue

What does Colorectal Cancer Treatment Involve?

Surgery is the primary treatment for Colorectal cancer. The specifics of the surgery, including its extent, are determined by the location and spread of the cancer. Whether you also receive Chemotherapy and/or Radiation, in addition to surgery, depends on the grade and stage of your cancer.

The surgical procedure involves removing the diseased section of the intestine, which runs from your stomach to your anus. The most common surgery is a Bowel Resection, which involves removing a part of the intestine along with nearby lymph nodes. The precise location of the resection will vary based on where the cancer is situated. A list of the different types of bowel resections is provided below.

• Right hemicolectomy – removes right side of colon
• Transverse colectomy – removes middle part of colon
• Left hemicolectomy – removes left side of colon
• Sigmoid colectomy – removes last part of colon
• Low anterior resection ( can cause LARS) – removes last part of colon and part of rectum – most common procedure currently in Canada
• Proctocolectomy – removes rectum and part of sigmoid colon (last part of the colon)
• Abdominoperineal resection – removes rectum, anal canal and surrounding muscles
• Subtotal colectomy – removes most of the colon
• Total colectomy – removes all of the colon

Side Effects of Colorectal Cancer Treatment

The side effects most often observed in our clinic are also those that were most frequently reported in the CHRISTENSEN et al. 2020 study.

• incontinence (97%)
• high stool frequency (80%)
• urgency (67%)
• evacuatory dysfunction (47%)
• problems with gas–stool discrimination (34%)
• effects on health related quality of life (80%)

Most Frequent Worries/Issues we hear from our patients:

• Finding toilets when away from home
• Getting to the toilet in time
• Emitting odour in social situations
• Experiencing bowel accidents
• Not tolerating the same diet as prior to surgery
• Having a sense of lack of bowel control and knowing what foods to eat when dining out
• Overall trouble feeling comfortable in social situations outside of their known environment which impacts their quality of life

How Can Cornerstone’s Cancer Rehab Program help?

• Empowerment through Education: Gain a clear understanding of the recovery process, including a realistic timeline (up to 1 year) for functional improvement.
• Coordinated Multidisciplinary Care: Facilitating connections with essential resources such as registered dietitians and other specialized therapists.
• Specialized Pelvic Floor Rehabilitation: Addressing urgency, fecal incontinence, and evacuation difficulties through strengthening and relaxation techniques, biofeedback using anorectal manometry, and internal manual therapy or dilator training for managing radiation fibrosis, stenosis, and painful intercourse.
• Core Strength and Conditioning: Improving abdominal strength post-surgery to enhance posture, reduce pain, aid stool evacuation, and optimize general reconditioning.
• Scar Management: Reducing pain and improving mobility through targeted scar tissue treatment.
• Advanced Bowel Symptom Management: Offering options like tibial nerve electrical stimulation combined with acupuncture for managing bowel urgency and frequency, as clinically indicated by your therapist.
• Neurological Rehabilitation: Implementing specific training to mitigate the symptoms of Chemotherapy-Induced Peripheral Neuropathy (CIPN), thereby improving dexterity, balance, and reducing fall risk.
• Lymphedema Treatment: Providing expert management and treatment for lower extremity lymphedema.
• Overall Quality of Life Improvement: Our comprehensive approach is dedicated to significantly enhancing your overall quality of life.

Bladder Cancer Rehabilitation

Bladder cancer, currently the fifth most common cancer, is typically diagnosed in older adults (aged 70+) and affects men three times more often than women. Incidence is declining in Western countries, a trend likely linked to the decrease in smoking, which is believed to be a contributing factor in 34–50% of all bladder cancer cases.

What is Bladder Cancer?

Did you know the bladder is a muscle? Bladder cancer develops when abnormal cells begin to grow in the lining of the bladder, multiplying uncontrollably to form a tumor. The most common type is Urothelial carcinoma, which is categorized as either non-muscle invasive or muscle invasive. Non-muscle invasive cancer is confined only to the lining of the bladder, whereas muscle-invasive cancer means the tumor has grown into the bladder muscle.

Common Symptoms of Bladder Cancer

• Blood in urine **** (most common symptom) – painless
• Urinary urgency and frequency
• Irritative voiding symptoms

Side Effects of Bladder Cancer Treatment

Surgical impact

• Post-op scar tissue affecting mobility of bladder and pain
• Can affect pelvic nerves that regulate bladder function
• Damage to internal or external urethral sphincter

Chemotherapy impact

• Bladder lining irritation and increased sensitivity to certain liquids (bladder irritants), causing urgent need to urinate.
• Chemo-induced menopause, which can lead to vulvovaginal atrophy and increased urinary frequency due to urethral and bladder overactivity.

Radiation impact

• Radiation Cystitis (inflammation of the bladder) = increased urinary frequency, urgency and sometimes painful urination
• Radiation fibrosis = varying levels of irritation and functional impairment to the bladder lining and muscle

How Physiotherapy can help with these side effects

Our Pelvic Oncology Physiotherapy team assists individuals after bladder cancer treatment in restoring comfort, confidence, and daily function. We offer support to retrain bladder capacity, manage urgency, and improve bladder emptying for urinary retention. Through personalized education, including the use of a bladder diary, we help identify bladder irritants and develop practical, tailored strategies.

Physiotherapy can also address pain, reduced abdominal mobility related to surgery, scar tissue, or radiation changes, as well as cancer related fatigue. Our objective is to help you rebuild strength, enhance movement, and return to the activities that you enjoy.

We also provide care for bowel changes, erectile dysfunction, and painful intercourse, which can occur after bladder cancer treatment. These concerns are common for those who have undergone neobladder (new bladder) reconstruction.

Pancreatic Cancer Rehabilitation

The pancreas, an organ located deep within the abdomen, has two vital roles: aiding digestion by producing digestive enzymes, and regulating blood sugar by creating insulin. Pancreatic cancer is a disease characterized by the growth of abnormal cells in this organ.

Common Symptoms of Pancreatic Cancer

• Abdominal or back pain
• Unexplained weight loss or loss of appetite
• Yellowing of the skin or eyes (jaundice)
• Digestive problems (bloating, greasy stools)
• New-onset diabetes or worsening blood sugar control

How is Pancreatic Cancer Treated?

Pancreatic cancer treatment usually involves a combination of therapies, chosen based on the stage of the cancer, overall health, and treatment goals.

1. Surgery
   • Surgery is an option when the cancer is found early enough and has not spread. Common procedures include the Whipple procedure, distal pancreatectomy, or total pancreatectomy.
2. Chemotherapy
   • Chemotherapy is often used before surgery, after surgery, or as the main treatment if surgery is not possible.
3. Radiation Therapy
   • Radiation may be used with chemotherapy or to help control symptoms such as pain.

Side Effects of Pancreatic Cancer Treatment

Side Effects of Surgery

• Abdominal pain and stiffness
• Fatigue and reduced endurance
• Weakness and muscle loss
• Scar tissue and reduced abdominal mobility
• Digestive changes (bloating, diarrhea, difficulty digesting fats)
• Weight loss
• Breathing changes due to pain or abdominal tightness

Side effects of Chemotherapy

• Cancer-related fatigue
• Nausea and appetite changes
• Muscle weakness and deconditioning
• Peripheral neuropathy (numbness or tingling in hands and feet)
• Balance problems and increased fall risk
• Brain fog or reduced concentration

Side effects of Radiation

• Fatigue (often builds over time)
• Skin irritation in the treated area
• Abdominal discomfort or cramping
• Reduced flexibility or tightness in abdominal tissues
• Pain or stiffness from radiation fibrosis

The Role of Physiotherapy

We are dedicated to helping you manage pain, enhance mobility, increase strength, restore function, and significantly improve your overall quality of life following cancer treatment by:

• Optimizing respiratory function through targeted breathing exercises to improve effectiveness and lung capacity, along with postural guidance post-surgery.
• Addressing balance difficulties associated with neuropathy.
• Designing safe, highly effective, and personalized programs for re-conditioning, strength building, and mobility restoration.
• Providing strategies for the effective management of cancer-related fatigue.
• Facilitating a secure return to daily activities and meaningful movement.

Kidney Cancer Rehabilitation

Your kidneys are two bean-shaped organs located in your lower back that filter waste from the blood and produce urine. Kidney cancer occurs when cells in the kidney grow uncontrollably, forming a tumor.

Common Symptoms of Kidney Cancer

• Blood in the urine (pink, red, or cola-colored)
• Pain or pressure in the side or lower back
• A lump in the abdomen or side
• Unexplained weight loss or fatigue
• Fever or night sweats
• High blood pressure in some cases

Side Effects of Kidney Cancer Treatment

• Pain or discomfort around the surgical site
• Reduced mobility or stiffness, especially in the abdomen, back, or hip
• Weakness or fatigue from surgery and recovery
• Scar tissue formation, which may limit trunk movement
• Changes in posture or gait due to pain avoidance
• Gastrointestinal issues (diarrhea, nausea)
• Fatigue
• Muscle or joint pain

Role of Physiotherapy in Kidney Cancer Care

• Improve strength, endurance, and balance
• Manage post-surgical pain or stiffness
• Support safe return to daily activities and exercise
• Address cancer-related fatigue and overall conditioning

Anal Cancer Rehabilitation

Anal cancer is a disease where abnormal cells grow in the tissues of the anus (the opening at the end of the digestive tract). Anal cancer is relatively rare when compared to incidence of other cancers but cases have been increasing over time.

Common Symptoms of Anal Cancer

Symptoms associated with Anal cancer usually present fairly early, however many people delay seeking medical because they think their symptoms are due to hemorrhoids.

• Rectal bleeding
• Itching, discharge
• Fistula
• Mass at anal opening (can feel fullness or might be able to palpate)
• Narrowing of stools (change)
• Fecal Incontinence
• Swollen lymph nodes in the anal or groin areas

How is Anal Cancer Treated?

Squamous cells of the anal canal are highly radiosensitive so respond really well to radiation. Sometimes patients will be given a type of chemotherapy (known as chemoradiation) to make them even more radiosensitive in hopes of improving effects of the treatment.
For small tumors that do not involve the sphincter (<1cm) local excision (surgery) can be performed . If the cancer is more invasive or larger it will not be addressed with surgery. Most patients are given chemoradiation after surgery to ensure the cancer was fully eradicated.

Side Effects of Anal Cancer Treatment

• Abrupt onset of menopause (true for pelvic radiation in general)
• Fecal Incontinence
• Chronic rectal pain – stenosis (narrowing and decreased extensibility due to radiation fibrosis)
• Sexual Dysfunction – stenosis (narrowing and decreased extensibility due to radiation fibrosis)
• Hip fractures – insufficiency fractures of the femoral heads

How Physiotherapy can help

Our Pelvic Health team can help with toileting techniques to reduce straining and ensure proper emptying in addition to pelvic floor strengthening to help with incontinence. Our dieticians can assist with dietary strategies to relieve symptoms.

Fee Schedule

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Resources

Our Partners and Additional Resources
Preventing Lymphedema After Breast Reconstruction: Why Early Physiotherapy Matters
Breast Cancer Rehabilitation: What to Expect