An internal assessment is recommended as the gold standard for accurately evaluating pelvic floor function. However, it is never required. We only proceed with your full consent, and your physiotherapist will discuss all available options to ensure you feel comfortable.
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If you have been diagnosed with a gynecological cancer, having the right support makes a profound difference. Cancer treatments often affect the body in ways that aren’t widely discussed. A pelvic physiotherapist with specialized oncology training can help you understand and manage these changes with care and confidence. To achieve the best possible outcomes, it is vital to work with a professional who understands the unique intersection of pelvic health and oncology.
At Cornerstone, our pelvic physiotherapists possess advanced training in oncology rehabilitation. They understand the physiological impact of surgery, chemotherapy, and radiation, and utilize evidence-based strategies to facilitate your recovery. By staying at the forefront of clinical research, our team provides expert care for medically induced menopause, pelvic pain, bladder and bowel dysfunction, and sexual health concerns. You don’t have to navigate this journey alone. We are here to ensure you feel informed, supported, and empowered at every stage.
Our Assessment for Women’s Reproductive Cancers
Your initial assessment is a one-hour, one-on-one session in a private treatment room. Your therapist will review your full medical history and perform a gentle objective exam. This typically includes an internal assessment, which is the gold standard for evaluating the pelvic floor muscles and organs located within the pelvis.
This exam is performed with the utmost care. We use a gloved finger (rather than a speculum) to assess tissue mobility, strength, and sensitivity. This approach allows us to be precise while remaining mindful of any tissue fragility or narrowing. Afterward, we will explain our findings and collaborate with you to develop a personalized treatment plan.
Treatment and Care
Sessions are 30 or 60 minutes, depending on your specific needs. Every visit includes a personalized “homework” plan to maintain your progress between sessions. In-person care may include:
- Comprehensive Education: Guidance on your condition, pain systems, diet, and the side effects of cancer treatment.
- Stress Management: Targeted relaxation strategies.
- Manual Therapy: Hands-on care for the abdomen, hips, pelvis, and lower back.
- Complete Decongestive Therapy: Lymphatic massage, specialized exercise, and pressure garments.
- Bowel & Bladder Retraining: Including anorectal manometry to measure sphincter strength and rectal sensation.
- Specialized Modalities: Biofeedback, bladder/fiber diaries, dilator work, and custom stretching and strengthening programs.
Common Symptoms Associated with Reproductive Cancer Treatment
- Painful intercourse or penetration
- Physical changes to the vagina (shortening, narrowing, or radiation-induced stenosis)
- Altered sensation during orgasm
- Pelvic and/or abdominal pain
- Medically Induced Menopause
- Urinary urgency, incontinence, or retention
- Lymphedema
- Bowel urgency or constipation
- Chemotherapy-induced peripheral neuropathy
- Fatigue
Ovarian Cancer Rehabilitation
Ovarian cancer is a type of cancer that starts in the ovaries, which are part of the female reproductive system. The ovaries are two small organs that produce eggs (ova) and hormones such as estrogen and progesterone. Ovarian cancer occurs when cells in or near the ovary grow abnormally and uncontrollably. Most ovarian cancers actually begin in the fallopian tubes or the surface (epithelium) of the ovary, then spread to the ovary and surrounding areas.
Common Symptoms of Ovarian Cancer
- Abnormal vaginal bleeding
- Poor sexual function
- Significant dyspareunia
- Difficulty controlling bowel movements (20%)
How is Ovarian Cancer Treated?
Surgery is typically the first line of defence and chemotherapy is often given after to ensure they got it all or in-line with surgery to help to shrink the tumor. Less commonly radiation might be used – this is typically reserved for if there is a recurrence.
Why would I do physiotherapy as part of my post-op ovarian cancer care?
Physiotherapy can play a really helpful role in recovery after ovarian cancer. It can help to: rebuild strength, mobility and stamina, manage/improve cancer related fatigue, manage pain and lower extremity or trunk lymphedema that may occur and help to improve bladder and bowel control.
Uterine/Endometrial Cancer Rehabilitation
Uterine cancer is the most common type of gynecological malignancy. Uterine cancer is also known as endometrial cancer, is a type of cancer that starts in the uterus, the organ in a woman’s pelvis where a baby grows during pregnancy. Most uterine cancers develop in the endometrium (the inner lining of the uterus), so “endometrial cancer” is the most common type of uterine cancer. A Sarcoma is another form of uterine cancer, specifically one that develops in the muscle layer of the uterus or the connective tissue.
Common Symptoms of Uterine Cancer
- Abnormal vaginal bleeding (most common, especially after menopause)
- Unusual vaginal discharge
- Pelvic or lower abdominal pain
- Pain during urination or sexual intercourse
- Unexplained weight loss or fatigue
How is Uterine Cancer Treated?
Surgery (typically a total hysterectomy with BSO and possible lymphadenectomy). Surgery is commonly followed by radiation (brachytherapy = internal) +/- chemotherapy dependent on the severity and type of cancer.
What Role does Physiotherapy play in my recovery from Uterine cancer treatment?
Physiotherapy is highly beneficial following a hysterectomy. It assists in restoring movement in the hips, low back, and abdomen, managing pain in these regions, and improving strength and re-conditioning through a personalized and graded home exercise program.
Treatment for uterine cancer may weaken or disrupt the pelvic floor muscles. If this occurs, pelvic floor physiotherapy can help to enhance bladder and bowel control and alleviate feelings of pelvic heaviness and discomfort.
Cervical Cancer Rehabilitation
Cervical cancer is a type of cancer that begins in the cervix (the lower, narrow part of the uterus that connects the uterus to the vagina). It develops when abnormal cells in the cervix grow uncontrollably and form a tumor.
Common Symptoms of Cervical Cancer:
- Most women have no symptoms in early stages, this is why getting your routine PAP exam done is important!
- Abnormal vaginal bleeding (between periods, after intercourse, or after menopause)
- Pelvic pain
- Low back pain
How is Cervical Cancer Treated?
The standard initial treatment is surgery. Should the cancer return, subsequent treatment may involve chemotherapy and/or radiation.
For younger patients concerned about future fertility following a diagnosis, there are fertility-sparing surgical options, which include: Simple hysterectomy, Radical Trachelectomy, or the LEEP procedure (reserved only for very early-stage detection). In other cases, a radical hysterectomy is typically recommended.
What are the side effects of Cervical Cancer Treatment?
- Pelvic and Urogynecological Impacts:
- Bladder and Bowel Dysfunction: Symptoms are highly prevalent, including mixed urinary incontinence, stress urinary incontinence, and overactive bladder/detrusor overactivity. Urinary dysfunction is noted as the most common long-term complication (76%).
- Bowel Complaints: Patients often experience difficulty with social functioning related to bowel issues.
- Lymphedema: Swelling, typically in the legs or pelvic area, is a potential complication.
- Sexual and Psychological Impacts:
- Changes in Sexual Function: This includes general sexual function changes, difficulty with sexual/vaginal function, and sexual worry.
- Body Image Concerns: Individuals may struggle with their body image following treatment.
- Impact of Radiation Therapy:
- Patients who have undergone radiation treatment are often more likely to experience painful intercourse (dyspareunia), defecation urgency, and more adverse effects on the overall function of the pelvic floor muscles.
Cervical Cancer Recovery: How Pelvic Physiotherapy Can Help
Are you wondering if you need physiotherapy after your cervical cancer treatment?
At Cornerstone, our pelvic physiotherapists are highly trained in cancer rehabilitation and lymphedema management. Pelvic Physiotherapy can effectively address all of the side effects you may be experiencing, helping to significantly improve your quality of life after cervical cancer. You don’t have to suffer in silence; we are here to help.
Vulvar Cancer Rehabilitation
Vulvar cancer is a rare malignancy, accounting for only 5% of all gynecological cancers and 1% of all cancers diagnosed in women. This type of cancer develops on the vulva, the external female genitalia, and typically affects older women.
Common Symptoms of Vulvar Cancer
- Lumps or Growths
- Persistent itching or Burning
- Changes in Skin Appearance – patches of thickened skin or change in normal colour
- Pain or Tenderness (local to area, discomfort when sitting/walking)
- Abnormal bleeding
- Non-healing Sores
- Changes in Urination or Sexual Activity (pain or difficulty)
How is Vulvar Cancer Treated?
The first line of defence for vulvar cancer is surgery and this is sometimes combined with radiation (can be external beam or internal brachytherapy). If spread continues Chemotherapy or Immunotherapy is often brought on board.
What are the side effects of Vulvar Cancer Treatment?
- Pain and swelling in the vulvar area
- Difficulty sitting or walking for a while
- Scarring
- Swelling in the legs (lymphedema)
- Numbness and sensitivity
- Radiation fibrosis = skin irritation, burns, redness, peeling, soreness, pain with urination and/or bowel movements
How Pelvic Floor Physiotherapy Can Help After Vulvar Cancer Treatment
Our Pelvic Floor Physiotherapists offer support and treatment for a variety of post-treatment concerns, including:
- Vaginal Health Education: Guidance on using intra-vaginal and external moisturizers, as well as lubricants for sexual activity/intercourse.
- Vaginal Dilator Programs: Assistance with starting and navigating a vaginal dilator program, which is often recommended, especially after radiation therapy.
- Musculoskeletal Pain Relief: Improving the function and mobility of your pelvic floor muscles to help alleviate associated back, hip, and tailbone pain.
Frequently Asked Questions
Do I need to start pelvic physiotherapy before surgery?
Starting before surgery (prehabilitation) is highly beneficial. It allows us to establish your “normal” baseline for goal setting and teaches you how to correctly activate and relax the pelvic floor before treatment begins. Prehabilitation also prepares you for what to expect, as hospital care often focuses on other immediate medical needs. Our therapists serve as a trusted source of clarity during what can be an overwhelming time.
Is pelvic floor physiotherapy safe after cancer treatment?
Yes. Our physiotherapists are specifically trained in oncology rehabilitation. We tailor every treatment to your specific stage of recovery, current side effects, and overall health status.
How common is Ovarian Cancer?
- Ovarian cancer is considered a relatively uncommon but a serious cancer
- ~3,000 women diagnosed annually in Canada
- It is rare under the age of 40
- It is the 5th leading cause of death in women (unfortunately not often diagnosed in the early stages as it is often asymptomatic at this point)
What are the Risk Factors Associated with Developing Ovarian cancer?
- Obesity (BMI>30)
- Some fertility drugs (clomid)
- Cowden’s syndrome (mutations in the PTEN gene)
- Lynch Syndrome
- Talcum Powder – applied to genital area = carcinogenic to ovaries
- Family history of ovarian, breast or colorectal cancer
- Personal history of breast cancer (BRCA1 BRCA2)
What are the risk factors for developing Uterine Cancer?
- Obesity
- 3.5x the risk
- Physical activity decreases risk
- 1st period before 12
- Never having had children
- Menopause after 55
- Diabetes
- Radiation
- Family history of uterine and/or colorectal cancer
- High blood pressure
- Endometrial hyperplasia (abnormal overgrowth of the endometrium) – most common after 40 – will cause heavy periods, bleeding between periods and bleeding after menopause
What are the differences in certain types of Hysterectomies?
- Partial Hysterectomy/subtotal
- Cervix is left intact
- Complete/Total Hysterectomy (most common)
- uterus and cervix removed
- BSO (Bilateral Salpingo Oophorectomy)
- tubes and ovaries removed
- Radical Hysterectomy (with cancer spread)
- Cervix, uterus, upper part of the vagina next to the cervix as well as some of the supporting tissues and nearby lymph nodes in the pelvis are also removed
What are the risk factors for developing Cervical Cancer?
- HPV (most common cause, accounts for 90%+)
- Family history
- Smoking
- Unprotected Sex
What is HPV?
- stands for human papillomavirus
- common group of viruses that infect the skin and mucous membranes, including the genital area, mouth, and throat
- there are many different types of HPV. Most are harmless and go away on their own without causing any symptoms. However, some high-risk types of HPV can cause changes in cells over time that may lead to cancers, including cervical cancer, as well as cancers of the vagina, vulva, anus, throat, and penis.
- HPV is a sexually transmitted virus
- HPV usually doesn’t cause symptoms, which is why regular cervical screening (Pap tests and HPV testing) is so important
Why is the HPV Vaccine Important?
HPV is the most common cause of cervical cancer (accounting for 90%+ of all cervical cancer cases). This is the solution to completely eradicating this cancer in the future, with widespread vaccination this would happen! The HPV vaccine is currently recommended for male and females at age of 11 or 12 and in those not previously vaccinated until age 26 y.o – vaccine loses effectiveness as you age so it is best to be vaccinated early – HPV vaccinations are provided in the Ontario school system in the seventh Grade
What are the risk factors associated with developing vulvar cancer?
- Women with cervical cancer
- Age: Under 50: 20% Over 70: 50%
- HPV
- Smoking
- HIV/AIDS
- Lichens Sclerosis
Fee Schedule
Resources
Our Partners and Additional Resources
The side effects of Radiation Therapy
Cervical Cancer: How physiotherapy can support recovery and quality of life
Urinary Incontinence: Guide to types, causes, treatment and devices
Understanding vaginal, vulvar and bladder changes in menopause (GUSM)
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Understanding how we can help with you with your condition can be confusing. We’re dedicated to answering any questions you have to help you make the best choice. Contact us today and ask us anything!
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