Senior faculty member Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC sat down with the Pelvic Rehab Report to talk about the role pelvic therapists play on the oncology team that will work with the patient throughout treatment and into survivorship and the impact pelvic health has on quality of life for people with cancer.

Alison is part of the HW faculty team that wrote and instructs the Oncology course series, the next course is Oncology and the Pelvic Floor Level 1 on January 27-28, 2024.

Did you know that there are over 15 million cancer survivors in the United States? As advancements in care and early diagnosis improve, this is expected to increase to over 20 million survivors in the next 10 years. The continuum of care for patients with cancer ideally begins at diagnosis and the rehabilitation professional is an integral part of the oncology team that will work with the patient throughout treatment and into survivorship.

Pelvic cancers can include bladder cancer, cervical cancer, colorectal cancer, ovarian cancer, prostate cancer, and uterine cancer, among others. These patients can experience changes in how their body functions during or after cancer and its treatment.  Changes caused by the treatment of cancer can lead to pain, discomfort, and problems with bowel, bladder, and sexual function

 Why did you become a pelvic therapist?
I was attracted to pelvic therapy because I enjoy helping people who aren’t getting the help they need from other sources. When I first started working in pelvic floor therapy, there were not as many therapists working in the field. I absolutely loved it! I really enjoyed seeing the improvements patients made and the excitement that they had when they could come in and share with me that they saw improvements. They would share with me news about bowel, bladder, or sexual function that they would not even share with their partner. To see the happiness that people had with improvements in this intimate part of their lives really brought me joy. I enjoy helping people have hope in their lives and working with these patients is very rewarding to me.

What role does a rehab practitioner play on the oncology team?
Rehab professionals are key members of the oncology team. While the other members of the oncology team are focused on curing the cancer and helping the patient live longer, rehabilitation professionals focus on getting the patient to be able to do things in their lives that they enjoy. We are trained in working with the body and identifying dysfunction within the body that is limiting the patient and keeping them from functioning to their full potential. We have skills to address the musculoskeletal, visceral, nervous, and integumentary systems that can help improve the way a patient’s body is working and therefore improve function. Sometimes we address the little things with patients that then make the biggest impact in them living their lives. One patient of mine said that “her doctors saved her life, but her therapist helped her put her life back together so she could live it.” This quote really demonstrates the role a rehabilitation professional can have on an oncology patient.

What are some of the most important things you (and pelvic therapists) do for people with cancer in your role?
One of the most important things we therapists can do for our oncology patients is to listen. We spend a lot of time with our patients and develop a rapport with our patients. They then often share things with us they may not other providers. We have the skills to treat and help our patients with very personal symptoms in intimate areas. Pelvic floor therapists can help oncology patients return to a life that is more similar to their life before their cancer diagnosis. This is important. Their lives have been changed forever with their cancer diagnosis. If we can listen to the patient, and improve some of the symptoms they are experiencing; it can make a bigger difference than we think in helping them return to living their lives.

What are some common concerns oncology patients have, and how do you help address them?
One of the biggest issues oncology patients experience is restricted movement within the body. Surgery, and radiation both cause changes to the body that lead to scarring, fibrosis, and adhesions. This leads to a tightness that limits the normal movement of a body part, or decreased glide of the tissues. We address this a lot in the oncology series. We learn how to work with this restricted movement and help improve it. If the rehabilitation clinician can improve the ability of the body to move (whether it is a joint, a muscle, or the glide within the tissues), then this can ease pain, improve the function of that body part, and improve overall mobility and function for the patient. 

What is the number one thing that practitioners should be aware of when it comes to pelvic therapy and cancer?
Radiated tissue is never the same as before it was radiated. Even if it has been years. Radiation changes the tissues. It can lead to inflammation, fibrosis, scarring, adhesions, texture change, and elasticity changes, among other effects. The effects of radiation can continue for years, and the tissues should be treated differently even if it has been many years since the patient underwent radiation. The therapist should learn to “listen” with their hand to see what state the tissues are in, and how to treat these tissues in a gentle and non-aggressive manner.

How can people with cancer better communicate with their pelvic therapists, and how can the practitioner facilitate these conversations?
I would encourage any cancer survivor to tell their therapist what is keeping them from doing what they love. When someone is diagnosed with cancer and goes through treatment, they often become limited in some of their activities. Unfortunately, many people don’t return to the activities that brought them joy. I would encourage patients to tell their therapist things that they wish they could do but cannot. Even if it is something little like making the bed, cooking a meal, or walking to the bathroom without leaking. Or if it is something bigger, like jumping on the trampoline with their kids, or returning to their exercise routine.

The therapist needs to know what it is that the patient would like to do but cannot do at this time. That way we can analyze the situation and figure out what can be done to help the patient reach their goal. I encourage therapists to ask their patients “What do you wish you could do but can’t now?”, or “What activities bring you joy?”  If they are not able to do these activities after cancer treatment, work with the patient to see if you can help them return to that activity. It may be in baby steps, but that still can bring the patient joy!

What are some of the most rewarding parts of your job?
What I enjoy most about my job and working with oncology patients is the hope that I get to experience alongside these patients. I have the privilege of being able to work with these fighters and help them to gain function. The happiness they have when they can return to a loved activity, have an orgasm again, or be able to go to a movie without having fecal urgency is so very rewarding. I work with patients and try to instill an optimism that they can return to a better state. However, they also give me hope in life. Seeing their perseverance, their will to live, and their fight is inspirational! Working with oncology patients provides a positive light in my life; knowing that I am helping people that really need it, and the inspiration I get from working with these patients is amazing!

Join Oncology and the Pelvic Floor Level 1 on January 27-28, 2024 to learn more about working with oncology patients as part of an interdisciplinary oncology team to improve patient outcomes and quality of life.