Wednesday, December 12, 2018

Pelvic Health After a Gyn Cancer Diagnosis Chat - Dec 12, 2018

We finished another wonderful year of informative chats by discussing Pelvic Health After a Gyn Cancer Diagnosis. We were pleased that Dr Tracy Sher (@PelvicGuru1), pelvic physical therapist, was able to join us as our guest.

Some responses to the topic questions may be found below. You may find the complete transcript of this chat here and the analytics here.

T1: What is pelvic health and why is it important?
  • Great question because most people don't know what #pelvichealth is. It involves the entire area of the bony pelvis, lower abdomen, genitals, reproductive organs, muscles, bowel/bladder/sexual function, nerves...and more (for male and female parts).
  • @bcmhouston website states : "Pelvic Health is best possible functioning & management of the bladder, bowel, and reproductive organs. It is not merely the absence of disease or weakness in these organs." 
T2: How do treatments for gynecologic cancers impact women's pelvic health? 
  • Treatment for GYN cancers often create issues with other organs & systems in the pelvis. GYN survivors often have bladder/bowel issues after radiotherapy & surgical treatment
  • During #brachytherpay, radiation is applied directly to the cervix. While effective in treating #cervicalcancer, it’s side effects can be devastating to the pelvis and vagina.
  • Pelvic cancers impact pelvic health - both disease and the treatment can cause pain and organ dysfunction - both surgery and radiation can effect function of the bowel and bladder
  • hysterectomy to treat cancer has complications which need proper care. Hormonal Changes in pelvic structure (improved with pelvic Physio for MSK training which has level 1 evidence Bø et al.)
  • The pelvis is a complex space - with bowel, nerves, bladder, blood vessels - cancer or cancer treatment can impact any of the components.
T3: What options are there for alleviating pelvic pain? What specialists typically treat pelvic pain? What has been your experience with pelvic pain?
  • Many women in our Cervivor community are finding relief from pelvic pain after working with a Pelvic Floor Therapist. However, for those in more rural areas, they may not have this option
  • So, we highly recommend seeking out professionals who know about pelvic pain. Such as GYNs, Urogynecologists, Urologists, Pelvic Physical Therapists, OTs, NPs (to name a few) who attend conferences or take courses in pelvic pain care. (Such as @PelvicPainOrg
  • Seems like several specialists are involved in overall pelvic health - gynecologist, gastroenterologist, urologist, GI docs and there is even a urogynecologist. Seems like patients would need navigation related to their particular symptoms.
  • Here are just some of the things @MayoClinic lists as pelvic pain treatment options: Medication, Physical therapy, Stretching, massage and other relaxation techniques, TENS, Neurostimulation (spinal cord stimulation), injections and psychotherapy. https://www.mayoclinic.org/diseases-conditions/chronic-pelvic-pain/diagnosis-treatment/drc-20354371
T4: How does pelvic health impact intimacy and sexual health? What are tips and resources to maintain intimacy and sexuality after gyn cancer?
  • It’s hard to feel sexy with pelvic pain. 
  • "Asking about sexual pain and dyspareunia and performing a thorough physical examination are essential steps to guide management, which must be tailored to individual patient goals."   Yes! Tailor treatment to the needs of patients https://www.ncbi.nlm.nih.gov/pubmed/27607852
  •  Don’t give up on intimacy. Be patient with yourself. If you have a partner, COMMUNICATE. Communication is KEY to finding what will work for you and your partner.
  • #SexualHealth IS #pelvichealth. It's important for those who have partners to continue to have all sorts of emotional and touch intimacy. Not just penetration focus. I see so many cases where this changes.
  • From a needs assessment in 2010 "Greater than 40% of survivors expressed interest in receiving sexual healthcare, but few had ever sought such care" 
  • It was recommended for me to follow excellent work by people like @will2lovedotcom for resources. Check this out at https://www.will2love.com/ 
T5: What is pelvic physical therapy? How long after pelvic surgery can it be helpful? 
T6: What are some pelvic health resources for those impacted by cancer-related diagnoses? What have you found helpful?
  • Love this question because so many people still don't realize that there are physical therapists who specialize & care for pelvic health conditions. Doing this 20 years and my mentors many more. Patients often say "WHY didn't I know this type of care existed before!?"
  • You can also find excellent people at @APTAtweets @womens_PT @HermanWallace and ask her on twitter with #pelvicmafia
  • Typically, there's a recommendation to wait at least 6-8 weeks after a gyn surgery to do any type of internal/vaginal assessments/treatments for pelvic PT, but there's so much we can do even before that in terms of movement, touch, education, etc.
  • In addition to those organizations and practitioners joining along on #gyncsm, many find the @hystersisters site - not a nonprofit btw and does have ads - helpful. https://www.hystersisters.com/vb2/article_757741.htm

We look forward to having you join us next year on January 9, 2019 when we discuss Vaccines in Cancer Care and Risk Reduction.

Our wishes for the #gyncsm community.:




Dee
Co-moderator

Resources 

@GYNCancer Renewing Intimacy & Sexuality after Gynecologic Cancer brochure https://www.foundationforwomenscancer.org/wp-content/uploads/Sexuality-Brochure_Final.pdf

@DanaFarber Sexual Health, Intimacy and Cancer https://www.dana-farber.org/health-library/articles/sexual-health,-intimacy,-and-cancer/

Gynecologic cancers predict coexisting pelvic floor disorders Publish date: March 30, 2015 https://www.mdedge.com/familypracticenews/article/98401/oncology/gynecologic-cancers-predict-coexisting-pelvic-floor

Life After Cancer: The Role of Pelvic Physical Therapy
https://pelvicpainrehab.com/female-pelvic-pain/2983/life-after-cancer-the-role-of-pelvic-physical-therapy/

American Physical Therapy Association
https://www.apta.org/

Urinary incontinence
https://www.womenshealthapta.org/wp-content/uploads/2013/11/Urinary_Incontinence.pdf

Pelvic Pain
https://www.womenshealthapta.org/wp-content/uploads/2013/11/Pelvic_Pain.pdf


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