Pelvic physiotherapy after cervical cancer: why is it so important? | Drauzio Varella

Treating gynecological tumors with radiotherapy can cause long-term problems such as urinary incontinence and vaginal stenosis.

The cervix is ​​at the end of the vagina, and as it is located between the external and internal organs, it is more exposed to the risk of contracting diseases and virus infections, such as the Human Papillomavirus (HPV).

Most of the time, HPV infection does not cause other diseases, however, if it is a subtype with carcinogenic potential, over the years, cellular changes may occur that evolve into cervical cancer.

Although there are preventive measures for this type of tumor (pap smear It is HPV vaccine), it is still common among Brazilian women, being the third most frequent. Still, it is a cancer with great potential for cure, especially if it is diagnosed in the early stages.

The big issue is the side effects that usually appear after treatment, which may involve surgery, chemotherapy and radiotherapy (especially in cases of advanced tumors).

“What happens is that radiotherapy can cause tissue fibrosis (excessive formation of stiff and inelastic tissue) and have important repercussions on the region, such as pain, mucositis, sexual dysfunction and sometimes urinary and bowel movements”, explains Anderson Coelho, physiotherapist, president of Crefito-4 MG (Regional Physiotherapy Council).

Pelvic physiotherapy

Pelvic physiotherapy plays a fundamental role and must be started early to reduce these symptoms and improve the patient’s quality of life. Therefore, it is extremely important that women undergo an assessment with a physiotherapist during the pre-operative period and begin treatment post-operatively.

The main objective of physiotherapy is to strengthen the pelvic floor muscles, which is a region made up of several layers of muscles suspended like a “hammock” hanging from two points, in front and behind the pelvis. These muscles control the urethra and anal sphincter and prevent problems such as urinary and fecal loss.

According to Anderson, the classic indication for rehabilitation is training the pelvic floor muscles, associated with muscular resistance exercises with progression, in order to bring independence to the patient.

In addition to these exercises, electrotherapy techniques (use of electrical currents), biofeedback (behavioral technique) and vaginal dilators (prevent complete closure of the vaginal canal) can be used for cases of vaginismus (pain during sexual intercourse due to involuntary contraction).

“It is important that these exercises are performed individually, not only with strength training, but observing possible tensions and disorders in muscle tone. The objective is for the patient to learn to control and coordinate the pelvic floor muscles and have more control”, says the physiotherapist.

The number of sessions depends on the clinical and muscular condition of each patient. On average, when a woman already has control of her pelvic floor muscles (she knows how to contract properly), a single session may be enough.

Normally, to promote full recovery and strengthening with the development of muscular hypertrophy, it is recommended to practice 12 consecutive weeks, incorporating the exercises into the daily routine.

Urinary incontinence

Another very common side effect after treatment, which deserves attention, is urinary incontinence, which is the involuntary release of urine. It occurs because the procedures used in cancer treatment can break nerve fibers, facilitating leaks.

The pelvic muscles control the flow of urine, contraction of the perineum, and closure of the anus. Both the urethra and the anus have a sphincter (special muscles that work like locks) that ensure the retention of urine and feces.

In these cases, to strengthen these muscles, kegel exercises may be indicated, where the patient performs selective and repetitive voluntary contractions, which help maintain the integrity and proper functioning of the urethra and the position of the organs within the pelvis.

After evaluation by a specialist, these exercises can even be done at home, several times a day.

An example is a woman, with her bladder emptied, sitting on the floor face down and trying to release and hold the urine. As you become more aware of your body, you can do this exercise standing or sitting.

See also: Pelvic physiotherapy – What is it for?

Vaginal stenosis

Another problem that may arise in the pelvic region after radiotherapy is vaginal stenosis, which causes shortening and narrowing of the vaginal canal.

As a result, the patient may feel pain during sexual intercourse and have difficulty undergoing gynecological examinations that require visualization of the vagina and cervix.

In these cases, in addition to exercises with vaginal dilators, perineal massage may be indicated to improve the elasticity of the region, in addition to the use of specific creams.