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Current Oncology Reports
Published in: Current Oncology Reports 3/2024

31-01-2024 | Gynecologic Cancer | REVIEW

Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies

Authors: Alice L. Ye, Eleanor Johnston, Sarah Hwang

Published in: Current Oncology Reports | Issue 3/2024

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Abstract

Purpose of Review

This review provides evidence-based updates for the first-line management approaches for pelvic floor disorders in patients with gynecologic malignancies, as well as important provider considerations when referring for pelvic floor physical therapy.

Recent Findings

Currently, there is strong evidence to recommend pelvic floor muscle training as initial treatment for urinary incontinence and for pelvic organ prolapse; some evidence to recommend a more targeted pelvic floor muscle training program for fecal incontinence; and mostly expertise-based evidence to recommend vaginal gels or estrogen to aid with dyspareunia causing sexual dysfunction. More research is greatly needed to understand the role of overactive pelvic floor muscles in survivors with chronic pelvic pain and the treatment of post-radiation pelvic complications such as vaginal stenosis and cystitis.

Summary

While pelvic floor disorders are common concerns in gynecologic cancer survivors, there are evidence-based initial noninvasive treatment approaches that can provide relief for many individuals.
Literature
1.
Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–6.PubMedPubMedCentralCrossRef
2.•
Ramaseshan AS, Felton J, Roque D, Rao G, Shipper AG, Sanses TVD. Pelvic floor disorders in women with gynecologic malignancies: a systematic review. Int Urogynecology J. 2018;29(4):459–76. Systematic review of over 6,000 patients on the prevalence of pelvic floor disorders before and after cancer treatment.
3.
Vargas Maldonado D, Madsen AM. Vaginal symptoms in women who are affected by gynecologic cancer. Curr Opin Obstet Gynecol. 2021;33(6):474–82.PubMedCrossRef
4.
Hazewinkel MH, Sprangers MAG, van der Velden J, van der Vaart CH, Stalpers LJA, Burger MPM, et al. Long-term cervical cancer survivors suffer from pelvic floor symptoms: a cross-sectional matched cohort study. Gynecol Oncol. 2010;117(2):281–6.PubMedCrossRef
5.••
Bø K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Int Urogynecol J. 2017;28(2):191–213. Multidisciplinary consensus report on the key standard terminology and standards used for conservative female pelvic floor dysfunction.PubMedCrossRef
6.
7.
Thomas SG, Sato HRN, Glantz JC, Doyle PJ, Buchsbaum GM. Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients. Obstet Gynecol. 2013;122(5):976–80.PubMedCrossRef
8.
Melville JL, Katon W, Delaney K, Newton K. Urinary incontinence in US women: a population-based study. Arch Intern Med. 2005;165(5):537–42.PubMedCrossRef
9.
Andrews CN, Bharucha AE. The etiology, assessment, and treatment of fecal incontinence. Nat Clin Pract Gastroenterol Hepatol. 2005;2(11):516–25.PubMedCrossRef
10.
Amaro JL, Moreira ECH, De Oliveira OrsiGameiro M, Padovani CR. Pelvic floor muscle evaluation in incontinent patients. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(5):352–4.PubMedCrossRef
11.
Hagen S, Glazener C, McClurg D, Macarthur C, Elders A, Herbison P, et al. Pelvic floor muscle training for secondary prevention of pelvic organ prolapse (PREVPROL): a multicentre randomised controlled trial. Lancet Lond Engl. 2017;389(10067):393–402.CrossRef
12.
Lin KY, Granger CL, Denehy L, Frawley HC. Pelvic floor muscle training for bowel dysfunction following colorectal cancer surgery: a systematic review. Neurourol Urodyn. 2015;34(8):703–12.PubMedCrossRef
13.•
Padoa A, McLean L, Morin M, Vandyken C. “The overactive pelvic floor (OPF) and sexual dysfunction” Part 1: pathophysiology of OPF and its impact on the sexual response. Sex Med Rev. 2021;9(1):64–75. Review on the mechanistic framework underlying overactive pelvic floor disorders, including chronic pelvic pain.PubMedCrossRef
14.
Padoa A, McLean L, Morin M, Vandyken C. The overactive pelvic floor (OPF) and sexual dysfunction. Part 2: evaluation and treatment of sexual dysfunction in OPF patients. Sex Med Rev. 2021;9(1):76–92.PubMedCrossRef
15.
Center for Substance Abuse Treatment (US). Trauma-informed care in behavioral health services. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 1, Trauma-informed care: a sociocultural perspective. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. Available from: https://​www.​ncbi.​nlm.​nih.​gov/​books/​NBK207195/​.
16.
Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013;19(10 Suppl):s191-196.PubMed
17.
Prather H, Camacho-Soto A. Musculoskeletal etiologies of pelvic pain. Obstet Gynecol Clin North Am. 2014;41(3):433–42.PubMedCrossRef
18.
19.
Westin SN, Sun CC, Tung CS, Lacour RA, Meyer LA, Urbauer DL, et al. Survivors of gynecologic malignancies: impact of treatment on health and well-being. J Cancer Surviv. 2016;10(2):261–70.PubMedCrossRef
20.
21.
22.
23.
24.
Altman D, Granath F, Cnattingius S, Falconer C. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet. 2007;370(9597):1494–9.PubMedCrossRef
25.
Husby KR, Gradel KO, Klarskov N. Pelvic organ prolapse following hysterectomy on benign indication: a nationwide, nulliparous cohort study. Am J Obstet Gynecol. 2022;226(3):386.e1-386.e9.PubMedCrossRef
26.
Forsgren C, Zetterström J, Lopez A, Nordenstam J, Anzen B, Altman D. Effects of hysterectomy on bowel function: a three-year, prospective cohort study. Dis Colon Rectum. 2007;50(8):1139–45.PubMedCrossRef
27.
Lee SH, Bae JW, Han M, Cho YJ, Park JW, Oh SR, et al. Efficacy of nerve-sparing radical hysterectomy vs. conventional radical hysterectomy in early-stage cervical cancer: a systematic review and meta-analysis. Mol Clin Oncol. 2020;12(2):160–8.PubMed
28.
Dedden SJ, van Ditshuizen MAE, Theunissen M, Maas JWM. Hysterectomy and sexual (dys)function: an analysis of sexual dysfunction after hysterectomy and a search for predictive factors. Eur J Obstet Gynecol Reprod Biol. 2020;1(247):80–4.CrossRef
29.
Forsgren C, Amato M, Johannesson U. Effects of hysterectomy on pelvic floor function and sexual function—a prospective cohort study. Acta Obstet Gynecol Scand. 2022;101(10):1048–56.PubMedPubMedCentralCrossRef
30.
Till SR, Schrepf A, Pierce J, Moser S, Kolarik E, Brummett C, et al. Sexual function after hysterectomy according to surgical indication: a prospective cohort study. Sex Health. 2022;19(1):46–54.PubMedPubMedCentralCrossRef
31.
Kingsberg SA, Larkin LC, Liu JH. Clinical effects of early or surgical menopause. Obstet Gynecol. 2020;135(4):853.PubMedCrossRef
32.
Stone HB, Coleman CN, Anscher MS, McBride WH. Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol. 2003;4(9):529–36.PubMedCrossRef
33.
Bosch R, McCloskey K, Bahl A, Arlandis S, Ockrim J, Weiss J, et al. Can radiation-induced lower urinary tract disease be ameliorated in patients treated for pelvic organ cancer: ICI-RS 2019? Neurourol Urodyn. 2020;39(S3):S148–55.PubMedPubMedCentralCrossRef
34.
Wang L, Wang X, Zhang G, Ma Y, Zhang Q, Li Z, et al. The impact of pelvic radiotherapy on the gut microbiome and its role in radiation-induced diarrhoea: a systematic review. Radiat Oncol. 2021;16(1):187.PubMedPubMedCentralCrossRef
35.
Krol R, Smeenk RJ, van Lin ENJT, Yeoh EEK, Hopman WPM. Systematic review: anal and rectal changes after radiotherapy for prostate cancer. Int J Colorectal Dis. 2014;29(3):273–83.PubMedCrossRef
36.
Razavian N, Laucis A, Sun Y, Spratt DE, Owen D, Schonewolf C, et al. Radiation-induced insufficiency fractures after pelvic irradiation for gynecologic malignancies: a systematic review. Int J Radiat Oncol. 2020;108(3):620–34.CrossRef
37.
Rutledge TL, Heckman SR, Qualls C, Muller CY, Rogers RG. Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study. Am J Obstet Gynecol. 2010;203(5):514.e1-514.e7.PubMedCrossRef
38.
Chang CP, Wilson CM, Rowe K, Snyder J, Dodson M, Deshmukh V, et al. Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study. Support Care Cancer. 2022;31(1):51.PubMedPubMedCentralCrossRef
39.••
Todhunter-Brown A, Hazelton C, Campbell P, Elders A, Hagen S, McClurg D. Conservative interventions for treating urinary incontinence in women: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev. 2022;9(9):CD012337. Recent Cochrane review concluding that there is high certainty evidence of benefit from pelvic floor muscle training for stress, urge, and mixed urinary incontinence.PubMed
40.
41.
Rutledge TL, Rogers R, Lee SJ, Muller CY. A pilot randomized control trial to evaluate pelvic floor muscle training for urinary incontinence among gynecologic cancer survivors. Gynecol Oncol. 2014;132(1):154–8.PubMedCrossRef
42.
43.
Cody JD, Jacobs ML, Richardson K, Moehrer B, Hextall A. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database Syst Rev. 2012;10(10):CD001405.PubMed
44.
Bø K, Herbert RD. There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: a systematic review. J Physiother. 2013;59(3):159–68.PubMedCrossRef
45.
Herbison GP, Dean N. Weighted vaginal cones for urinary incontinence. Cochrane Database Syst Rev. 2013;2013(7):CD002114.PubMedPubMedCentral
46.
Stewart F, Berghmans B, Bø K, Glazener CM. Electrical stimulation with non-implanted devices for stress urinary incontinence in women. Cochrane Database Syst Rev. 2017;12(12):CD012390.PubMed
47.
Villeirs L, Tailly T, Ost P, Waterloos M, Decaestecker K, Fonteyne V, et al. Hyperbaric oxygen therapy for radiation cystitis after pelvic radiotherapy: systematic review of the recent literature. Int J Urol. 2020;27(2):98–107.PubMedCrossRef
48.
Pascoe C, Duncan C, Lamb BW, Davis NF, Lynch TH, Murphy DG, et al. Current management of radiation cystitis: a review and practical guide to clinical management. BJU Int. 2019;123(4):585–94.PubMedCrossRef
49.
50.
Bliss DZ, Savik K, Jung HJG, Whitebird R, Lowry A, Sheng X. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health. 2014;37(5):367–78.PubMedPubMedCentralCrossRef
51.
Markland AD, Burgio KL, Whitehead WE, Richter HE, Wilcox CM, Redden DT, et al. Loperamide versus psyllium fiber for treatment of fecal incontinence: the fecal incontinence prescription (Rx) management (FIRM) randomized clinical trial. Dis Colon Rectum. 2015;58(10):983–93.PubMedCrossRef
52.
53.
54.•
Bø K, Anglès-Acedo S, Batra A, Brækken IH, Chan YL, Jorge CH, et al. International urogynecology consultation chapter 3 committee 2; conservative treatment of patient with pelvic organ prolapse: pelvic floor muscle training. Int Urogynecol J. 2022;33(10):2633–67. Recent multidisciplinary consensus statement concluding that there is high-level evidence to recommend pelvic floor muscle training as first-line treatment of pelvic organ prolapse.PubMedPubMedCentralCrossRef
55.
Bugge C, Adams EJ, Gopinath D, Stewart F, Dembinsky M, Sobiesuo P, et al. Pessaries (mechanical devices) for managing pelvic organ prolapse in women. Cochrane Database Syst Rev. 2020;11(11):CD004010.PubMed
56.
Candy B, Jones L, Vickerstaff V, Tookman A, King M. Interventions for sexual dysfunction following treatments for cancer in women. Cochrane Database Syst Rev. 2016;2(2):CD005540.PubMed
57.
Flynn P, Kew F, Kisely SR. Interventions for psychosexual dysfunction in women treated for gynaecological malignancy. Cochrane Database Syst Rev. 2009;2009(2):CD004708.PubMedPubMedCentral
58.
Lee YK, Chung HH, Kim JW, Park NH, Song YS, Kang SB. Vaginal pH-balanced gel for the control of atrophic vaginitis among breast cancer survivors: a randomized controlled trial. Obstet Gynecol. 2011;117(4):922–7.PubMedCrossRef
59.
Rahn DD, Carberry C, Sanses TV, Mamik MM, Ward RM, Meriwether KV, et al. Vaginal estrogen for genitourinary syndrome of menopause. Obstet Gynecol. 2014;124(6):1147–56.PubMedPubMedCentralCrossRef
60.
Mili N, Paschou SA, Armeni A, Georgopoulos N, Goulis DG, Lambrinoudaki I. Genitourinary syndrome of menopause: a systematic review on prevalence and treatment. Menopause. 2021;28(6):706.PubMedCrossRef
61.
Frühauf S, Gerger H, Schmidt HM, Munder T, Barth J. Efficacy of psychological interventions for sexual dysfunction: a systematic review and meta-analysis. Arch Sex Behav. 2013;42(6):915–33.PubMedCrossRef
62.
Razali NA, Sidi H, Choy CL, Roos NAC, Baharudin A, Das S. The role of bupropion in the treatment of women with sexual desire disorder: a systematic review and meta-analysis. Curr Neuropharmacol. 2022;20(10):1941–55.PubMedPubMedCentralCrossRef
63.
Achilli C, Pundir J, Ramanathan P, Sabatini L, Hamoda H, Panay N. Efficacy and safety of transdermal testosterone in postmenopausal women with hypoactive sexual desire disorder: a systematic review and meta-analysis. Fertil Steril. 2017;107(2):475-482.e15.PubMedCrossRef
64.
Jaspers L, Feys F, Bramer WM, Franco OH, Leusink P, Laan ETM. Efficacy and safety of flibanserin for the treatment of hypoactive sexual desire disorder in women: a systematic review and meta-analysis. JAMA Intern Med. 2016;176(4):453–62.PubMedCrossRef
65.
Denton AS, Maher EJ. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database Syst Rev. 2003;2003(1):CD003750.PubMedPubMedCentral
66.
Johnson N, Miles TP, Cornes P. Dilating the vagina to prevent damage from radiotherapy: systematic review of the literature. BJOG Int J Obstet Gynaecol. 2010;117(5):522–31.CrossRef
67.
Gondi V, Bentzen SM, Sklenar KL, Dunn EF, Petereit DG, Tannehill SP, et al. Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an inter-era analysis. Int J Radiat Oncol Biol Phys. 2012;84(4):973–82.PubMedPubMedCentralCrossRef
68.•
Stahl JM, Qian JM, Tien CJ, Carlson DJ, Chen Z, Ratner ES, et al. Extended duration of dilator use beyond 1 year may reduce vaginal stenosis after intravaginal high-dose-rate brachytherapy. Support Care Cancer. 2019;27(4):1425–33. Study of over 200 women following radiotherapy showing that vaginal dilator use beyond one year may mitigate risk of vaginal stenosis.PubMedCrossRef
69.
Ell K, Sanchez K, Vourlekis B, Lee PJ, Dwight-Johnson M, Lagomasino I, et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecological cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(13):3052–60.CrossRef
70.
Klapheke AK, Keegan THM, Ruskin R, Cress RD. Depressive symptoms and health-related quality of life in older women with gynecologic cancers. J Geriatr Oncol. 2020;11(5):820–7.PubMedCrossRef
71.
Vistad I, Cvancarova M, Kristensen GB, Fosså SD. A study of chronic pelvic pain after radiotherapy in survivors of locally advanced cervical cancer. J Cancer Surviv. 2011;5(2):208–16.PubMedPubMedCentralCrossRef
72.
van der Ploeg J, van der Steen A, Oude Rengerink K, van der Vaart C, Roovers J. Prolapse surgery with or without stress incontinence surgery for pelvic organ prolapse: a systematic review and meta-analysis of randomised trials. BJOG Int J Obstet Gynaecol. 2014;121(5):537–47.CrossRef
73.
Tubaro A, Puccini F, De Nunzio C. The management of overactive bladder: percutaneous tibial nerve stimulation, sacral nerve stimulation, or botulinum toxin? Curr Opin Urol. 2015;25(4):305–10.PubMedCrossRef
74.
Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485–93.PubMedCrossRef
75.
76.
77.
78.••
Frawley HC, Neumann P, Delany C. An argument for competency-based training in pelvic floor physiotherapy practice. Physiother Theory Pract. 2019;35(12):1117–30. Summary of the clinical, legal, and ethical risks involve in pelvic floor-related care that providers should be aware of.PubMedCrossRef
79.•
Brennen R, Lin KY, Denehy L, Soh SE, Frawley H. Patient and clinician perspectives of pelvic floor dysfunction after gynaecological cancer. Gynecol Oncol Rep. 2022;41:101007. Recent qualitative study showing that the pipeline for patients to receive pelvic floor dysfunction care may be limited.PubMedPubMedCentralCrossRef
80.
Dahl L, Wittrup I, Petersen LK, Blaakaer J, Væggemose U. Paradoxes of follow-up - health professionals’ views on follow-up after surgical treatment in gynecological cancer. Acta Oncol Stockh Swed. 2015;54(2):194–9.CrossRef
81.
82.
Oaknin A, Bosse TJ, Creutzberg CL, Giornelli G, Harter P, Joly F, et al. Endometrial cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up☆. Ann Oncol. 2022;33(9):860–77.PubMedCrossRef
83.
Fox J, Haig AJ, Todey B, Challa S. The effect of required physiatrist consultation on surgery rates for back pain. Spine. 2013;38(3):E178.PubMedCrossRef
84.
Greiss C, Yonclas PP, Jasey N, Lequerica A, Ward I, Chiaravalloti N, et al. Presence of a dedicated trauma center physiatrist improves functional outcomes following traumatic brain injury. J Trauma Acute Care Surg. 2016;80(1):70.PubMedCrossRef
85.
Alfano CM, Ganz PA, Rowland JH, Hahn EE. Cancer survivorship and cancer rehabilitation: revitalizing the link. J Clin Oncol. 2012;30(9):904–6.PubMedCrossRef
Metadata
Title
Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies
Authors
Alice L. Ye
Eleanor Johnston
Sarah Hwang
Publication date
31-01-2024
Publisher
Springer US
Published in
Current Oncology Reports / Issue 3/2024
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-024-01498-6

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