• Emily Reul, PT, DPT

Colorectal Cancer & the Pelvic Floor

Hello friends! This week we are going to talk about that nasty “C word”—cancer. March is Colorectal Cancer Awareness Month so we are going to discuss all things colorectal and the pelvic floor. Many of the signs and symptoms of colorectal cancer can mimic those of pelvic floor dysfunction. Additionally, many of the treatments for colorectal cancer can cause pelvic floor problems.


Colorectal cancer is the 2nd leading cause of cancer deaths in the United States (Goodman, 2009). The prognosis for colorectal cancers is highly linked to the stage in which it is found. This means that the earlier the cancer is found, the more likely treatments will be successful.


What Increases My Risk of Getting Colorectal Cancer? (Goodman, 2009)

  • Getting older

  • Family history of colorectal cancer

  • Diet low in fiber and high in animal fat and protein

  • Inflammatory bowel disease (Chron’s disease and ulcerative colitis)

  • Intestinal polyps

  • History of other cancers (especially breast and reproductive cancers in women)

  • Sedentary lifestyle

  • Compromised immune system

  • Smoking and alcohol consumption


How Can I Help Prevent Colorectal Cancer? (Goodman, 2009)


While all of the things above may increase your risk for colorectal cancer, there are some things you can do to help PREVENT it. This can include increasing the amount of physical activity you get—which can be as simple as adding a brisk walk to your schedule a few times per week. The American College of Sports Medicine recommends 150 minutes of activity weekly.


Increasing the amount of fruits and vegetables you eat is another good step to preventing colorectal cancer. This increases the amount of fiber you intake—which can help to prevent pelvic floor problems like constipation.


Getting enough calcium and vitamin D can also be beneficial in preventing colorectal cancer. Fish and dairy products can be great sources of vitamin D and calcium. The National Institutes of Health recommends adults get 1,000-1,300 mg of calcium each day depending upon age, gender, and whether or not you are breastfeeding. For vitamin D, it is recommended adults consume 15-20 mcg per day depending on age.


What are the Signs and Symptoms of Colorectal Cancer? (Goodman, 2009)


While there are often very few signs of colorectal cancer early in the disease, many of these symptoms may sound similar to pelvic floor dysfunction. These symptoms include:


  • Bright red blood in stool or melena (dark, tarry stool)

  • Abdominal/stomach cramping

  • A feeling of needing to have a bowel movement that’s not relieved by having one

  • Changes in bowel habits that lasts more than a few days like persistent stomach pain, gas, diarrhea, or constipation *Remember, ideally your poop will be a 3, 4, or 5 on the Bristol Stool Scale



Since colorectal cancer often has few warning signs, it’s important to keep up with regular screenings. It is recommended that adults over 50, or those with family history of colorectal cancer get screened. Screenings can include testing a stool sample, bloodwork, a colonoscopy, and more. Talk with your provider about what’s right for you and when you should start getting screened.



How Does Colorectal Cancer Affect My Pelvic Floor? (Goodman, 2009)


Both the symptoms of colorectal cancer, and the treatments for it, can cause pelvic floor dysfunction. For example, chronic constipation and straining can lead to pelvic organ prolapse and pelvic floor muscle weakness.


Treatments for colorectal cancer are different for each individual but they may consist of surgeries and/or radiation treatments. Surgeries can impact the functioning of your pelvic floor by causing scar tissue. If scar tissue forms anywhere in the core (including the abdominals and pelvic floor muscles) this can prevent things from working the way they were designed. This can to leading to issues like constipation, incontinence, and other pelvic floor problems. Remember, leaking pee or poop (even just a little) is a sign that your pelvic floor is not working properly. A pelvic floor physical therapist is specially trained in treating these issues to help you restore your quality of life and return to moving freely (Lin, 2015; Chan, 2011).


Radiation therapy can burn body tissues and limit their ability to move and stretch. A pelvic physical therapist can help you learn how to stretch, move, and massage these tissues once you get clearance from your oncologist. Physical therapists can also guide you in dilator training and pelvic wand use to help your pelvic floor function at its best! There are many vaginal dilators and pelvic wands on the market, but we have our favorites in our Amazon Store.



Have you been impacted by colorectal cancer? Here are some helpful resources:

  • Ask your healthcare provider for a referral to a pelvic therapist.

  • Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.

  • Visit our YouTube channel for more videos on the pelvic floor.

  • Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics

  • Sign up for our email newsletter!

  • Visit our Instagram page for more on pelvic health.


For providers, check out these courses to help clients with colorectal cancer or bowel dysfunction restore their quality of life. Consider joining our Ambassador Program and most of our courses are included with your membership!

And more! Check the rest of our courses here.

You can also watch our YouTube videos for FREE



What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  


Written by Emily Reul, PT, DPT


References

1. Goodman CG, Fuller KS. Pathology: implications for the physical therapist. 3rd edition. Elsevier: St. Louis, Missouri. 2009.

2. 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):703-712.

3. Chan KYC, Suen M, Coulson S, Vardy JL. Efficacy of pelvic floor rehabilitation for bowel dysfunction after anterior resection for colorectal cancer: a systematic review. Support Care Cancer. 2021;29(4):1795-1809.

4. American Heart Association recommendations for physical activity in adults and kids. (2021, April 18). Retrieved March 08, 2021, from https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults

5. Calcium fact sheet for consumers. (2019, December 06). Retrieved March 08, 2021, from https://ods.od.nih.gov/factsheets/Calcium-Consumer/

6. Vitamin D fact sheet for consumers. (2021, January 07). Retrieved March 08, 2021, from https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

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This information is for awareness purposes and not individual medical advice. You should seek your own professional counsel for any medical condition or before starting or altering any exercise or fitness program.

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