OLDAncer treatment has significant improvement Over the past few decades, that means more and more people are living longer after undergoing surgical and medical interventions. This has led to the emergence of an area of cancer care known as survivability, which takes a holistic view of a patient’s health and sometimes involves therapies that are not always available. part of the cancer playbook.
In the case of bladder cancer, survival and improved quality of life after surgery sometimes means physical therapy focused on improving pelvic floor function.
Matthew Mossanen, an oncologist with the Dana-Farber Cancer Institute in Boston and an assistant professor of surgery at Harvard Medical School, says: The pelvic floor refers to “the muscles involved in health and bowel and bladder function”.
Ting-Ting Kuo, a board-certified women’s health clinician and director of rehabilitation at Memorial Sloan Kettering Cancer Center in New York City, describes this area as “a muscle group, Ligaments and connective tissue form a bowl-like structure at the base of the pelvis. “
Having proper muscle tone and control in this area helps stabilize the core, bowel function and urinary controland provide support to other internal organs.
But bladder cancer treatment can be invasive and disrupt these structures and functions. While data suggests that chemotherapy after surgery often offers the best chance of long-term survival, surgery can disrupt the way this area of the body works.
Some bladder cancer patients undergo cystectomy, a major surgical procedure that “includes removal of the bladder and, in men, it includes removal of the prostate,” says Mossanen. “For women, it involves removing the uterus, ovaries, fallopian tubes, and part of the vagina. It’s a huge surgery, and it’s done when the bladder cancer has become life-threatening.”
Fortunately, “the vast majority of patients with bladder cancer do not have cyst removal surgery,” says Dr. Emily Slopnick, a urologist at the Cleveland Clinic in Ohio. This procedure is reserved for people with advanced bladder cancer and those who are young and healthy enough to endure such a complicated surgery.
After its removal, the urinary system needs to be rebuilt, as the urine the kidneys still produce needs to go somewhere. Mossanen says this mainly takes one of two forms.
The first option is a ureterectomy, in which the surgeon creates an opening in the abdomen through which urine can drain into an external bag, which can then be emptied when full. . The second major option is the neoplasm, which means creating a new bladder inside the body. “The neoplasm is a replacement bladder formed from a segment of bowel,” says Mossanen.
Creating a neoplasm “can give patients a very good quality of life by helping some younger patients stay out of pocket,” says Mossanen.
However, all this disruption to the urinary system can create problems, says Slopnick. “Whenever any kind of trauma occurs in the pelvis, the pelvic floor can react to that. People tend to have tension or spasms, almost like pelvic floor spasms,” as the body tries to protect itself from injury. This can affect regulation, sexual function, and bowel function.
Furthermore, especially after vesicle reconstruction, some patients may develop a variety of undesirable symptoms, including urinary incontinence, inability to completely drain the bladder, and fistula. leaking urine, especially when laughing, coughing, or sneezing. But Mossanen says it can be helpful to refer patients with these problems to a pelvic floor physiotherapist, because restoring those vital structures can help cancer survivors. bladder enjoy a higher quality of life.
When it is used
While physical therapy is often considered a postoperative intervention aimed at restoring function that has been affected by disease and surgery, in the case of bladder cancer, pelvic floor rehabilitation can also could be encouraged, Mossanen said.
“I really strongly believe in rehab,” he said. At the Dana-Farber Cancer Institute, Mossanen has developed programs along these lines to help patients prepare for surgery. These efforts include classes on overall health, nutrition, and exercises that patients can do to help build their bodies before surgery.
The concept of prehab makes sense: if you’re stronger during surgery, you’ll be able to recover faster. While this idea has not been entirely successful everywhere, Mossanen believes that prehab will likely become a more common feature of bladder cancer treatment in the future.
Prehab can be especially helpful when a patient is about to have a cystectomy and the recovery period from surgery is long — about three months or longer —. “Many patients will be fatigued after surgery and recover slowly or have complications,” says Mossanen, because chemotherapy often occurs before surgery to remove the cyst, says Mossanen. “Because of these factors, some patients are not able to participate in rehabilitation, so there is a great reason to do detox first so that the patient can recover with better recovery. “
Whether you’ll be participating in pre-pelvic floor rehabilitation or bladder cancer-related rehabilitation, you’ll be working with a pelvic floor specialist — usually a pelvic floor physiotherapist. or a doctor of restorative medicine, also known as a physical therapist. These therapists are trained and knowledgeable to help you recover and reduce complications.
When and how that provider is involved, Kuo says, “depends on the symptoms being experienced” as well as the type of care provided. “The multidisciplinary team of patients with bladder cancer will determine the appropriate time to introduce pelvic floor therapy.”
What happens to physical therapy after bladder cancer?
Slopnick says: If you’re going to undergo physical therapy after bladder cancer, get a physical exam. “They will judge where you are strong, where you are weak.”
This may involve using a probe in the vagina or rectum to create visual feedback on a screen that maps how the muscles are moving. The therapist will also test your strength and coordination in the rest of your core, including your hips, spine, back, and abs.
Your medical history will be carefully considered in the development of your individual care plan. “That includes looking at past and present medical history, imaging tests, social history, lifestyle, and bowel and bladder habits,” says Kuo. For example, if your urgency increases after surgery or you go to the bathroom more often, those changes can provide insight into what the pelvic floor specialist focuses on during the procedure. therapy.
The therapist will take basic measurements of the pelvic floor function during this initial assessment and may recheck those metrics over time to determine how effective the therapy is and whether the plan of care needs to be adjusted.
As for the therapy itself, Slopnick says it’s best to work with a trained provider. “I wouldn’t recommend just reading about it online and trying to figure it out on your own, because you’ve already gone through a complicated disease process and have some complicated treatments. It’s really important to get someone evaluated to find out if it’s just the pelvic floor and make sure nothing else happens.”
It is difficult to estimate exactly how long pelvic floor therapy will last, as it depends on each person’s needs and physical condition. But typically, says Kuo, “usually starting once or twice a week.” She notes that patients may need to complete exercises at home, in addition to therapy sessions. “What really matters is the consistency of personal care.”
Potential therapy may include breathing exercises, strengthening or relaxation exercises, and hand massage to relieve muscle tension. In other words, there’s more to it than just doing some Kegels. “And it’s not just about the muscles around the pelvis. It’s your legs, your torso, your abs, your core, your back. We look at muscle balance and we make sure there’s really good movement across the area,” says Kuo. Even exercises to improve posture and attitude sitting or standing work in this therapy.
Benefits of pelvic floor rehabilitation for bladder cancer
As therapy progresses, “we’ll look at some objective measures of pelvic floor muscle strength and coordination,” says Kuo. This may include evaluation of soft tissue flexibility and mobility, reduction of scar tissue, and relief of symptoms. “We consider whether [patients] reduce the number of pads they are using or increase the time they go to the bathroom. “
Mossanen adds that for some patients, these improved metrics may – depend on the psychological benefits they get from working closely with a physical therapist to improve their well-being. pelvic floor. “I think there is an emotional and cognitive benefit to having support from another team member who can bring out things that I can’t,” as a surgeon, he say.
Read more: How to get back to normal after cystectomy
Outside physical therapy, rehabilitation after bladder cancer often involves nutritional counseling. Especially for patients with a neoplasm from a segment of bowel, bowel function is a matter of concern. “That’s the main thing that we’re watching after the surgery, which is waiting for bowel function to recover,” says Slopnick.
“The intestines slow down” as they recover from surgery, “and it takes a few days to a week for things to start working again,” she says. During that time, patients are often advised to avoid eating too much fiber and instructed to drink plenty of fluids to help their bowels recover and function.
Kuo notes that drinking plenty of water is also especially important for patients who have had a cystectomy; That new bladder was created from a portion of intestinal tissue that didn’t have the same nerve endings or muscles as the urinary bladder. The sense of urgency in needing to urinate can be quite different from a neoplasm. “They won’t have bladder muscles to tell them when they need to go, so they may need to schedule a ride every few hours,” she said.
Gentle exercise, such as getting up and walking as soon as possible after surgery, can help keep the digestive tract active and prevent potential complications such as blood clots.
There’s a lot to know when it comes to bladder cancer surgery, and some of these topics can make you feel a little uncomfortable. You’re not alone if you feel awkward talking about bowel and bladder function, and what goes on in the bathroom, to anyone, let alone the doctor’s office. But your care team is always ready to help. “If you are experiencing any of these symptoms, talk to your healthcare provider,” urges Kuo.
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