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Patient Services

Pelvic Floor Therapy

Patients can benefit from physical therapy both before and after treatment that focuses on the pelvic floor — the muscular base of the abdomen that is attached to the pelvic bones.
Pelvic floor therapy for rectal cancer consists of training for the external muscles and internal muscles of the pelvic floor that may be affected by surgery or radiation. Surgery may remove or weaken key muscles used in digestion and bowel movements, and radiation may shorten muscle fibers in the pelvic floor. The effects of radiation can last five to 10 years after treatment.

Pelvic floor therapy can help with:

  • Urinary continence
  • Constipation
  • “Clustering” — having a bowel movement three to seven times in a row
  • Sexual dysfunction, including problems getting and maintaining an erection, vaginal dryness or tightness from radiation, and pain during intercourse. These problems may occur for the first time after rectal cancer treatment, or treatment may exacerbate earlier sexual dysfunction.

Pelvic floor therapy includes:

  • Clinic visits where muscles are manipulated by the physical therapist, with the goal of having the pelvic muscles work together in a coordinated way after treatment. Biofeedback, training to turn muscle action “on and off,” may be a significant part of this therapy.
  • At-home exercises including Kegel muscle exercises and deep breathing and relaxation exercises, which can help patients gain control over urinary function and bowel movements
  • Diet recommendations: Some rectal patients find digestion of gluten, dairy and high-fat foods especially difficult after treatment.

If possible, patients with rectal cancer should seek out physical therapy before treatment to ensure that the pelvic floor is in the best possible shape, as well as after treatment. It is also recommended that patients with a temporary ostomy should receive pelvic floor therapy while their ostomy is in place, to prepare the muscles for when the ostomy is discontinued and bowel movements resume through the anus. Pelvic floor physical therapy usually begins with therapy sessions once or twice weekly, gradually tapering to fewer treatments over the course of three to six months after rectal cancer treatment is completed.

ERAS Pathway

The ERAS Pathway: A Quicker Recovery After Colorectal Surgery | Colorectal Surgeon Jonathan Efron

Jonathan Efron discusses the implementation of the ERAS pathway across the Johns Hopkins Health System and its multiple benefits for patients, including reduced pain after surgery and improvements in breathing, moving and talking.

Fertility Preservation

Patients of child-bearing age who are scheduled for radiation therapy may wish to take advantage of fertility preserving options before beginning their treatment. The Johns Hopkins rectal cancer team can recommend fertility specialists for both men and women to discuss these options. For men, sperm banking may be an option. For women, options include a laparoscopic surgical procedure called ovarian transposition, which temporarily moves the ovaries out of the field of radiation during treatment.

Colon Cancer Patients Couples Retreat

The couples retreat is for patients living with metastatic colorectal cancer and their partners and provide an opportunity to share and network with others facing the same challanges. It is designed to ease psychological distress for the patient and the spouse and faciilitate interactions in an environment that is comfortable and conducive to open frank discussions about emotional impact of metastatic colorectal cancer on the patient, spouse and other family members.

Living with Metastatic Colon Cancer - A Couples Retreat

The couples retreat is for patients living with metastatic colorectal cancer and their partners and provides an opportunity to share and network with others facing the same challenges. It is designed to ease psychological distress for the patient and the spouse and facilitate interactions in an environment that is comfortable and conducive to open frank discussions about emotional impact of metastatic colorectal cancer on the patient, spouse and other family members.

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