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  1. Massa, Lisa PT, WCS, CLT


Medical research continues to extend the life of cancer patients beyond their initial diagnosis. One of the challenges for both cancer survivors and the health care professionals who care for them is to comprehensively address all the issues that impact their quality-of-life. Issues regarding mobility, return to work, cosmesis, and self-care are readily identified and addressed. There are other activities of daily living that may be more hidden but should be included in a comprehensive rehabilitation program. Continence (urinary and fecal) and the ability to engage in sexual activity have been well documented to impact the quality-of-life scores for individuals with various types of cancer.1-6 Individuals who experience incontinence and limitations in their ability to engage in sexual activity often have lower scores in the health/function, psychological/spiritual, and family domains in quality-of-life assessments. In one study, it was noted that cervical cancer survivors were noted to have an increased rate of divorce compared to the general population.7 The pelvic floor plays a role with both continence and sexual activity. To effectively address pelvic floor dysfunction, a thorough understanding of pelvic floor anatomy and physiology is essential. The physical therapist will incorporate this knowledge with an appreciation of the impact of surgery, chemotherapy, and radiation can have on the function of the pelvic floor. This will allow the therapist to be able to evaluate and treat their patient's dysfunction and improve their incontinence and sexual intimacy limitations. In this article, we will review the anatomy and physiology of the pelvic floor and its supportive structures. Next, we will include discussion of testicular, prostate, and penile cancer in men, ovarian, uterine, cervical, and vulvar/vaginal cancer in women and rectal cancer in both men and women. Then, we will proceed with a brief review of the literature and the impact of pelvic floor dysfunction on this patient population. Finally, we will discuss how to evaluate the pelvic floor and develop a comprehensive treatment program.