Pelvic Oncology

Published January 1, 2026

What You Need to Know 

Pelvic health physical therapy is essential for people living with and beyond cancer (PLWBC), especially those with pelvic cancers. Compared to the general population, PLWBC face higher rates of pelvic floor disorders (PFD), which can arise during any phase of cancer care.

Key Points: 

• PFDs can include bladder/bowel dysfunction, pelvic pain, prolapse, and sexual dysfunction.

• Early, multimodal PT—including prehabilitation—improves outcomes and reduces long-term effects.

• Breast, lung and stem cell transplant survivors also experience high rates of PFD, highlighting the need for broad screening beyond pelvic cancers.

• Special considerations include lymphedema, surgical/radiation changes, psychological impacts, and age-specific needs.

As of January 2025, more than 18 million people in the U.S. were living with a history of cancer, a number projected to exceed 22 million by 2035.(Wagle et al., 2025) Among these, pelvic cancers, including prostate, colorectal, and uterine, are among the most prevalent diagnoses.(Wagle et al., 2025) Pelvic floor disorders (PFD) such as bladder and bowel dysfunction, pelvic pain, pelvic organ prolapse, and sexual dysfunction, are common in People Living With and Beyond Cancer (PLWBC), particularly those with pelvic cancers. Compared to the general population, PLWBC experience a substantially higher prevalence and severity of PFD. (Emanu et al., 2016; Ramaseshan et al., 2018; Colombage et al., 2022; Zhu et al., 2023; Shan et al., 2023). 

PFD among cancer survivors can be influenced not only by the type and combination of treatments received, but also by the cancer itself. (Neron et al., 2019). Pelvic health concerns can develop at any point along the care continuum, from diagnosis through acute care, long-term recovery, and late effects experienced months or years after treatment. The growing number of PLWBC experiencing PFD indicates the critical need for pelvic health physical therapists trained in this specialty area.  

Although pelvic health physical therapy interventions vary depending on the cancer diagnosis, stage of survivorship, and treatments received, early and multimodal rehabilitation is recommended to address PFD among PLWBC.( Cyr et al., 2024) Prehabilitation, for example, can improve functional performance, reduce treatment side effects, enhance outcomes, and address pre-existing pelvic floor symptoms, and it is increasingly integrated into pelvic oncology care pathways.(Gennuso et al., 2024)   Across the survivorship continuum, pelvic health physical therapy interventions often include education and behavioral strategies such as bladder and bowel retraining, pelvic floor muscle training (PFMT), electrical modalities, progressive therapeutic exercise, manual therapy for scars and radiation fibrosis, and training in the use of supportive devices such as vaginal or rectal dilators and vacuum erection devices.( Cyr et al., 2024; Bakker et al., 2014; Baumann et al., 2022 ; Zeng & Wang, 2024 ; Tim & Mazur-Bialy, 2023 ; Matos et al., 2019 ; Wolin et al., 2012 ; Cyr et al., 2022 ; Shu et al., 2025).

Although the rates of PFD among PLWBC are highest among those with pelvic cancers, breast cancer survivors also experience high rates of PFD and sexual dysfunction, with up to 90% of breast cancer survivors reporting sexual dysfunction. (Vitorino et al., 2024; Agrawal et al., 2025). Similarly, lung cancer survivors and stem cell transplant recipients have higher rates of PFD and sexual dysfunction compared to the general population, (Agrawal et al., 2025) highlighting the importance of screening beyond only pelvic cancers. Additional special considerations for pelvic cancer includes development of pelvic cancer-related lymphedema from cancer and cancer treatment, which necessitates the need to collaborate with a Certified Lymphedema Therapist (CLT),( Facondo et al., 2025; Hayes et al., 2017) anatomical changes from pelvic surgery and radiation therapy (e.g., fibrosis/stenosis impacting exams, continence, and sexual activity),( Raj et al., 2024) psychological sequelae (body image and intimacy),( Bowie et al., 2022; Plinsinga et al., 2024) and the unique needs of adolescents and young adults (sexual development, fertility, identity, and school/work participation).( Sopfe et al., 2020; Janssen et al., 2025).

References