Don’t Let Covid-19 Distract You From Managing Your Risk for Colorectal Cancer
During this time of Covid-19, this pandemic has become somewhat all-consuming in most of our lives. It is creating financial and emotional stress and truly limiting our options to exercise to manage this stress. This is the perfect storm setting up relapse for smokers, an extra glass of wine for all the parents trying to manage telecommuting and schooling, exhaustion for health care workers, and ulcers for all of us just not knowing what will come next. Social distancing is also significantly limiting access to non-essential medical procedures used as screening measures that help us manage risk for other potentially life-threatening illnesses. This article is intended to remind all of us not to forget about these screening measures and to continue to try, at least, to prioritize healthy coping skills during this incredibly stressful time.
Colorectal cancer will affect 1 in 19 people. Some risk factors are genetic and cannot be helped; but others can be altered through diet and exercise. Key risk factors are a diet high in red and processed meats, physical inactivity, obesity, type 2 diabetes, smoking, and excessive alcohol consumption. So, again, stress eating, smoking, an extra cocktail over the long period of time it may take to resume a more normal lifestyle in the wake of the Novel Coronavirus can really add up.
According to the Internal Journal of Molecular Epidemiology and Genetics, as of 2016 colorectal cancer was “the third deadliest cancer in the US.” Colorectal cancer consistently claims the lives of nearly 50,000 Americans every year. For men it trails third behind lung and prostate cancer. For women it trails third behind lung and breast cancer. However, as research continues and landmark discoveries are being made related to risk factors and therefore prevention, there is good news. The five-year survival rate has increased over fifteen percent and the death rate, for both men and women, has nearly been cut in half.
Katie Couric made media history on March 21st, 2018 when she had her colonoscopy on national television. Driven by the loss of her husband to colorectal cancer, Katie wanted to raise awareness of the dangers of colorectal cancer and the incredible benefit of having a colonoscopy. As with all cancers, education is the key to prevention and early detection is the key to increasing cure rates and improving quality of life after associated treatments. Katie’s action helped take the fear out of the procedure, and for most people who have followed in her footsteps, the prep is really the worst part of having a colonoscopy. The American Cancer Society Guideline for screening either via stool-based tools such as Cologuard or colonoscopy is now forty-five years of age. If you are over forty-five and have no significant symptoms and minimal genetic and lifestyle risk, this may be an appropriate time to opt for a stool-based screening that can, thankfully, be performed in the context of social distancing.
However, there are likely exceptions for what is consider a non-essential procedure. Do not assume that you cannot have a colonoscopy due to Covid-19. If you experience any of the following symptoms, notify your medical team immediately:
- changes in bowel habits: either new constipation or diarrhea or loose stools that last for more than a few days
- rectal bleeding or dark stools
- cramping abdominal pain
- continued sense of needing to defecate after voiding.
These are all possible symptoms of colorectal cancer. Many of us get pretty excited when the scale drops a few pounds but one should recognize that unintended weight loss is also a red flag for systemic disease such as cancer. Any of the above signs and symptoms must be reported to your physician promptly. Almost all doctor’s offices are able to support telemedicine visits. So, please contact your primary care physician or GI specialist if you have any concerns.
Unfortunately, during normal circumstances, only about half of those recommended for colonoscopy follow through and get screened. Don’t be that person. According to “CostHelper > Health & Personal Care,” an online resource, the cost for an uninsured person to have a colonoscopy can range from ~$1,500 – $3,700. If you are uninsured, try to research resources that may help, such as the ColonscopyAssist Program. (not an endorsement of this resource, just an illustration that there may be financial help out ther). When it comes to getting screened for colorectal cancer being “penny wise and pound foolish” could be deadly. Many of us are experiencing significant financial uncertainty, but know that the cost of this preventative measure pales in comparison to the cost of cancer treatment.
There are various types of colorectal cancer but all are essentially staged according to three factors: tumor size and extent of invasion into the surrounding tissue, involvement of lymph nodes, and presence and extent of metastases. Staging and oncotyping (identifying which genetic alteration caused the tumor) are key factors in developing a treatment plan. It will include one or all of the following: surgery, radiation, chemotherapy, targeted therapy, and immunotherapy. Fascinating advancements are being made in all fields of treatment. Oncology is ever- evolving. In the event you are diagnosed with cancer, your care team will assign you to a nurse navigator that will help you with treatment journey. Clinical trials can provide additional hope for all cancer patients and their loved ones. Visit www.cancertrialshelp.org or call 1-877-227-8451 to find out more about clinical trials that may be available for you or a loved one. Always discuss potential clinical trials with your oncology team.
Unfortunately, despite advancement in the treatment technologies of colorectal cancer, there can be adverse side effects including fecal and urinary incontinence, pelvic pain, and sexual dysfunction. There is help to deal with any of these unintended consequences suffered from these life saving techniques. Trauma to the pelvic floor structures is mitigated with pelvic floor physical therapy. What, Physical Therapy for the pelvic floor? Yes, that’s right. Physical Therapist who have specialized in pelvic floor treatment are qualified to help survivors regain more control of their pelvic floors and help restore their quality of life. Physical therapy intervention starts with a complete history and an external and internal pelvic floor examination. Yes, physical therapists do that. A personalized plan of care then targets the findings.
If pelvic floor muscles are rendered weak as an unintended side effect of treatment, the first step in physical therapy is helping a person find and contract these muscles. This may sound simple but in reality it isn’t. These muscles nestle inside the pelvic girdle and do not move a joint like bending an elbow or knee or lifting an arm. Therefore, you do not get visible feedback or all the information from the signaling organs in and around a joint. There are several options for using biofeedback to help a person “find and fire” his or her pelvic floor muscles. Once this is accomplished a very specific regiment of home exercise is prescribed to then strengthen these muscles.
It is not enough to just do a quick contraction multiple times a day. So, if you think you are doing the exercise, commonly referred to as a “Kegel” correctly, reconsider. The American Physical Therapy Association recommends contractions be sustained for ten to fifteen seconds and repeated at least twenty-four times a day to improve muscle strength of the pelvic floor. This will, in turn, build muscle mass and create improved support of the pelvic organs, improved tone of the pelvic sphincters, and improved awareness and coordination to be able to engage all of these to defer and control urges to evacuate both bowel and, or bladder. Typically, clients are started lying on their sides or back to perform their pelvic floor strengthening progression and eventually pelvic floor contractions are performed in conjunction with other exercises. If someone has real difficulty with the initial stages of strengthening the pelvic floor, there are tools that can physically assist their contraction: specifically, neuro-muscular electrical facilitation or NMES (how about that fifty cent word) is a great option pelvic floor physical therapists have in their tool kit.
The pelvic floor can also cause problems if the muscles or the connective tissue get too tight. A hyperactive pelvic floor can cause just as many problems as one that is too weak. This often results in poor emptying of the bladder, feeling of needing to strain to empty the bowels, in addition to pelvic pain. Biofeedback can be used to help clients recognize what the resting state of their pelvic floor is and use relaxation techniques and voiding strategies to improve symptoms. There are medications that can be used, such as diazepam suppositories to bring down the tone of the pelvic floor. Throughout a course of pelvic floor therapy your therapist will be in contact with your medical team to discuss further intervention if needed. This may include pelvic floor injections to manage trigger points or overall resting tone.
If pelvic pain persists despite more conservative interventions, a person may be referred to a physician who can perform pelvic nerve “blocks”. The three most typical nerves to be addressed are the Pudendal, Inferior Hypogastric Plexus, and Ganglion of Impar. These can be performed by a number of different medical specialists and your physical therapist and physicians can help you find resources if these are deemed necessary.
The good news is that physical therapy is considered essential medical business and we, at Longevity Physical Therapy Center, continue to be here to help you and your loved ones during this Covid-19 crisis. If you, or a loved one suffer from pelvic floor dysfunction due to treatment for colorectal cancer, or any other diagnosis, please contact us to schedule an evaluation. We are able to help via telemedicine options as well. The nature of physical therapy requires hands on treatment techniques to achieve the best outcomes. However, there are many valuable interventions that can be initiated via telemedicine as well. Whatever your comfort level, we can help jump-start your recovery from pelvic floor dysfunction.