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Treating Pelvic Cancer Patients: An Interview with Allison Ariail

 

Allison Ariail is one of the creators of the Herman & Wallace Oncology of the Pelvic Floor Course Series. Practitioners who took the main Pelvic Floor course still weren’t sure how to handle oncology tissues, what they could do, or how to treat these patients. Thus the oncology series was created to provide additional instruction for treating pelvic cancer patients.

Allison Ariail is a physical therapist who started working in oncology in 2007 when she became certified as a lymphatic therapist. She worked with breast cancer, lymphedema patients, head and neck cancer patients, and the overall oncology team to work with the whole patient to help them get better. When writing these courses, Allison was part of a knowledgeable team that included Amy Sides, Nicole Dugan, Tina Allen, Jennafer Vande Vegte, and Megan Pribyl.

The Oncology Series is comprised of three different courses, with the first course, Oncology of the Pelvic Floor Level 1, designed as an overview of the oncology world. Allison explains that the reason level 1 is an introduction is that “this is because the oncology medical world is so different from what a lot of rehab professionals are used to.”

Oncology of the Pelvic Floor Level 2A addresses colorectal cancers, anal cancers, and cancers that affect male genitalia. New information about how to treat prostate cancers is also discussed. The third course, Oncology of the Pelvic Floor Level 2B, is being launched this year in 2022 and covers gynecological cancers and bladder cancers. The tentative launch will be in November 2022.

There are a lot of labs in all of these courses that are specific to the side effects that these patients have after going through radiation and other surgical treatments. Oncology patients can have a range of problems from radiation fibrosis, range of motion issues, and weakness. While these patients may be seeing a certified lymphatic therapist, that CLT is not going to have time to address these additional issues. Allison Ariail explains, “that is where this knowledge from these courses comes in. Not just as a supplement for that patient, but as a completely different treatment, where that patient really needs to see both therapists. One for lymphedema and one for radiation fibrosis, or weakness, or other side effects, that can affect their quality of life.”


Certified Lymphatic Therapists can skip OPF1 or dive in at OPF2A or OPF2B as long as they have taken the main Pelvic Floor Level 1 course prior.

Oncology of the Pelvic Floor Series 2022 Schedule

Oncology of the Pelvic Floor Level 1

Oncology of the Pelvic Floor Level 2A

Oncology of the Pelvic Floor Level 2B

  • TBD – course launch is tentatively scheduled for November 2022
  • If you are interested in attending this course, please contact us!
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Short Interview Series - Episode 7 featuring Allison Ariail

A different approach to treating prostatectomy patients.

The Pelvic Rehab Report sat down with Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC to discuss her upcoming courses Rehabilitative Ultrasound Imaging - Orthopedic Topics and Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics scheduled for November 12-14, 2021. Allison specializes in the treatment of the pelvic ring and back using manual therapy and ultrasound imaging for instruction in a stabilization program. She also specializes in women’s and men’s health including conditions of chronic pelvic pain, bowel and bladder disorders, and coccyx pain.

 

As a pelvic floor clinician, you may have worked with patients who are suffering from urinary incontinence following prostatectomy. During a prostatectomy the prostate, seminal vesicles, prostatic urethra, and some connective tissues are removed. The extent of the removal will depend on the size of the tumor and if the tumor has spread into the surrounding tissues.  Because of the surgery, and the loss of smooth muscle surrounding the urethra, there is an inherent risk that these patients will suffer from urinary incontinence. Recently, there have been studies that examined the difference between patients who return to continence and those who do not return to continence following prostatectomy. They found that continent prostatectomy men demonstrated increased displacement of the striated urethral sphincter, bulbocavernosus, and puborectalis compared to incontinent men. They also found that continent prostatectomy patients demonstrated better puborectalis and bulbocavernosus function than controls! (1) This has made researchers conclude that continent men following prostatectomy compensate for the loss of smooth muscle by having better than normal function in their pelvic floor.

In another recent article, researchers put together recommendations for a rehabilitation program. They argue that traditional methods that have been used in pelvic floor therapy are based on applied principles for stress incontinence in women, not men. Men suffer from incontinence for a different reason than women. Thus, their treatment should be approached differently as well.  Additionally, the authors state that examining the pelvic floor muscles via a digital rectal exam does not allow the examiner to assess the underlying issue that leads to incontinence in men, the striated urethral sphincter. Instead, a digital rectal exam identifies issues in the external anal sphincter and puborectalis. They highly recommend the use of transperineal ultrasound imaging in order to view the contraction of the pelvic floor and confirm where the contraction is originating from. They also highly recommend the use of ultrasound in treatment for the use of motor re-learning(2).

We will discuss this more in-depth as well as learn how to use ultrasound imaging to help both male and female patients suffering from incontinence. We also will be learning how to use ultrasound imaging to address orthopedic conditions such as back pain, sacroiliac joint pain, and diastasis rectus. The course “Rehabilitative Ultrasound Imaging for the Pelvic Girdle” is now being offered with satellite locations as well as a limited number of self-hosted online groups and is scheduled for November 12-14, 2021. There are two courses being offered. The 2-day version, Rehabilitative Ultrasound Imaging - Orthopedic Topicsaddresses the use of ultrasound imaging to help back and lumbopelvic conditions. While the 3-day course, Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics, includes more pelvic floor related conditions such as prolapse and post-prostatectomy issues. The course includes ample lab time so participants leave with the clinical skills to be able to use ultrasound imaging in their practice.

 


 

  1. Stafford R.E., Couglin G., Hodges P. Comparison of dynamic features of pelvic floor muscle contraction between men with and without incontinence after prostatectomy and men with no history of prostate cancer. Neurourology and Urodynamics. 2020; 39:170-180.
  2. Hodges, PW., Stafford RE, Hall L., et al. (2020). Consideration of pelvic floor muscle training to prevent and treat incontinence after radical prostatectomy.  Urologic Oncology: Seminars and Original Investigations.  38: 354-371
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