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Herman & Wallace Blog

Colorectal Cancer: Complications after the Cure

Curing cancer but not addressing life-altering complications can be compared to feeding the homeless on Thanksgiving but turning your back on them the rest of the year. We love hearing positive outcomes of a surgery, but we are not always aware of what happens beyond that. Colorectal cancer is often treated by colectomy, and sometimes the survivor of cancer is left with urological or sexual dysfunction, small bowel obstruction, or pelvic lymphedema.

Panteleimonitis et al., (2017) recognized the prevalence of urological and sexual dysfunction after rectal cancer surgery and compared robotic versus laparoscopic approaches to see how each impacted urogenital function. In this study, 49 males and 29 females underwent laparoscopic surgery, and 35 males and 13 females underwent robotic surgery. Prior to surgery, 36 men and 9 women were sexually active in the first group and 13 men and 4 women were sexually active in the latter group. Focusing on the male results, male urological function (MUF) scores were worse pre-operatively in the robotic group for frequency, nocturia, and urgency compared to the laparoscopic group. Post-operatively, urological function scores improved in all areas except initiation/straining for the robotic group; however, the MUF median scores declined in the laparoscopic group. Regarding male sexual function (MSF) scores for libido, erection, stiffness for penetration and orgasm/ ejaculation, the mean scores worsened in all areas for the laparoscopic group but showed positive outcomes for the robotic group. In spite of limitations of the study, the authors concluded robotic rectal cancer surgery may afford males and females more promising urological and sexual outcomes as robotic.

Husarić et al., (2016) considered the risk factors for adhesive small bowel obstruction (SBO) after colorectal cancer colectomy, as SBO is a common morbidity that causes a decrease in quality of life. They performed a retrospective study of 248 patients who underwent colon cancer surgery, and 13.7% of all the patients had SBO. Thirty (14%) of the 213 males and 9 (12.7%) of the 71 females had SBO; consequently, they found patients being >60 years old was a more significant risk factor than sex regarding occurrence of SBO. The authors concluded a Tumor-Node Metastasis stage of >3 and immediate postoperative complications were found to be the greatest risk factors for SBO.

Vannelli et al., (2013) explored the prevalence of pelvic lymphedema after lymphadenectomy in patients treated surgically for rectal cancer. Five males and 8 females were examined one week before and 12 months after being discharged from the hospital. All 9 of the patients (4 males, 5 females) with extra-peritoneal cancer exhibited lymphedema via MRI, but the 4 (1 male, 3 females) patients with intra-peritoneal cancer had none. The authors concluded pelvic lymphedema can be elusive after rectal surgery, but pelvic disorders persist and patients should be routinely examined for it.

Obviously saving a life is the primary goal when it comes to cancer. But just like caring for the destitute for one day doesn’t cure a lifetime of hunger, ignoring the negative post-surgical sequelae of a colectomy prevents a cancer survivor from living a healthy life. Herman & Wallace offers two pelvic floor oncology courses, “Oncology and the Male Pelvic Floor” and "Oncology and the Female Pelvic Floor" , which address how pelvic cancers affect the quality of life of our patients and how practitioners can make a positive impact.


Panteleimonitis, S., Ahmed, J., Ramachandra, M., Farooq, M., Harper, M., & Parvaiz, A. (2017). Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study. International Journal of Colorectal Disease, 32(2), 241–248. http://doi.org/10.1007/s00384-016-2682-7
Husarić E., Hasukić Š, Hotić N, Halilbašić A, Husarić S, Hasukić I. (2016). Risk factors for post-colectomy adhesive small bowel obstruction. Acta

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Soccer Star Struggles with Ulcerative Colitis

Ulcerative Colitis (UC) dramatically effects a patient’s livelihood.  UC is often confused with Crohn’s Disease, another major inflammatory bowel disease.  While they do differ in origin, both diseases share similar symptoms, such as blood in a patient’s stool.  Furthermore, like Crohn’s Disease, UC tends to affect young people (those between the ages of fifteen and thirty).

Chronic and often severe, UC has no known cure and, in rare cases, can even be life-threatening to the patient.

The Daily Mail posted a news article about Manchester United’s Darren Fletcher, who recently underwent his third surgery for UC.  Over the last few years, Fletcher has frequently struggled to stay fit.  He has played just thirteen games since December 2011.

Multiple surgeries, as in Fletcher’s case, are not uncommon.  UC spreads and deeply infects the lining of a patient’s colon and rectum.  Although there is no known cure, correctly applied therapy has been known to markedly reduce symptoms and even lead to long-term remission.

Herman & Wallace offered their first on Bowel Pathology and Function in Stony Brook, NY last month and is in the midst of confirming dates for another course in 2014.  Keep a look out for updates!

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Upcoming Continuing Education Courses

Pelvic Floor Level 2B - Houston, TX

Apr 24, 2021 - Apr 25, 2021
Location: Texas Children’s Hospital

Pelvic Floor Level 2B - Garden City, NY Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Metro Physical & Aquatic Therapy

Pelvic Floor Level 2A - West Norriton, PA Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Level 2B - Self-Hosted (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Kenosha, WI Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Aurora Health Care

Pelvic Floor Level 2A - Self-Hosted

Apr 24, 2021 - Apr 25, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - Self-Hosted (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Self-Hosted Course

Pelvic Floor Capstone - St George, UT Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Dixie State University

Pelvic Floor Capstone - Manchester, IA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Physical Therapy Solutions

Pelvic Floor Level 2B - Houston, TX Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Texas Children’s Hospital

Pelvic Floor Level 2A - Charlottesville, VA Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Capstone - Cranford, NJ Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Capstone - Alexandria, VA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Inova Physical Therapy Center

Pelvic Floor Capstone - Brooklyn, NY Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: PT of the City

Pelvic Floor Capstone - Tacoma, WA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Olympic Sports and Spine

Pelvic Floor Capstone - San Diego, CA Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: FunctionSmart Physical Therapy

Pelvic Floor Level 2B - San Diego, CA Satellite Course

Apr 24, 2021 - Apr 25, 2021
Location: Water and Sports Physical Therapy Clinics

Peripartum Advanced Topics - Remote Course

Apr 24, 2021 - Apr 25, 2021
Location: Replacement Remote Course

Pelvic Floor Capstone - Asheville, NC Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Cornerstone Physical Therapy

Pelvic Floor Level 2A - Truckee, CA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Tahoe Forest Center for Health and Sports Performance / Alliance Therapy Partners

Pelvic Floor Level 2A - Jacksonville, FL Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Summit Physical Therapy

Pelvic Floor Level 2A - Hinsdale, IL Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Ivy Rehab Physical Therapy

Pelvic Floor Capstone - Marietta, GA Satellite Location

Apr 24, 2021 - Apr 25, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2A - New York City, NY Satellite Location (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: KNOSIS Center for Physiotherapy & Wellness

Male Pelvic Floor - Brooklyn, NY Satellite Location

Apr 25, 2021 - Apr 26, 2021
Location: ODA Primary Health Care Network

Male Pelvic Floor - Self-Hosted

Apr 25, 2021 - Apr 26, 2021
Location: Self-Hosted Course

Bowel Pathology and Function - Remote Course

Apr 30, 2021 - May 1, 2021
Location: Replacement Remote Course

Mobilization of Visceral Fascia: The Urinary System - Self-Hosted

Apr 30, 2021 - May 2, 2021
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Urinary System - Torrance, CA Satellite Location

Apr 30, 2021 - May 2, 2021
Location: Women's Advantage Inc