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Macmillan and Cancerbackup merged in 2008. Together we provide free, high quality information for people affected by cancer through our publications, website and phone service. Find out more|.
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This information is for men who are having, or are about to have, radiotherapy to the pelvic area (lower part of the abdomen). Radiotherapy to the pelvis can cause side effects for some people. This information is about the possible side effects and how they can be controlled if they occur.
The pelvic area is the lower part of the abdomen (lower tummy). In a man it includes the prostate gland, testicles, penis and bladder. It also includes the lower end of the large bowel (colon, rectum and anus) and part of the small bowel called the ileum. There are also some lymph nodes, which are also known as lymph glands.
The male pelvic area
View a large copy of the diagram of the male pelvic area|
Radiotherapy| treats cancer by using high-energy rays to destroy the cancer cells while doing as little harm as possible to normal cells. Radiotherapy can be given to the pelvic area to treat a number of different types of cancer. In men, it is mainly used to treat cancer of the prostate gland|, but may also be used to treat cancer of the bladder|, rectum| or anus|. Radiotherapy may sometimes be given to the lymph nodes in the pelvic area.
Radiotherapy can either be given externally from outside the body or internally from within the body.
External radiotherapy| is normally given as a series of short daily treatments in the radiotherapy department at the hospital, using equipment similar to a large x-ray machine.
Treatment is often given over several weeks, once a day, Monday-Friday, with a rest at weekends. Each treatment takes several minutes and is painless. It won't make you radioactive and it is safe for you to be around other people, including children. You may be able to have your treatment as an outpatient or you may need to stay in the hospital.
Internal radiotherapy| is also known as brachytherapy| and is sometimes used to treat cancer of the prostate or anus. Brachytherapy may either be permanent using radioactive seeds or temporary using radioactive needles or wires that are briefly placed close to the tumour.
These are small radioactive metal implants about the size of a grain of rice. They are most commonly used to treat prostate cancer. These are usually inserted under a general anaesthetic and left in place so that radiation is released slowly over a period of time. The radioactivity gradually fades over several months. All the radioactivity is absorbed by the prostate gland so it is safe for you to be around other people.
For about two months after the treatment, children and women who are pregnant (or who may be) should not stay very close to you for long periods of time. However, it is safe for them to be in the same room as you.
This is sometimes used to treat cancer of the prostate or anus. When treating prostate cancer it is called high-dose rate brachytherapy and is usually done under a general anaesthetic. Small hollow tubes will be inserted through the skin close to the tumour. Inside the tubes are radioactive needles or seeds. When the tubes have been in place for long enough, the doctor will remove them and the radioactive source.
When temporary brachytherapy is used to treat anal cancer, thin radioactive wires are put into the area close to the tumour. This is usually done under a general anaesthetic. The wires are left in place for a couple of days and because they release radioactivity, you will be nursed in a separate room and your visitors will be restricted. Once the treatment is finished, the wires will be removed and it is safe for you to go home.
Although radiotherapy can destroy cancer cells, it can also have an effect on some of the surrounding normal cells. You should be given the opportunity to discuss any possible side effects with your doctor or radiographer. As there is often a lot of information to absorb, it may help to take a relative or friend with you when you see them. You can also ask your doctor or radiographer to write down important points or to record the conversation for you.
Radiotherapy affects people in different ways so it is difficult to predict exactly how you will react to your treatment. Most side effects will be temporary. It is fairly common for the short-term side effects to continue to get worse for a couple of weeks after the treatment, before they get better. They then usually improve gradually over a few weeks.
Radiotherapy can make you feel tired|, and the tiredness may increase towards the end of the course of treatment. It may last for weeks or sometimes months after the treatment has finished.
Sometimes tiredness can be minimised by carefully planning your day, getting help with jobs in the house and making sure you sleep well. It is important to take time to allow yourself to recover after the treatment and not try to do too much. However, if you are able to gently exercise, this can help you feel less tired. This may be the last thing you feel like doing. You may feel so tired that doing any exercise seems impossible. Sometimes, however, the less you do, the less you feel like doing. Just a short walk every day can help. You can try to increase the distance you go each time. Your doctor, nurse or radiotherapist can give you information about exercise.
Radiotherapy can cause a skin reaction and you may find that your skin gets very sore. This is more likely to be a problem in the skin folds of the groin and the cleft of the buttocks. In some situations the skin may become broken.
It's important to keep the area of the body that is being treated clean during treatment. Wash it with lukewarm water only and use unperfumed soaps. The area should be patted dry with a clean towel. Talcum powder and other scented products shouldn't be used as they can irritate the skin. It is helpful to wear loose clothing to prevent any friction on the skin.
Your radiotherapy department will advise you about how to look after your skin during treatment and the doctor can prescribe a cream, such as aqueous cream, to ease any soreness. Always check with the radiotherapy department staff before using any creams on your skin.
Radiotherapy will make the hair fall out| in the area being treated. Other body hair isn't affected. The hair should begin to grow back again within a few weeks of the treatment finishing but hair loss can be permanent for some people.
Radiotherapy can cause inflammation of the lining of the bladder. You may find that you have some of the following effects:
It's usually possible to reduce or control these effects.
Let your doctor know if you have any problems passing urine. They may give you a urine test to make sure you haven’t got an infection. Medicines such as anti-inflammatory drugs, antibiotics and painkillers can be prescribed if needed.
The following may help:
After radiotherapy for prostate cancer, it is common to need to pass urine frequently and not to be able to hold urine for very long. This may be due to irritation of the urethra and swelling of the prostate gland. It may continue for several months and then usually improves gradually. Your doctor may prescribe a type of drug called an alpha blocker: tamsulosin (Flomax®), terazosin (Hytrin BPH®), or doxazosin (Cardura® ), which may help reduce these effects.
Some men may find it difficult to pass urine and may need to have a tube (catheter) put into their bladder for a short while. Some men find that they have mild incontinence for a few months once the catheter is removed, but this is very rare. It is possible to deal with this by using incontinence pads which you can get from the radiotherapy department or your chemist. You can get advice about coping with incontinence from a specialist nurse or a continence adviser at the hospital. Let your doctor or nurse know if you are having difficulty passing urine.
If you need to go to the toilet more often, or feel that you can’t wait when you do want to go, you can get a card to show to staff in shops, pubs and other places. The card allows you to use their toilets, without them asking awkward questions. You can get the card from The Bowel and Bladder Foundation|.
If the radiotherapy area includes the small bowel (ileum), this may cause inflammation and irritation of the bowel. This may cause watery diarrhoea| and cramping pains in your abdomen (belly). If you already had diarrhoea, it can make the problem worse. Your doctor or radiotherapist can give you advice and may prescribe anti-diarrhoea medicines, such as loperamide (Imodium®) to help control it.
Drugs to reduce spasms or cramps (antispasmodics or muscle relaxants) can also be prescribed.
It's helpful to drink plenty of fluids to replace those lost through diarrhoea. A dietitian can give you advice about your diet, although there is currently no evidence that changing your diet during pelvic radiotherapy - for example, eating less fibre - can prevent diarrhoea.
The digestive system
View a large copy of the illustration of the digestive system|
As well as diarrhoea, radiotherapy to the bowel may cause the following problems:
These symptoms should begin to improve once the radiotherapy has finished. It may take a few months for the bowel to settle down, although most men will have a permanent change to their bowel habit, which is usually mild.
Let your doctor or nurse know about any symptoms you have, especially if you are passing blood. They may be able to help relieve the symptoms for you.
Some men have a sharp pain when they ejaculate. This is because the radiotherapy can irritate the tube that leads along the penis from the bladder (the urethra). The pain should ease off a few weeks after treatment finishes.
Pelvic radiotherapy may make you unable to father children (infertile)|. Your doctor or specialist nurse can talk to you about the effect radiotherapy is likely to have on you.
Many men find that losing their fertility can be very difficult to come to terms with. For some men, it may be possible for their sperm to be collected before the treatment starts (sperm banking). The sperm can then be stored for use in the future. It is important to talk to your doctor or nurse before your treatment starts. They can advise you about sperm collection and storage.
If you are having radiotherapy treatment, it's fine to have sex if you want to. But as you may still be producing sperm for some time after the treatment, you will need to avoid fathering a child. Some doctors recommend using contraception for six months and others for up to two years after treatment. Sperm produced after treatment may still be fertile but damaged, and could cause abnormalities in a child conceived soon after pelvic radiotherapy.
If you have had brachytherapy (seed implantation) for prostate cancer, it is advisable to use condoms during intercourse for the first few weeks after treatment. This is in case a seed becomes misplaced and is present in your semen, but this is very rare.
For many people, most of the side effects will be temporary (short term) and will disappear over a few weeks or months once the treatment has ended. For some men, one or two of the side effects may never go away after treatment and may become long-term problems. Sometimes side effects which start during radiotherapy get better after the treatment finishes, but then problems start to occur many months or even years later.
It is very important to let your cancer specialist know if the side effects of your radiotherapy have not got better a few weeks after the treatment has ended. It is also important to let your doctor know if you get new side effects or if any side effects get worse after the treatment. There may be a lot of things that can help you.
Some people get long-term bladder or bowel problems after pelvic radiotherapy. Many men also have erection difficulties| that can often be improved with medicines or medical devices.
A very rare late side effect of radiotherapy to the pelvic area is damage to bones| in the region. Tiny cracks in the bone can cause pain and make it difficult to walk and move around.
In a small number of men, the lymph channels that drain fluid from the legs become blocked, and this can cause swelling (lymphoedema) of the legs or genital area. All these effects are discussed in our section about the long-term effects of pelvic radiotherapy.
Most men will have some change in the way that their bladder or bowel works, and some may have erection difficulties (impotence), and changes in the physical and emotional feelings associated with sex. The impact of these side effects varies from person to person:
Much can be done to help if this happens.Your cancer specialist or GP may be able to help you. They can also refer you to a doctor who is a specialist in treating long-term side effects of radiotherapy. These doctors are not in every hospital, so you may need to travel to see one.
The effects of pelvic radiotherapy may be difficult to talk about|. It can be embarrassing to say that you have problems with your bowel, bladder or sex life. However, doctors and specialist nurses are very used to discussing intimate problems. You can tell them exactly what is happening to you. They will then be in the best position to help. Your doctor or nurse can also refer you to a continence adviser or relationship and sexual therapist if needed. The Bladder and Bowel Foundation can put you in touch with a local continence adviser.
COSRT| provides information on sexual problems. A list of therapists is available on thewebsite or from the information department.
The Sexual Advice Association| provides information and leaflets about sexual difficulties. Has leaflets on all the medicines and pumps used for erectile dysfunction and impotence.
Crohn's and Colitis UK| is a national organisation for people with inflammatory bowel disease. Has information on coping with diarrhoea.
The Bladder and Bowel Foundation| provide support and information for people affected by bowel and bladder problems. Has a ‘Just Can’t Wait’ card to allow holders access to toilets in shops and pubs.
This information has been compiled using information from a number of reliable sources including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
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