Possible late effects on the bowel or bladder

Most people have side effects during, and for a few weeks after rectal cancer treatment. Usually these effects gradually lessen and disappear. But some people may have side effects that continue months after treatment and sometimes become permanent. Other people may develop delayed side effects of treatment months or years later. These effects after treatment is over are called long-term effects or late effects of treatment.

Tiredness and difficulty concentrating are common late effects. Other possible effects vary depending on the type of treatment you had.

Surgery and radiotherapy can both cause changes in bowel, bladder or sexual function. Chemotherapy may cause changes in sensation to hands and feet (peripheral neuropathy).

Not everyone has, or gets, these late effects and many get better over time. It’s important that you let your doctor or nurse know of side effects you had during treatment aren't going away, or if you develop new problems after treatment has finished. There are things that may help to manage or treat late effects.

Long-term and late effects

There are two commonly used terms:

  • long-term effects
  • late effects.

Long-term effects begin during or shortly after treatment and don’t go away within six months. Symptoms may gradually get better for up to a year or two after treatment ends. Some long-term effects may eventually go away on their own. But some may be permanent.

Late effects are a delayed response to treatment. They don't appear during treatment but can happen months or even years later.

In this information we use the term late effects to include both long-term and late effects.

There are many things that can be done to manage or treat late effects. It’s important that you don’t feel you just have to put up with them.

Late effects may be minor and not affect your day-to-day life much. Or, they may be more troublesome or difficult to live with, and interfere with your daily life. If you have late effects, there are usually lots of things that can help you cope with them. This will help you live life as fully as possible. Some late effects improve over time and may eventually go away on their own.


Talking to your doctor

If treatment effects don’t go away, always let your cancer doctor or specialist nurse know. If you have any new symptoms or problems after treatment, it is also important to tell them.

The more information you give your doctor, the more likely they are to be able to help you. You may feel embarrassed talking about problems with your bowel or difficulties with your sex life. But doctors and nurses are very used to discussing intimate problems like this, so don’t be put off.

Some late effects symptoms may be similar to the symptoms you had when you were first diagnosed. This can be frightening and you may worry the cancer has come back.

Your cancer doctor or bowel surgeon will assess your symptoms. They will explain whether they could be caused by your treatment. Your doctor may arrange tests to be certain about the cause of your symptoms. Sometimes symptoms are caused by other conditions not related to the cancer or its treatment.

Remember that you can arrange to see your cancer doctor or specialist nurse in between appointments. And you can contact your GP at any time.

Getting expert help

Some people with late effects are referred to a doctor or nurse with expertise in that area. For example:

  • a doctor who specialises in bowel problems, called a gastroenterologist
  • a specialist nurse or physiotherapist who gives advice on incontinence and treatment (continence adviser).

Some expert doctors specialise in treating late effects of radiotherapy. This is a specialised area and there are not many of these doctors. You may need to travel to see one.

A few hospitals have special clinics for people with late effects. Ask if there are any near you. Your doctor or nurse can refer you to other specialists if needed.


Possible late effects of rectal cancer treatments

The main treatments for rectal cancer are surgery, radiotherapy and chemotherapy.

They can all affect the bowel in different ways. But some late effects cause changes to the bladder or to your sex life. Other late effects can affect the nerves. It depends on the treatments you had.

We have information about ways you can manage and reduce late effects on the bowel or bladder.


Surgery

Surgery for rectal cancer involves removing some of the rectum and sometimes part of the colon. These operations cause changes in how the bowel works.

Some people need to have a new opening in the abdomen called a colostomy or ileostomy. This is usually called a stoma. It may be temporary or permanent.

If you have a stoma you’ll need to learn new skills to manage this. Specialist nurses, called stoma care nurses, will help and support you with this. You’ll need time to adjust to the changes in your body.

After rectal surgery, some people may have changes in how their bladder works or to their sex life.

Surgery can cause changes in the tissues of the tummy (abdomen). The skin may be less stretchy and the abdominal wall less strong. Weakness in the muscle of the tummy can lead to a hernia developing months or years later. Sometimes, scar tissue inside the abdomen (adhesions) may cause pain or discomfort, or may narrow the bowel.


Radiotherapy

Radiotherapy to the rectum and surrounding tissues (called pelvic radiotherapy) often causes bowel symptoms. These usually get better within a few weeks of treatment ending. But it can also cause late (delayed) effects months or years after treatment. Possible late effects include changes in the way your bowel or bladder works. It can also cause sexual difficulties.

We have more information about managing the late effects of pelvic radiotherapy.


Chemotherapy

Some chemotherapy drugs can damage nerves and cause pins and needles or numbness in your hands and feet. These changes may take several months to get better and for some people they are permanent.

Cancer treatment can also cause more general changes in how you feel. You may be more tired than usual for many months after treatment. Some people may have difficulty concentrating or remembering things. These side effects usually improve gradually over time.

Back to Long-term and late effects

Changes in how your bowel works

Treatment for rectal cancer may lead to changes in how your bowel works. These can usually be managed successfully over time.

Managing bladder problems

There are ways to manage changes in the way your bladder works. It’s important to talk to your doctor if you’re having problems.