Late effects of pelvic radiotherapy

Talk to your cancer doctor or specialist nurse if you have:

• side effects that do not go away
• new symptoms or problems after treatment has ended.

If you have problems with your bowel, bladder or sex life, you may feel embarrassed to talk about them. But doctors and nurses are used to speaking about these issues. If they know you are having problems, they can answer your questions and help you.

It can be frightening to have symptoms after treatment has finished. You may worry that the cancer has come back.

Your doctor or nurse can explain whether your symptoms may have been caused by the treatment you had. You may need tests to check for other causes.

Some late effects may not affect your daily life very much. Others can be more difficult to live with. Help and support is available, and there are usually things that can help you cope.

Pelvic radiotherapy can cause long term changes to the bowel

Possible symptoms of late effects to the bowel include:

• bleeding from the back passage (rectum)
• passing mucus (a clear, sticky substance)
• cramps or spasms in the bowel, which may be painful
• feeling that you need to pass stools even when your bowel is empty – this is called tenesmus
• not being able to empty the bowel completely
• diarrhoea or constipation
• needing to rush to empty your bowels (urgency)
• problems controlling your bowel, causing leakage or soiling (bowel incontinence)
• passing a lot of wind, or losing control of passing wind.

Some people have mild symptoms that do not cause too many problems. They may only notice small changes, such as having to go to the toilet twice a day instead of once. For other people, bowel changes have a much bigger impact and can affect daily life. Bowel symptoms can affect your appetite or weight. Talk to your doctor if you notice that you are losing weight.

It is important that you get ongoing bowel symptoms checked by your doctor.

These symptoms might not be caused your radiotherapy treatment. They can be a sign of a more serious problem. It is important to find out the cause as soon as possible.

There are 4 symptoms you must always talk to your doctor about:

• passing blood from your back passage
• waking up from sleep to open your bowels
• needing to rush to open your bowels
• bowel incontinence.

The right treatment for you will depend on the symptoms or side effects you have and how much of a problem they are.

We have more information about treating bowel problems and managing bowel symptoms.

Pelvic radiotherapy can cause changes that affect your sex life. These difficulties may be temporary and gradually improve over time. But even permanent changes that affect your sex life can often be improved.

Pelvic radiotherapy may cause:

• reduced desire for sex or a low sex drive (libido)
• changes in sexual sensation
• menopausal symptoms
• vaginal changes, such as dryness, narrowing, bleeding or infections
• erection problems
• changes in ejaculation
• changes to the anus or rectum.

We have more information about coping with changes that affect your sexual well-being. This includes information about managing:

• side effects that affect the female pelvis and hormones
• side effects that affect the male pelvis and hormones.

Lymphoedema is swelling that develops because of a build-up of fluid in the body’s tissues. This happens when the lymphatic system, which normally drains the fluid away, is not working properly.

Pelvic radiotherapy sometimes causes lymphoedema in the legs, pelvic area or genitals. The swelling can develop weeks, months or even years after cancer treatment.

Lymphoedema can be managed. It is usually possible to reduce the swelling if it is diagnosed and treated early. There are also things you can do to help reduce your risk of developing lymphoedema.

The signs and symptoms of early lymphoedema include:

• swelling – you may notice your clothing or shoes feeling tighter than usual, even before you see any swelling
• changes in sensation – the affected area may feel heavy, tight, full or stiff
• skin changes – the affected area may feel tight, stretched or a thicker texture, and sometimes it can be dry, flaky, rough or scaly
• aching in the affected area.

If you have any of these symptoms, ask your doctor or specialist nurse for advice as soon as you notice them. This can help to reduce the risk of the lymphoedema getting worse.

We have more information about lymphoedema. 

Pelvic radiotherapy can affect the way the ovaries work and cause an early menopause. This means the ovaries gradually stop producing the hormones oestrogen and progesterone. Monthly periods will gradually stop and you will not be able to get pregnant. You may get symptoms of the menopause such as:

• hot flushes and sweats
• vaginal dryness
• loss of interest in sex
• difficulty sleeping
• needing to pass urine more often
• weight gain
• mood swings
• loss of confidence
• poor concentration.

Menopause can also increase your risk of other health problems including bone thinning and heart disease.

There are different ways of managing menopausal symptoms. There are also ways to reduce your risk of other health problems. We have more information about menopausal symptoms after cancer treatment. 

Having pelvic radiotherapy may slightly increase your risk of developing a new cancer in the treated area. But the benefit of having pelvic radiotherapy outweighs the risk. Your doctor or nurse can explain this.