Other late effects

Pelvic radiotherapy can cause some other, less common types of changes in your body.

Pelvic lymph nodes can be damaged by radiotherapy. This can cause fluid to build up and legs can become swollen. Protecting your skin, legs and feet, simple massage and compression garments can prevent and reduce swelling.

Pelvic bones can be damaged by radiotherapy; this can cause fine cracks in the bones. Your doctor may prescribe painkillers to control any pain, bone strengthening drugs and vitamin supplements. You may be referred to a specialist bone doctor for advice.

Pelvic radiotherapy can also cause changes in women. Early menopause causes symptoms such as hot flushes, mood swings and low sex drive. Your doctor may be able to prescribe hormone replacement therapy to help but it’s not suitable for everyone.

Changes to vagina include narrowing, dryness and bleeding. These can usually be managed or treated successfully.

Having pelvic radiotherapy slightly increases your risk of a second cancer but this is outweighed by the benefits of pelvic radiotherapy as initial treatment. Your doctor or nurse will discuss this with you.


The lymph nodes (sometimes called lymph glands) are part of our immune system and help us fight infection. Sometimes lymph nodes (glands) in the pelvic area become damaged by radiotherapy or surgery.

When this happens, lymph fluid, which flows along fine channels between the nodes, can build up. One or occasionally both legs can become swollen. This is called lymphoedema and it can develop months or years after treatment. Some people get swelling in the genital area or in the lower tummy area but this is rare.

Lymphoedema is not common after pelvic radiotherapy. If you’ve had surgery to remove the pelvic lymph nodes as well as pelvic radiotherapy they you may be at a slightly higher risk.

Reducing your lymphoedema risk

There are things you can do to reduce your risk of lymphoedema, in particular protecting the skin on your legs and feet. Infections can trigger lymphoedema, so it’s important to avoid damage to the skin. If you notice swelling in your foot or leg, always get it checked by your doctor or nurse. The earlier lymphoedema is treated the more effective and straightforward it is.

What you can do:

  • Keep the skin clean and use moisturisers to keep it supple.
  • Clean grazes or cuts straight away and see your GP if the area gets red, hot or swollen.
  • Wear well-fitting shoes.
  • Use nail clippers instead of scissors to cut your toenails.
  • Cover up or use a high factor sun cream (SPF 30 or above) on sunny days.
  • Keep to a healthy weight.
  • Keep physically active and avoid standing for too long in the same position.
  • If you are travelling wear compression garments (see below) such as flight socks.

Managing lymphoedema

If you develop lymphoedema, you should be referred to a clinic for specialist advice. There are lots of things that can be done to reduce the swelling and prevent it getting worse.

At the lymphoedema clinic, you’ll be given advice on caring for your skin. You’ll also be shown positioning exercises and how to do self-massage. A specialist will measure you for a compression garment to wear on the affected leg to reduce the swelling. They may also recommend other treatments for you.

We have more information about lymphoedema and how it’s managed. We also have several videos on our website about coping with lymphoedema.

Bone changes

Radiotherapy to the pelvis may damage the bones in this area. But most people won’t develop bone problems as a result of their treatment.

If radiotherapy damages the pelvic bones, it may increase the risk of fine, hair-line cracks in the bones. Doctors call these pelvic insufficiency fractures and they can be painful. The pain is usually in the lower back or pelvis when you’re moving around. It can make walking difficult but it isn’t usually a problem when you’re resting or sleeping.

Always let your cancer doctor or nurse know if you have pain or aching in the bones. A number of conditions can cause this, but it’s important to get it checked. If you have symptoms for more than a few weeks, your doctors will need to do tests, such as a bone scan or MRI scan. You can have a scan called a DEXA scan to check your bone strength.


Pelvic insufficiency fractures don’t usually need an operation. Your doctor will prescribe regular painkillers to control the pain and refer you to specialist bone (orthopaedic) doctor for advice.

A physiotherapist will show you how to limit stress on the bones and give you exercises to do. If you’re having problems with day-to-day tasks, an occupational therapist can assess you and help with equipment to make things easier.

If you are diagnosed with bone thinning you’ll probably be prescribed drugs known as bisphosphonates. These help to strengthen the bones. Your doctor may also prescribe calcium and vitamin D supplements for your bone health.

Bone health

Radiotherapy damage to the bones isn’t common but other factors, such as ageing, can also contribute to bone changes.

In younger women, pelvic radiotherapy can cause early menopause. This increases the risk of bone thinning (osteoporosis), but only if you can’t take hormone replacement therapy (HRT).

Men taking hormonal therapy drugs for prostate cancer are more at risk of bone thinning (osteoporosis).

Try to look after your bone health and follow your doctor’s advice if you have any bone problems.

What you can do:

  • Keep physically active to keep bones strong, but if you have bone problems ask your doctor for advice.
  • Keep to a healthy weight to avoid strain on your joints.
  • Eat healthily to get plenty of calcium and vitamin D, and avoid too much caffeine.
  • Avoid smoking – it’s bad for the bones and it increases the risk of certain cancers and other illnesses.
  • Drink alcohol within sensible guidelines, as alcohol can interfere with the balance of calcium in the body. Current guidelines recommend that women should drink no more than 14 units and men no more than 21 units of alcohol per week.

Other late effects in women

Early menopause

Pelvic radiotherapy stops the ovaries from working and from producing the hormones oestrogen and progesterone. Your periods will stop and you’ll start menopause. Doctors usually say early menopause is before the age of 45.

Some symptoms of menopause are:

  • hot flushes and sweats
  • vaginal dryness
  • passing urine more often
  • lower sex drive
  • sleep problems
  • aches and pains
  • mood swings and poor concentration.

Talk to your doctor or specialist nurse if you’re having these symptoms. They can give you advice and treatment that can help cope with them. The menopause also means your ovaries are no longer producing eggs, so you will not be able to get pregnant. There’s more information about this in our fertility section.

Changes to the vagina

Radiotherapy to the pelvis can make the vagina narrower, less stretchy and drier. This may make having sex uncomfortable. It may also be more difficult for you to have internal examinations. Talk to your doctor if you are having problems.


The blood vessels in the lining of the vagina can become fragile and bleed more easily, especially after sex. Bleeding may also be caused by the vaginal tissue sticking together or scar tissue causing the vagina to narrow.

Always let your cancer doctor or nurse know if you have any bleeding. They will examine you and explain if it’s likely to be caused by the radiotherapy. If the bleeding is minor, once you know the cause you may find that it doesn’t trouble you much.

Using oestrogen creams (see next page) or trying to prevent vaginal narrowing (see above) may help reduce bleeding. Making sure you use lubricants during sex and trying different techniques and positions may also help.

If the bleeding doesn’t improve, your doctor may be able to use a drug called silver nitrate to seal off the bleeding points. A drug called tranexamic acid may also be prescribed for you.

Rarely, bleeding may be due to a sore (ulcer) in the vagina that’s developed as a result of radiotherapy. You’ll probably be advised to avoid penetrative sex until it has healed. Antibiotics are prescribed to treat any infection, and you may have the area rinsed regularly with antiseptic fluids (irrigation). Treatments can be applied directly to the ulcer to help it heal. Some people may have an operation to remove the area of tissue with the ulcer. Rarely, hyperbaric oxygen therapy may be used.

Always tell your cancer doctor or nurse if you have vaginal bleeding.

Back to Late effects of pelvic radiotherapy

About late effects

Some people may have long term or late effects of pelvic radiotherapy. These can usually be treated or managed successfully.

Bladder changes

Late effects on the bladder can usually be managed or treated successfully. Talk to your doctor about any symptoms.

Bowel changes

Late bowel effects of pelvic radiotherapy are usually managed or treated successfully. Talk to your doctor if you notice any symptoms.

Late effects and sex life

Pelvic radiotherapy can have some late effects on your sex life. Talk to your doctor for advice on how to manage these.