Late effects of pelvic radiotherapy

At your hospital follow-up appointments, your specialist will assess your late effects and how they are being managed. They will also check that there are no signs of the cancer coming back. 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.

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.

You can arrange to see your cancer doctor or specialist nurse in between appointments if needed. You can also contact your GP.

The more you tell your healthcare team, the more they may be able to help you. Some problems may feel embarrassing to talk about. But try not to let that stop you getting advice. Doctors and nurses are used to speaking about these problems, and it is important that you get the right information and support.

Your doctor or nurse will check your symptoms. You may need tests to find out more and to check for other causes. Your doctor or nurse will give you advice and information about what may help.

Pelvic radiotherapy can cause long term changes to the bowel

Possible symptoms of late effects to the bowel include:

• bleeding from the rectum (back passage)
• passing mucus (a clear, sticky substance) from the rectum
• cramps or spasms in the bowel, which may be painful
• difficulty emptying the bowel completely and needing to return to the toilet quickly
• feeling that you need to pass stools (poo) even when your bowel is empty – this is called tenesmus
• diarrhoea (passing loose or liquid stools)
• constipation (not being able to pass stools as often as you normally do)
• needing to rush to empty your bowel (urgency)
• problems controlling your bowel, causing incontinence (leakage or soiling)
• 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.

Get symptoms checked

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 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 libido (sex drive)
• change in sexual sensation
• changes in how you feel about your body
• menopausal symptoms
• vaginal changes such as; dryness, narrowing, bleeding or infections
• erection problems
• changes to the anus or rectum.

If you identify as LGBTQ+, your healthcare team are there to support you and treat you in a way you feel comfortable with. The impact of cancer and cancer treatment are often the same whatever your sexual orientation or gender. But you may have some specific questions about any effects on your sexual well-being.

We have more information about coping with changes that affect your sexual wellbeing. 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 caused by a build-up of fluid in the body tissues. It happens when the lymphatic system is not working properly. This can be after damage from cancer or cancer treatment.

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

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 information about the signs and symptoms of lymphoedema. If you have any of symptoms lymphoedema, ask your doctor or specialist nurse for advice as soon as you notice them. 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.

Pelvic radiotherapy can affect the ovaries and cause an early menopause. This can cause symptoms that include vaginal dryness, low libido (sex drive) and hot flushes and sweats. Your doctor may prescribe hormone replacement therapy (HRT), to improve these symptoms.

There are different ways of managing menopausal symptoms and cancer treatment. There are also ways to reduce your risk of other health problems.

Having pelvic radiotherapy may slightly increase the risk of a new and different cancer in the treated area. This is not the same as secondary cancer, when cancer spreads from where it started. The benefit of having pelvic radiotherapy outweighs the risk of second cancer. Your doctor or nurse can explain more about this.