About pelvic radiotherapy late effects

Most people have side effects during pelvic radiotherapy. Usually, these gradually improve over a few weeks or months after treatment has ended.

Late effects are side effects that either:

  • start during or shortly after treatment and last for longer than 3 months – these are sometimes called long-term effects
  • do not affect you during treatment but begin months or even years later, as a delayed response to treatment.

Late effects after pelvic radiotherapy may also be called pelvic radiation disease.

Common late effects after pelvic radiotherapy include:

The impact of late effects may be minor and not affect your day-to-day life very much. Or it may be more difficult to live with. If you have late effects, there are usually things that can help you to cope and live life as fully as possible. It is important that you do not feel alone. Help and support is available.

Bladder problems after pelvic radiotherapy

Pelvic radiotherapy can cause long term changes to the bladder including:

  • Scarring and hardening (fibrosis) of the bladder wall

    This shrinks the bladder so it holds less urine. It can also weaken the pelvic floor muscles and the valve that holds the bladder closed. This means that small amounts of urine can leak out. This is called incontinence.

  • Weakening of the small blood vessels in the bladder lining

    The bladder lining may bleed easily. This can cause blood in your urine.

  • Narrowing of the urethra

    This is called a urethral stricture. It may make it more difficult to pass urine.

Symptoms of bladder changes

These changes can cause symptoms such as:

  • needing to pass urine (pee) more often than usual (frequency)
  • a burning feeling when you pass urine
  • being unable to wait to empty your bladder (urgency)
  • leaking urine (incontinence)
  • blood in your urine (haematuria)
  • difficulty passing urine (retention).

If you have any of these symptoms, it is important to have them checked by your doctor. Blood in the urine should always be checked by a doctor as soon as possible.

Treating bladder problems

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 how different bladder problems may be treated. This includes things you can do to help reduce bladder symptoms.

Bowel problems after pelvic radiotherapy

Pelvic radiotherapy can cause long term changes to the bowel including:

  • Weakening of the lining of the bowel and the small blood vessels in it

    This may cause bleeding from the bowel.

  • Scarring (fibrosis) in the large bowel

    This can make the large bowel narrower, thicker and less flexible. This causes waste to pass through more quickly than before. It can also mean the back passage (rectum) cannot hold as much poo (stool).

  • Changes to the muscles that help keep the stool inside the rectum

    This can cause problems with bowel control and leakage of stool (bowel incontinence).

Sometimes radiotherapy can cause changes in the small bowel. This may make it difficult to:

  • digest some types of food (food intolerance)
  • absorb bile acids used in digestion (bile acid malabsorption)
  • get rid of bacteria effectively (small bowel bacterial overgrowth or SIBO).

Symptoms of bowel changes

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 interfere with daily life.

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

  • bleeding from the back passage
  • waking up from sleep to empty your bowels (poo)
  • needing to rush to empty your bowels
  • leakage or soiling (bowel incontinence).

These symptoms may not be due to anything serious and they can often be easily treated. But you should always get them checked by your doctor. Occasionally, they can be a sign of a more serious problem. It is important to find out the cause as soon as possible.

Other symptoms

Other symptoms of late effects to the bowel include:

  • passing mucus (a clear, sticky substance)
  • cramps or spasms in the bowel, which may be painful
  • feeling that you need to poo (pass a stool) even when your bowel is empty (tenesmus)
  • not being able to empty the bowel completely
  • diarrhoea
  • constipation
  • passing a lot of wind or losing control of passing wind.

Treating bowel problems

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 how different bowel problems may be treated. This includes things you can do to help reduce bowel symptoms.

Sex and late effects of pelvic radiotherapy

Pelvic radiotherapy can cause changes that affect your sex life. Sexual problems are more likely if you have also had surgery to the pelvic area, chemotherapy or hormonal therapy.

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:

Fertility after pelvic radiotherapy

Pelvic radiotherapy may affect your ability to get pregnant or get someone pregnant (your fertility).

This treatment affects the womb and ovaries. This means you won’t usually be able to have children after your treatment.

The testicles where sperm are produced are also very sensitive to pelvic radiotherapy. This means you may not be able to get someone pregnant after treatment.

Infertility can be distressing. Getting the right support can help you find ways of coping. We have more information about:

Lymphoedema after pelvic radiotherapy

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.

Lymphoedema is not common after pelvic radiotherapy. But if you have had surgery to remove the pelvic lymph nodes as well as pelvic radiotherapy, the risk may be higher.

Lymphoedema is caused when lymph fluid cannot pass through the vessels or lymph nodes in the pelvic area and the fluid cannot drain away in the usual way. The fluid then builds up between the tissues and causes swelling in one or, occasionally, both legs. This 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.

We have more information about lymphoedema

Bone changes after pelvic radiotherapy

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

If radiotherapy damages the pelvic bones, it may increase the risk of fine, hair-line cracks in the bones. These are known as pelvic insufficiency fractures. They often do not cause any symptoms but may be seen on a scan. Sometimes they can be painful. The pain is normally in the lower back or pelvis when you are moving around. It can make walking difficult. Pain isn’t usually a problem when you are resting or sleeping.

Pelvic radiotherapy also causes an early menopause (see below) in younger women. The menopause increases the risk of bone thinning (osteoporosis), but only if you can’t have hormone replacement therapy (HRT).

If you have pain or aching in the bones, always let your cancer doctor or nurse know. It can be caused by lots of conditions, but it is very important to get it checked.

If you have symptoms that last for more than a few weeks, your doctors will need to do tests to check your bone health.

We have more information about bone health. This includes information about looking after your bones and treatments that can help protect your bones.

Early menopause after pelvic radiotherapy

If you have not had your natural menopause, pelvic radiotherapy will cause an early menopause. This is because it stops the ovaries working and they will no longer make the hormones oestrogen and progesterone. Your periods will gradually stop and you may get the symptoms of the menopause.

We have more information about menopausal symptoms after cancer treatment. 

Second cancer after pelvic radiotherapy

Having pelvic radiotherapy may slightly increase the risk of developing a new cancer in the treatment area. But the benefits of pelvic radiotherapy outweigh the risk of developing a second cancer. Your doctor or nurse will discuss this with you.

If you have late effects

Always let your cancer doctor or specialist nurse know:

  • if the side effects of treatment do not go away
  • if you have any new symptoms or problems after treatment.

The more you tell your doctor, the more they may be able to help you. 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, so do not feel embarrassed.

Some late effects are similar to symptoms you may have had when you were diagnosed with cancer. It can be frightening to have symptoms after treatment ends. You may worry that the cancer has come back.

Your cancer team will assess your symptoms and explain whether they could be caused by the treatment. You may need tests to check for other causes, such as the cancer coming back or a new cancer. 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. You can also contact your GP at any time.

Other types of 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 treating incontinence (continence adviser).

A few hospitals have special clinics for people with late effects. Ask your healthcare team whether there are any near you. Some doctors and nurses specialise in treating late effects. You may need to travel to see one. Your doctor or nurse can refer you to other specialists if needed.