Coping with changes

After pelvic radiotherapy or treatment for bowel cancer, changes to the bladder and bowel often cause the same day-to-day issues. So we have covered them together in this section.

Protect your skin

If you have problems with leaking (incontinence) from your bladder or bowel control, it can make the skin in that area sore.

You can protect your skin by keeping it clean and dry. There are lots of products available to help you. Your continence adviser can give you more information.

Here are some suggestions to help keep your skin clean and dry:

  • Use a skin cleanser instead of soap and water.
  • Try not to scratch if your skin is itchy, but if you do sometimes scratch it is best to keep your nails short to help prevent damage to your skin.
  • Use absorbent incontinence pads.
  • Wear cotton underwear, as it lets your skin breathe more than other materials.

Plan ahead when you go out

If you have problems with bladder or bowel control, you may feel worried about going out, especially to somewhere new. Planning ahead so that you are prepared can help you feel more confident.

If you are going somewhere new, it is a good idea to find out where the toilets are before you go. The Great British Toilet map can help you to find public toilets by postcode or through the location on your mobile phone. There are also toilet apps for mobile phones, that can find the toilets nearest to you.

Get a toilet card

Macmillan has a free toilet card you can use. It may help you access a toilet more quickly when you are out. You can use it in places such as shops and pubs. The card says you have a medical condition that means you need urgent access to a toilet.

Use disabled toilets

Disabled toilets often have more privacy and space. The National Key Scheme for toilets offers access to about 7,000 locked disabled toilets across the UK. You can buy a key from Disability Rights UK. They also have a guide that explains where the toilets are.

Take a bag with supplies

Pack a bag of the things you may need when you go out. This will help you feel more confident. You may want to include:

  • wet wipes or tissues
  • a non-oil barrier cream
  • incontinence pads and pants
  • a change of clothes
  • a sealable bag
  • anti-diarrhoea tablets (if you have problems with diarrhoea)
  • your Macmillan toilet card.

Specialist products for leakage or soiling

If you have problems with leakage or soiling (incontinence), there are different products that can help. These can help you feel more confident and protect your clothes. A continence adviser can help you choose products that suit your needs.

You can buy pads for mild to moderate incontinence in most supermarkets and pharmacies and online. If these are not absorbent enough, you can get different pads from your continence adviser. They can also explain what is available to you on the NHS. This will depend on where you live. The Bladder and Bowel Community also has information about different products.

Problems with leakage or soiling can mean you have extra expenses. Call Macmillan on 0808 808 00 00 to find out more about ways to help cover the cost.

Products for bladder incontinence

Pads and pull-ups have a layer that absorbs urine (pee), so your skin stays dry. Some are made to go inside your underwear and others are worn instead of underwear. You can also buy pads to cover your bed. It is best to avoid using sanitary pads, because they are made differently. Sanitary pads stay damp, which means the urine can make your skin sore.

Having a urine bottle near your bed may help you get a better night’s sleep. You will not have to walk to the toilet every time you need to go. If you are worried about getting to the toilet in time during the day, keep the bottle nearby. You may want to keep one in your car.

Urinary sheaths

A urinary sheath fits over the penis like a condom. It has a self-adhesive strip to keep it in place. The sheath has an outlet which you connect to a bag to collect urine. You strap the bag to your leg. You can buy underwear with a built-in pocket to hold the bag. Your continence adviser can help you choose products and show you how to use them.

Products for bowel incontinence

There are different types of pad you can wear during the day and at night. Pads and pants with charcoal linings may help to reduce smell from leakage or wind. There are also different types of pad you can use to cover your bed or chairs.

Anal plugs and inserts

Peristeen® anal plugs are inserted into the rectum to stop bowel leakage. They are made from soft foam covered with a film. When it is in place, the film dissolves and it swells up to fill the gap. They can stay in place for up to 12 hours. There is a cord attached to the plug, so you can remove it when you are ready to go to the toilet. Some people find anal plugs uncomfortable to begin with. But most people get used to them after using them a few times. 

Renew® anal inserts are made from soft silicone and are placed in the anus. There are 2 discs at either end. The top disc is inserted using an applicator and the lower disc sits outside the anus to stop the insert from moving further in. They stop any leakage until you are ready to go to the toilet. Then the insert either gets pushed out when you have a bowel movement, or you remove it first. You can also remove them before a bowel movement. 

Your continence adviser can help you choose products that suit your needs and show you how to use them.

Keep to a healthy weight

Cancer treatment can cause changes in weight. Being overweight puts pressure on your pelvic floor muscles. It is important to keep to a healthy weight if you have bladder or bowel problems after cancer treatment. Your health professional  can advise you on the ideal weight for your height.

Keep physically active

Keeping active will help you manage your weight and avoid constipation. This is important to help look after your pelvic floor muscles. Exercise also helps you feel better and can reduce stress.

If you have stress incontinence, anything that involves running or jumping may cause leakage. Your healthcare specialist can advise on things that can help. For example, they may suggest building up the distance you run, or the intensity of exercises. You may want to use a product, such as an incontinence pad, during these exercises to begin with.

Walking or swimming are lower-impact and are less likely to cause problems. Your specialist may be able to suggest suitable exercise for you.

If you have been advised to do pelvic floor exercises, it is important to keep doing these regularly. This can also help you gain more control over your bladder and bowel movements.

If you have a stoma, you should not play contact sports, but you can play other sports. Ask your stoma nurse if you are not sure what you can do.

Avoid constipation

Avoiding constipation can help protect your pelvic floor muscles. This may help with bladder and bowel symptoms.

To avoid constipation, you can try the following things:

  • choose foods that reduce constipation
  • make sure you are sitting in the correct position to empty your bowels and have a good toilet routine
  • drink plenty of fluids
  • keep active.

Drink plenty of fluids

Try to drink at least 1 to 2 litres (2 to 3½ pints) of fluids a day. If it is hot or if you are exercising, you will need to drink more than this. It is best to drink regularly throughout the day.

Not drinking enough could make bladder problems worse. Concentrated urine irritates the bladder. Drinking more fluids will help to:

  • reduce bladder irritation
  • train your bladder to hold more urine
  • reduce your risk of getting urine infections.

Try not to go to the toilet ‘just in case’

If you go to the toilet as a precaution, your bladder will not get used to holding more urine.

Drink the right fluids

Some drinks can irritate the bladder or bowel and make symptoms worse. Try to cut down or avoid:

  • alcohol (especially spirits)
  • fizzy drinks
  • drinks that contain caffeine (such as tea, coffee, cola and cocoa)
  • acidic drinks (such as fresh orange or grapefruit juice)
  • drinks with artificial sweeteners (‘diet’ or ‘light’ drinks).

Try to drink water, diluted fruit juice and herbal teas.

Stop smoking or vaping

Smoking or vaping can make bladder or bowel problems worse. This is because the chemicals in smoke from cigarettes and e-cigarettes stimulate the bowel, and irritate and damage the lining of the bladder.

Smoking or vaping can also make you cough more. Coughing may make you more likely to leak urine. Smoking is also a major risk factor for cancer and other serious health conditions.

If you smoke or vape, talk to your GP about getting help to stop.

Find ways of reducing stress

Anxiety and stressful situations can make bladder or bowel symptoms worse.

Learning to relax may help improve some of your symptoms. Some continence clinics and support groups teach stress management. Your doctor or specialist nurse can tell you about relaxation classes in your area.

Relaxation CDs are available from bookshops and some health shops. You can also download apps to your mobile phone or tablet, or relaxation podcasts from the internet.

Some people find that complementary therapies such as massage or yoga help them feel less stressed. For details of what is available in your area, call our cancer support specialists on 0808 808 00 00.

Getting support

Macmillan is here to support you. If you would like to talk, you can do the following:

About our information

  • References

    Below is a sample of the sources used in our pelvic radiotherapy information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Andreyev HJN, Muls AC, Norton C, et al. Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease. Frontline Gastroenterology, 2015; 6, 53-72.

    Dilalla V, Chaput G, Williams T and Sultanem K. Radiotherapy side effects: integrating a survivorship clinical lens to better serve patients. Current Oncology, 2020; 27, 2, 107-112.

    The Royal College of Radiologists. Radiotherapy dose fractionation. Third edition. 2019. Available from: www.rcr.ac.uk/system/files/publication/field_publication_files/brfo193_radiotherapy_dose_fractionation_third-edition.pdf [accessed March 2021]. 


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Chief Medical Editor, Professor Tim Iveson, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.