Side effects during treatment

You may have side effects during and shortly after pelvic radiotherapy. These may develop during your course of treatment, or in the days or weeks after. After you have finished radiotherapy, side effects may get worse for a time before they get better.

The side effects you have may depend on:

  • the area of your pelvis having treatment
  • whether you have external or internal radiotherapy
  • other cancer treatments you are having.

Some possible side effects are:

  • tiredness
  • effects on the skin in the area being treated
  • changes passing urine
  • bowel changes.

Your team will explain what to expect. But it is difficult for them to know exactly what side effects you will have. Always tell them if you have side effects during, or after, radiotherapy. They can give advice and support to help you cope.

If you smoke, try to stop. Stopping smoking during and after radiotherapy may help it work better. It can also reduce your side effects. Your radiotherapy team, GP or a pharmacist can help.

How radiotherapy might affect you

Radiotherapy destroys cancer cells in the area where it is given. It can also damage some normal cells in the same area. This may cause side effects (see below).

Side effects do not usually happen straight away. They may develop during your course of treatment, or in the days or weeks after treatment finishes. After you have finished radiotherapy, side effects may get worse for a time before they get better.

You may have a small risk of long-term side effects. Side effects can sometimes also start months or years after radiotherapy. These are called late effects.

Your team will explain what to expect from treatment. But it is difficult for them to know exactly what side effects you will have. Always tell them if you have side effects during, or after, radiotherapy. They can give advice and support to help you cope.

If you smoke, try to stop. Research shows that stopping smoking during and after radiotherapy may help it work better. It can also reduce the side effects of treatment. Your radiotherapy team, GP or a pharmacist can help.

You are unlikely to get all the different side effects of radiotherapy. The side effects you have may depend on:

Having chemotherapy at the same time as radiotherapy is called chemoradiation. This may cause more severe side effects.

You may also find it helpful to read our information about the type of cancer you are having treatment for. This has more detail about your treatment, and the other possible side effects.


Tiredness

Not everyone feels tired during radiotherapy treatment, but many people do. Tiredness (fatigue) can continue for weeks, or a few months after your treatment has finished. You might be more tired if you have to travel to hospital every day, or if you are recovering from other treatments. These may include surgery, chemotherapy or hormone therapy.

Some people are able to continue with their day-to-day activities. Others might need more rest.

Coping with tiredness

There are things you can do that may help you cope with tiredness:

  • Get plenty of rest, but balance this with some gentle exercise, such as short walks. This gives you more energy and keeps your muscles working.
  • Eat a healthy diet and drink plenty of fluids.
  • Save some energy for doing the things you enjoy.
  • Ask others for help doing everyday tasks, if they are making you tired.
  • If you feel very tired, it is best not to drive.

We have more information about coping with tiredness (fatigue).

Coping with fatigue

Denton describes how he coped with fatigue (tiredness) during his treatment for prostate cancer.

About our cancer information videos

Coping with fatigue

Denton describes how he coped with fatigue (tiredness) during his treatment for prostate cancer.

About our cancer information videos

It didn’t take long for me to get back to walking. Just a mile or two, but slowly building up.

John


Effects on the skin

Sometimes, pelvic radiotherapy can cause a skin reaction in the area being treated. This can be uncomfortable, particularly in sensitive areas. These areas may include the anus, vulva, penis, scrotum, either side of the groin or between the buttocks.

If a skin reaction happens, it usually starts after about 10 to 14 days of treatment. You may find your skin becomes red, or darkens in the area having treatment. It may also feel warm, itchy or sore. Sometimes, the skin gets very sore and may blister, break or leak fluid.

Your radiographer or nurse will check your skin regularly. Tell them if your skin is sore, or if you notice any other changes during, or after, radiotherapy. They will give you advice about managing it. They may give you dressings, or a gel or other products to help. They can also give you painkillers to take, if you need them.

Skin reactions can take time to improve. They are usually worst in the first 2 weeks after treatment finishes. They then start to get better as the skin heals.

Pelvic radiotherapy may also make your pubic hair fall out. It should start to grow back again within a few weeks after radiotherapy finishes, but it may be thinner. Sometimes, hair loss is permanent.

Skin care

Your radiographer or nurse will explain how to look after your skin during pelvic radiotherapy. They will usually give you advice, including some of the following:

  • Have showers rather than baths if you can. Soaking in a bath can make the skin too moist. When you shower, use a very gentle stream of lukewarm water. If you have a bath, do not use very hot water. Try not to soak in the water for longer than a few minutes.
  • Follow your team’s advice about using soaps, moisturisers, creams and deodorants.
  • Wear loose underwear or shorts made from natural fibres, such as cotton or silk. They should be loose-fitting so they do not rub against the skin. Avoid wearing tights, tight-fitting underpants or trousers.
  • Do not shave, wax or use hair removal creams in the treatment area during radiotherapy. Wait until a few weeks after radiotherapy is over and any skin reaction has healed.
  • Protect the skin of the treated area from the sun for the first year after radiotherapy. You should do this even after any skin reaction has settled. It is best to always wear sunscreen with a high sun protection factor (SPF) of at least 30.
  • If you smoke, try to stop. Smoking can make skin reactions worse.


Bladder side effects

Pelvic radiotherapy can irritate the lining of the bladder. This can cause side effects such as:

  • passing urine (peeing) more often than usual
  • passing urine during the night
  • a burning feeling when you pass urine (similar to a urine infection)
  • a feeling that you are not able to wait when you need to pass urine
  • blood in your urine
  • leaking small amounts of urine (incontinence).

Coping with bladder side effects

Always tell your radiotherapy team if you are having side effects during, or after your course of treatment. There are drugs that can improve bladder side effects and help you feel more comfortable. Your team may ask you for a urine sample to check if you have an infection. An infection is a common cause of symptoms and is easy to treat.

Contact the hospital straight away if:

  • your symptoms get worse
  • you have a high temperature
  • you feel you cannot pass urine.

Your team can advise you about coping with any bladder problems. If the problems do not improve within a few weeks, they may arrange tests. Or they may get more advice for you from a continence specialist.

People often feel embarrassed talking about bladder problems. But if you tell your doctor, radiographer or nurse, they can help and it is usually possible to improve it.

There are some things you can do that may help with bladder side effects:

  • Try to drink plenty. If your urine is dark and concentrated, it can irritate the bladder and make symptoms worse. Drinking more makes your urine paler and less concentrated. Aim to drink at least 2 to 3 litres (3½ to 5½ pints) of fluids a day.
  • Try to drink more water and less of drinks that may irritate the bladder. These include drinks containing caffeine, such as tea, coffee, drinking chocolate and cola. You should also try to drink less alcohol, fizzy drinks, acidic drinks (orange and grapefruit juice) and drinks with artificial sweeteners (diet or light drinks).
  • Try drinking cranberry juice or taking cranberry capsules to help reduce symptoms. But you should not have cranberry products if you are taking a drug called warfarin.
  • If you smoke, try to stop. Smoking can make bladder side effects worse.
  • Look at our tips below for finding a toilet when you are out in public.

Other urinary problems

If your treatment involves the prostate or penis, it may also cause swelling around the urethra. This is the tube that carries urine from the bladder, through the prostate, to the opening at the tip of the penis.

This can cause side effects such as:

  • passing urine more often than usual
  • a feeling that you cannot wait when you need to pass urine
  • needing to wait for the flow of urine to begin
  • having a weak flow of urine
  • feeling that you have not fully emptied your bladder.

Tell your team if you have any of these side effects. They may give you drugs to help.

It is important to contact the hospital straight away if you cannot pass urine at all. This is a rare side effect caused by swelling that closes the urethra completely. This stops urine flowing out of the bladder. It may affect you after brachytherapy for prostate cancer. You may have drugs that reduce the swelling. Or you may have a tube (catheter) put into the bladder for a short time.

I battled with my bowel and bladder. But luckily it settled after a few weeks. I noticed increased activity with my bowel and bladder but the sense of urgency had slightly improved!

Danielle


Bowel side effects

Pelvic radiotherapy can cause some of the following side effects:

  • loose stools (poo) or diarrhoea
  • hard stools or constipation
  • needing to empty your bowel (poo) urgently
  • cramping pains in your tummy (abdomen) or back passage (rectum)
  • passing a lot of wind.

Some other, less common side effects are:

  • feeling you need to go to the toilet although your bowel is empty (tenesmus)
  • passing mucus or blood when you empty your bowels
  • bleeding from piles (haemorrhoids)
  • slight soiling of your underwear or some leakage (incontinence).

Bowel side effects usually start to improve about 2 weeks after radiotherapy finishes. Sometimes, they may take a few months to get better.

Coping with bowel side effects

Tell your cancer specialist, specialist nurse or radiographer about any bowel side effects you have. They may advise you to make changes to your diet during radiotherapy. This will help prevent or improve bowel side effects. Or they may give you drugs to help. Follow their advice carefully, and tell them if your side effects get worse.

Diarrhoea is the most common side effect. It usually starts during, or after 2 weeks of radiotherapy. If you have diarrhoea, your team may give you tablets to help reduce it. Try to drink at least 2 to 3 litres of fluids a day.

If you have any soiling or incontinence, tell your team. The will give you advice about coping with this, and looking after your skin.

There are some things you can do that may help with bowel side effects:

  • Try drinking less of drinks that could make bowel side effects worse. These include drinks containing caffeine (tea, coffee, drinking chocolate, cola) and alcohol.
  • Avoid foods and drinks that give you wind, such as pickles, beans, curry and fizzy drinks.
  • Try doing gentle exercise to help if you have a lot of wind. Or try taking charcoal tablets, which you can buy at the chemist.
  • If you smoke, try to stop. Smoking can make bowel side effects worse.
  • Look at our tips below for finding a toilet when you are out in public.

We have more information about coping with bowel problems.

The medication sorted the diarrhoea out – it wasn’t bad. It doesn’t matter really in the end, if it’s getting rid of cancer, 6 weeks of diarrhoea is nothing.

Frances


Finding a toilet in a hurry

Bladder or bowel side effects may mean you need to go to the toilet more often. Or that you sometimes need to use the toilet urgently. Some people feel anxious about going out in public because of this. It may help to do some of the following things.

Plan ahead

Think about where you can find a toilet when you are not at home:

  • Many areas have lists, or maps of the local public toilets. Try typing ‘public toilets’ and the name of the place you are visiting into an internet search engine, such as Google.
  • Visit the website greatbritishpublictoiletmap.rca.ac.uk to see a map with details of public toilets.
  • Download a phone app that can help you find a public toilet.

Get a toilet card

You can show this quickly and easily to staff in shops, pubs and other places. It explains that you have a medical condition and need urgent access to a toilet.

We have a free toilet card you can use. The Bladder and Bowel Community also offer a free ‘Just Can’t Wait’ toilet card and phone app.

Use disabled toilets

These often have more privacy and space. The National Key Scheme for Toilets offers access to about 7000 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.


Changes to the vagina

If your treatment involves areas of the vagina, it can cause changes during and after treatment. Changes may include:

  • skin reactions in the vagina
  • vaginal dryness
  • narrowing of the vagina.

These changes can be uncomfortable, and may make having sex painful. They may also make it difficult if you need to have internal examinations in the future.

Your doctor, radiographer or nurse may also give you advice about ways you can prevent, or cope with vaginal changes. Try to follow their advice, and ask for more help if you need to. It can be hard to talk about these side effects, but your team can often help.

Coping with vaginal dryness

A personal lubricant or moisturiser may help with dryness. This is a gel, liquid or cream that you use inside the vagina. Your doctor can prescribe one, or you can buy it from a pharmacy, other shop, or online.

Some products you use every 2 or 3 days. Others you use during sex. Different products have different ingredients. Some can cause skin irritation. You may need to try a few until you find one that suits you.

Some products contain a small amount of the female hormone oestrogen. Your doctor may prescribe these for you. They come as a cream, or as a tablet called a pessary. You put the pessary into the vagina. Hormone products are not recommended if you have had womb (endometrial) cancer. Your cancer doctor or nurse can give you advice.

Preventing narrowing of the vagina

Your team may give you vaginal dilators to help stop the vagina from narrowing. Dilators are tampon-shaped, plastic rods of different sizes. You use these regularly with a lubricant after your radiotherapy has finished. Using a vibrator, lubricated fingers or having regular penetrative sex may also help prevent vaginal narrowing.

Your nurse or radiographer will explain if dilators may be helpful, and how to use them.

We have more information about radiotherapy in general.

Back to Pelvic radiotherapy explained

What is pelvic radiotherapy?

The pelvis is the lower part of the tummy between the hips. Radiotherapy to this area is called pelvic radiotherapy.

After pelvic radiotherapy

Your radiotherapy team will explain any follow-up you need, how they can help and how you can help yourself.