Abdominal or pelvic radiotherapy side effects
You may have radiotherapy to the area in between your hips (the pelvis) or to the tummy (abdomen).
The main side effects from abdominal or pelvic radiotherapy include:
- diarrhoea
- sickness
- weight loss
- bladder problems
- pain
- changes to your sex life and fertility
You may also experience more general side effects of radiotherapy such as sore skin and tiredness.
Like all side effects of radiotherapy, you might not feel these straight away. Side effects tend to come on gradually as you go through your treatment. And for a few weeks afterwards. These usually get better within a few weeks of finishing your radiotherapy treatment. Everyone reacts differently to radiotherapy, so how you feel varies from person to person.
Diarrhoea
It is normal to have 
during or after radiotherapy to your abdomen or pelvis. You might also have stomach cramps and wind. Diarrhoea can also be a long term side effect. This means it can continue for quite a while after your treatment ends.
It is unpleasant to have diarrhoea and it can also make you feel weak and tired, so it is important to rest if you need to.
Your bowel habit may change during radiotherapy and following treatment. You might:
- need to open your bowels urgently
- have to go several times before you feel the bowel is empty
- feel the need to open your bowels, even if you have done so recently and have an empty bowel (tenesmus)
- pass more wind than usual
- pass
mucus from your back passage
More rarely you might notice some blood in your poo. This can sometimes be due to irritation of the rectum lining because of opening your bowels more. Let your doctor or radiographers know if you have any bleeding.
There are several things that can help you, such as:
- anti diarrhoea drugs, which your healthcare team can give you
- anti spasm medicines from your healthcare team
- drinking lots – this is important as you can easily get dehydrated
- changing your diet – you can speak to your radiotherapy team or
dietitian for advice
Sickness
Radiotherapy to the abdomen can make you feel or be sick. This is called nausea and vomiting. The sickness might last for a few weeks after the treatment has finished. Medicines, diet and sometimes can help to control sickness.
Sickness can usually be well controlled with medicines. Your radiotherapy doctor can prescribe anti sickness tablets for you to take. Some people find that it helps to take an anti sickness tablet about 20 to 60 minutes before having treatment.
Other people find they manage better by taking anti sickness tablets regularly throughout the day. They do this during the course of their treatment. You can discuss which would be best for you with your radiotherapy team.
There are many anti sickness drugs available. So if the first one you try doesn't work, talk to your radiotherapy doctor who can prescribe another.
There are some foods which can help reduce your sickness, such as ginger, and others which are best to avoid.
Weight loss
Sickness or problems eating can cause you to lose weight. You may feel tired and weak. Sometimes you might not feel like eating at all. The dietitian or your doctor can give you advice if eating is a problem.
If your weight keeps on falling you might need to spend a short time in hospital. You might have liquid food through a fine tube called a . It goes up your nose and down into your stomach. Or you might have a special liquid feed into your bloodstream through a drip.
Bladder problems
Having radiotherapy to the pelvis might cause:
This is also called radiation induced cystitis. It is when your bladder becomes irritated and swollen because of radiotherapy. Bladder inflammation can cause the following symptoms:
- a burning feeling or pain when you wee (pass urine)
- feeling that you need to pass urine urgently or more often than usual
- feeling that you haven't finished passing urine when you have
- feeling that you need to pass urine again as soon as you've been
Always let your doctor or radiographer know if passing urine is painful. They might arrange for you to give a urine sample to check if you have an infection. This is a mid stream urine (MSU) test.
Tips to help reduce the effects of cystitis:
- Increase the amount of fluids you drink.
- Avoid strong coffee, tea and alcohol – they can irritate your bladder and make the symptoms worse.
- Ask your healthcare team for medicines to increase urine flow.
This can make your urine look cloudy or have a strong smell. You might also feel ill and have a high temperature. If you have an infection, you will need treatment with antibiotics.
Radiotherapy to your pelvic area can make the blood vessels in the bladder more fragile after your treatment has ended. This can cause blood in your urine. It's usually only a small amount. It is important to tell your doctor if this happens. They might arrange for you to have a test to look inside your bladder. This is a cystoscopy.
This is also called incontinence. It means you might struggle to control your bladder. This can lead to leaking urine. It happens because radiotherapy can weaken the bladder muscles. You may find that you only leak urine when you laugh, sneeze or exercise.
Not everyone will experience this. It can depend on the type of cancer and the dose of radiotherapy you have.
You can wear incontinence pads if you're worried about leaking urine. Pelvic floor exercises and medicines known as antimuscarinics can help. Your healthcare team can give you these medicines.
A physiotherapist or community continence adviser can give you advice and information about dealing with urine leakage. You can get details of your nearest continence clinic or adviser from the Bladder and Bowel Community.
You can get a card if you want to go to the toilet more often, or feel that you can’t wait when you do want to go. You can show the card to staff in shops or restaurants. It allows you to use their toilets, without them asking awkward questions.
You can get the cards from Disability Rights UK or the Bladder and Bowel Community. They also have a map of all the public toilets in the UK. Disability Rights UK can also give you a key for disabled access toilets. This is so you don't have to ask for a key when you are out.
Pain
You might have pain in your pelvis after radiotherapy. This can happen some time after your radiotherapy has finished. Let your healthcare team know if you have any pain during or after your treatment.
Possible reasons for pain can include:
Bladder infections can cause pain and can be common after pelvic radiotherapy. The pain is usually worse when the bladder is full. Or when you are passing urine.
If you have a bladder infection your urine might be cloudy or smelly or have small amounts of blood. You might also feel ill, have a high temperature or feel sick.
Your doctor might arrange a test to check your urine. This is a midstream urine (MSU) test. Your doctor can then prescribe the correct antibiotic if you do have an infection.
Radiotherapy can cause bowel changes, such as cramps and constipation.
When the muscles lining the bowel start to cramp, it can cause pain. This type of pain can be worse when you open your bowels. The pain might come in waves.
Constipation or a narrowing of the back passage (anal stricture) can cause pain. Sometimes the pain can be due to a split in the skin of the anus known as a fissure. A fissure causes a very sharp and intense pain when you open your bowels.
Your doctor might ask you to have an examination of your bowel after radiotherapy. This can help to find out whether there are any changes. You have a flexible tube put into your bowel. This is called a flexible sigmoidoscopy. A specialist in bowel problems usually does this test.
Radiotherapy for cancer in the pelvic area can sometimes lead to hip and pelvic bone problems later in life. Radiotherapy can damage bones in different ways. It can cause weaker bones and tiny cracks in the bones.
Radiotherapy can damage the bone cells in the pelvic area, and also lower the blood supply to the bones. The bones become weaker. This is called avascular necrosis. Damage to the bones can cause pain and sometimes makes it hard to walk or climb stairs.
Let your doctor know if you're having problems and they will monitor you carefully. This includes checking your bone strength with a DEXA scan. They might suggest treatment with painkillers and walking aids to help you get around, such as a stick. You might also need to take medicines to strengthen the bones called bisphosphonates. These drugs can help to control pain and reduce the risk of breaks (fractures).
Sometimes, tiny cracks can appear in the pelvic bones some years after treatment. They are called pelvic insufficiency fractures. This is more likely to happen in people who have a general weakening of their bones as they get older (osteoporosis). It is also more likely in people who are taking hormone therapies or steroids.
The pain, in this case, can be quite bad. It usually gets worse if you move around or do exercise and gets better when you sit still or rest. This type of pain normally goes away overnight. It doesn't stop you from sleeping well. Your doctor might ask you to have:
- x-rays
- a CT scan
- an MRI scan
This checks to see if there are any fractures in the bones.
You might experience pain if the cancer has come back. This is something that people often worry about, but there are many other reasons why you might have pain. You should see your doctor so that they can find the cause.
Pain from cancer coming back can vary from person to person. You might feel pain all the time or it might come and go.
For some people, they are still in pain when resting or it's worse when they move around or exercise. It can make sleeping difficult. Mild painkillers might help.
If you have pain that doesn't go away, your doctor should examine you. They can arrange for you to have X-rays or scans to find the cause.
Fertility
Radiotherapy to your lower abdomen or pelvis can affect your fertility and sex life.
For women, radiotherapy to this area may affect your womb and can stop your ovaries from working. If you haven’t already been through the menopause, this means your periods stop. So you won’t be able to become pregnant.
The risk of infertility depends on:
- the dose of radiation to your ovaries
- your age - the risk is higher the older you are
- whether you have chemotherapy with the radiotherapy
Finding out that treatment for your cancer may leave you infertile can be extremely distressing if you had hoped to get pregnant in the future. Your doctor, radiographer and nurse will support you and talk about possible options.
Radiotherapy can also cause vaginal dryness, fibrosis and narrowing of the vagina. The skin inside the vagina can also become thin, delicate and easily torn. This can cause pain and discomfort. You may find that you feel too sore to have sex comfortably.
For men, the effect on fertility can be temporary or permanent and means you might not be able to father a child in the future. Your doctor or radiographer will talk to you about this before your treatment. They can support you and talk about the possibility of storing your sperm (sperm banking).
It is common for men having pelvic radiotherapy to have some problems with sex. You might have some of the following issues:
- loss of interest in sex
- sharp pain when you ejaculate
- erection problems
You may have to wait several weeks after radiotherapy before you can have sex. Your doctor or radiographer can give advice about this.
You may not feel emotionally ready for much longer than this. Having cancer and its treatment can affect how you feel about your body, you may have ongoing side effects or other changes that may be affecting your body image. Talk to your partner about how you feel.
This video shows people affected by cancer talking about the side effects of radiotherapy for pelvic or abdominal cancer. The video is around 5 and a half minutes long.
Voice over: Radiotherapy can cause many different side effects, such as tiredness. The side effects you get will depend on the area you're having treatment to.
This video is about the side effects you might have if you are a woman having radiotherapy to the pelvis or abdomen.
Louise: The abdomen, the tummy, can be affected by radiotherapy, but it depends on which particular part of that we are treating as to what side effects you may experience. If we are treating the upper part of your abdomen and we are irritating your stomach, sometimes you can experience a little bit of nausea, potentially a little bit of vomiting.
This would normally start quite early on if it is going to be a problem and the doctor would prescribe you some medication to help with that.
Carla: I felt sick constantly. I was having Complan drinks and smoothies and milkshakes with fruit and things in. Jelly sweets, anything that had got sugar in that I could suck on or chew on.
And ice cream. I know it was like October/November when I had my treatment, but I was having ice cream every day.
Louise: If your bowels are being irritated by the radiotherapy, you may find you end up a little bit more gassy. Flatulence might be a bit of an issue and sometimes you can find you can end up with some diarrhoea.
Carla: I started to get really, really bad diarrhoea. And they were giving me Imodium-type tablets to combat that.
With the wind, the wind's horrible. It's not nice at all, as a lady, to have wind. There’s tablets available that I can take for that.
Louise: If you do find that you are having some issues with your bowels, always consult with the team before you take any action. It might be they recommend you make some small dietary changes to help with this, cutting out foods which are very high in fibre or very spicy foods.
If you're having issues with diarrhoea, they may also recommend some particular medication to help with that.
Some radiation treatments to the pelvis may also cause some irritation to your bladder, so you might find you need to pass urine more regularly. It may also be more urgent with you passing smaller volumes. Sometimes you may find that there's a little pain or discomfort when you're urinating, or you can't fully empty your bladder like you would do normally.
Carla: If I need to go, I need to go, and if I can't go, I've got to have pant-liners in.
Louise: We would highly recommend during your radiotherapy that you stay well hydrated. We would recommend you drink up to 2 litres of water or squash a day to ensure that this happens.
Drinks to avoid would include anything containing caffeine, so any kind of tea or coffee or decaffeinated drinks, fizzy drinks and alcohol as they all naturally aggravate your bladder.
Radiotherapy can unfortunately have an impact on a woman's sex life. This is because you can end up with some vaginal drying and also you can find that the tissues in the vagina can become a little bit tight as a result of the treatment. The radiotherapy team will support you during treatment to help with any of these particular symptoms.
Carla: You're given dilators when you first finish your treatment and you have to use it for 10 minutes every day just to keep the scar tissue from sticking together and causing an obstruction.
Louise: These are little tubes that are inserted into the vagina that just gently help stretch the tissue to prevent any scar tissue from building and any shrinkage of the muscles. We can also give you some lubrication to help with any sexual activity as well. This can help you moving forward with both your sex life, but also with future internal examinations.
Infertility is a possible side effect of radiotherapy. If you are concerned about infertility after treatment, before you do start any radiotherapy, it's best to talk to the team and they can talk you through potential fertility treatments, such as storing your eggs prior to starting treatment.
It's always best to be open with partners when you're going through any kind of treatment, especially as this may have an impact on them too. It means that you can work through the problems together.
Voice over: If you’re experiencing a side effect that hasn't been covered in this video, you can find more information on the Cancer Research UK website.
Worries about treatment side effects
You may feel anxious about radiotherapy side effects and this is normal. It can help to talk through any worries you have with your doctor, nurse or radiographer.
You can talk to the Cancer Research UK nurses for general information and support on freephone 0808 800 4040, from 9am to 5pm, Monday to Friday.
