Abdominal or pelvic radiotherapy side effects

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.

Find out more about having 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.

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.

Just Can't Wait card

Disability Rights UK

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.

Find out more about a flexible sigmoidoscopy

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).

Read more about having a bone density scan (DEXA)

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.

Read more about cancer and pain control