Late effects of radiotherapy treatment

• Most hospitals will have a continence service. They will often be staffed by continence nurse specialists and pelvic health physiotherapists.
• They can support you if you have:
  • Bladder problems like: 
    • Needing to pee in a hurry
    • Peeing more than usual
    • Leaking pee.
  • Bowel problems like: 
    • Constipation
    • Loose poo.

The team will ask you:

• To describe the problems you are having
• What medications you are taking
• About your medical history
• What has helped your problem or what has made it worse
• They may refer you for more tests to help find out what is causing your problems. 

• To find a continence service near you, look at our local services finder.

   

• Some hospitals run a ‘late effects service’. 
• There is no set standard for what they offer to patients. 
• Where some are very general, others specialise in: 
  • Stomach and bowel (gastrointestinal) or 
  • Peeing (urology) issues. 
• They are often run by specialist therapeutic radiographers. 
• They also have access to a wider team of specialist dieticians and continence specialists. 

What do they do?

They aim to help people to live well with the late effects of radiotherapy. 

They can offer:

• Advice and support to help you manage your symptoms
• Emotional support
• Advice on medications.
• Referrals to other specialists e.g. gastroenterologists if they feel that you need extra support or tests.
• The Pelvic Radiation Disease Association has a list of current late effects services (link will open in a new tab).  
• This is not exhaustive. Services may change and new services may be added. 
• Check with your GP or healthcare team if you feel you may benefit from a referral. 

• A gastroenterologist is a medical doctor who specialises in conditions that affect the gastrointestinal tract. 
• This includes:
  • The food pipe (oesophagus)
  • Stomach and intestines (small and large bowel)
  • Liver
  • Bile duct 
  • Gallbladder
  • Pancreas. 
• They are usually supported by a specialist nursing team. 
• They will ask you about your symptoms and order more tests. 

• Your doctor will usually carry out a rectal examination. 
• This involves them putting a gloved finger into your back passage (rectum). 
• They may also ask you for a sample of poo for testing. 

In some cases, you may have to have a camera passed into your bottom. This can be:

• A flexible sigmoidoscopy. This looks at the lower part of your bowel. See this animation by Cancer Research UK for more information about this test. The link will open in a new tab.  This will be carried out at the hospital.
• A colonoscopy: This looks at the whole of your large intestine. Look at this video from the NHS that explains what happens during a colonoscopy. 
• You may also have some blood tests to check your iron levels and general health.

• This can be caused by something simple like an infection in your pee. 
• Your GP may ask you for a sample of your pee. 
• This will be sent off for testing. 
• If you do have an infection, your GP may give you antibiotics.  

However, if they are worried, your doctor may refer you the urology team. They will carry out more tests. This may be: 

• A cystoscopy. A camera is passed into your bladder. This is done under a local anaesthetic. It can be done under a general anaesthetic if you are concerned about being awake during the procedure. More information can be found on the NHS website. This link will open in a new tab.

  

   

Problems with peeing may include:

• Peeing more than normal
• Needing to pee in a hurry (urgency)
• Not being able to hold on to your pee
• Dribbling after you have finished peeing. 

In addition:

• Your flow of pee may be slower than normal.  
• You may find it hard to control the direction of your pee. 
• If you have any of these symptoms it may mean that you have narrowing or scarring in the tube that goes from your bladder to the outside (urethra). This is called urethral stricture.

Your GP may talk to you about medicines that can help to reduce the leaking. If these do not work they may refer you to a urologist who will carry out further tests. These tests may include:

• An examination of your penis – sometimes narrowing can be seen at the tip of the penis. 
• A cystoscopy 

• A CT urogram. 

  • This is a type of CT scan.
  • It looks at the organs of your urinary system. 
  • This includes the kidneys, bladder and ureters. 
  • Your ureters take pee from your kidneys to your bladder.

   

• A urethrogram. 
  • This is an X-ray that shows the inside of your urethra. 
  • A tube (catheter) will be passed into the pipe that takes pee from your bladder to the outside (urethra). 
  • An X-ray dye will be passed into the catheter. This allows the clinician to see if there are any problems. 
  • For more information, read this leaflet from South Tees Hospitals NHS Foundation Trust. 
• An ultrasound scan. An ultrasound scan uses high-frequency sound waves to make an image of part of the inside of the body.Visit the NHS page on ultrasounds for more details.
• An MRI scan.  See our page on MRI scans. Link will open in a new tab. 
• Urodynamics test. This looks at how well your bladder is working.  For more information read this leaflet form Cambridge University Hospitals NHS Foundation Trust. 

You may also be asked to keep a bladder diary. Take a look at these examples. Both of these links will open in a new tab:

• The European Association of Urology.
• The Urology foundation.

• Your doctor will ask you some questions about your symptoms.
• They may also want to find out how much your symptoms are affecting your everyday life. 
• See the poo chart below for questions to think about before your appointment:

• It may be a good idea to keep a food and drink diary for a week before you see your doctor. 
• Make a note of what you are eating and any symptoms that you may have. 
• Examples of food diaries can be found at:
  • Sirona Health and Care.

  • University Hospitals Plymouth.

     

What symptoms may I get?

A. Constipation

You may be offered a medicine called a laxative. This will help you to poo. More information can be found on the NHS laxative webpage. This link will open in a new tab. You may also be given advice on your:

• Fibre and fluid intake
• Daily exercise
• Toileting routine

Toileting routine and correct positioning on the toilet

• Try to keep to a regular time each day. 
• Give yourself plenty of time to have a poo. 
• Go to the toilet when you feel the urge. Try not to hold on too long.
• Try putting your feet on a low stool. Raising your knees above your hips can help.

• Breathe slowly and regularly. Try not to hold your breath. 
• Try to relax and do not strain. 
• The Bladder and Bowel Community support people who are living with conditions that affect their bladder or bowel. 
• They have a useful webpage called ‘toilet positions to relieve constipation’.  This link will open in a new tab. This gives some pointers that may help you to empty your bowels. 

B. Loose poo (diarrhoea)

• You may be given a medicine that will help to slow down the passage of food as it passes through your gut. 
• This is called Loperamide (Immodium). To find out more about loperamide, visit the NHS England website. This link will open in a new tab.
• This medicine allows your body to reabsorb more water. This helps to thickens up your poo. 
• Pelvic floor exercises may also help. Learn more about the pelvic floor and exercises later in this page. You may also be given advice on:
  • Healthy fibre and dietary fat intake
  • Giving up smoking
  • Cutting out fizzy drinks 
  • Cutting out or down food containing sorbitol. E.g. chewing gum and sugar free drinks or sweets.

C. Farting or wind (flatulence). 

• There are several possible causes for wind. 
• The treatment will depend on the actual cause of your wind. 
• You may be referred to a dietician who may ask you to keep a food diary for 7 days before you see them. 
• The Guts charity have a good leaflet that covers:
  • The different types of wind
  • Possible causes of wind
  • Symptoms
  • What you can do to help yourself
  • Diet and other treatments.

D. Bleeding from the back passage (Rectal bleeding)

• If you already have piles (haemorrhoids) or have had piles before, these can flare up with the radiotherapy. 
• The lining of the bowel can be damaged after radiotherapy. 
• As part of natural healing, the bowel makes new, small blood vessels. These are called telangiectasias. These are formed on the surface of the bowel lining. 
• They may be broken when:
  • You strain too hard when on the toilet
  • Your poo is hard
  • You are pooing quite often.
• Sometimes they will just break for no reason. 
• You will probably be sent for either a sigmoidoscopy or colonoscopy to rule out any other serious cause for the bleeding. 
• See Macmillan Cancer support for more information.

E. Pain in and around the back passage

• If the skin in this area gets sore or broken, talk to your healthcare team for advice. 
• Try to avoid perfumed soaps or shower gels. 
• Use soft, unperfumed toilet paper or a damp cotton wool pad after having your bowels open.
• Pat rather than rub around your back passage after a shower or bath.
• If you wear incontinence pads, make sure you change them regularly.
• Avoid tight jeans or trousers that may rub on the area. 
• Your healthcare team may be able to prescribe a barrier ointment or cream. The barrier ointment will protect the area. Creams may make you feel more comfortable. 
• If you get pain when opening your bowels, your doctor may prescribe a local anaesthetic gel.

F. Pelvic pain

• If you have sudden, severe pelvic pain, contact 111 or 999 straight away. This may be a medical emergency. 
• Talk to your doctor about your pain and when you get it. There are a few different reasons for getting pelvic pain. This may be:
• Constipation
• Gastritis
• Bile acid diarrhoea or malabsorption
• Small Intestine bacterial overgrowth 

• Some people get cramping pain, spasms or colic type pain before, during or after they have their bowels open. 
• If this happens to you, your GP may offer you anti-spasmodic medicines like buscopan or  mebeverine (both links take you to the NHS webpage for these medicines). 
• You may also be advised to take peppermint oil or drink peppermint tea. 

Other things that may help include:

• Tummy (abdominal) massage
• A TENS machine
• Acupuncture

• Diet can play a big part in helping to keep you well. 
• It can also help to control some of the symptoms you are experiencing. 
• The Pelvic Radiation Disease Association have produced a booklet called: Diet, nutrition and pelvic radiation disease’. This is a PDF and may not be compatible with screen readers.   Listen to the PDF on diet and nutrition. This provides information on managing the symptoms of radiotherapy by making changes to your diet. 

Visit a dietician

• If you are struggling with your diet, you can ask to be referred to a dietician. 
• If you have been referred to the radiotherapy late effects service, they may be able to make this referral. 
• Otherwise, your hospital may have an oncology dietician who can help with your symptoms.
• You can also access a dietician privately. The British Dietetic Association have a ‘find a dietician’ page.  This link will open in a new page. 
• Many dieticians now carry out consultations online as well as face-to-face. 
• Dieticians can offer dietary advice on a number of different areas. 

Many issues with peeing, pooing and erections can be helped by strengthening the pelvic floor muscles. The pelvic floor is important in: 

• Bladder and bowel control
• Helping to keep an erection

In men, the pelvic floor goes from the tailbone (coccyx) to the pubic bone. It supports the bladder and bowel.

• Pelvic Obstetric and Gynaecological Physiotherapy (POGP) is a UK based professional network of the Chartered Society of Physiotherapy. 
• They have a section on men’s health. This includes an audio instruction of how to carry out your pelvic floor exercises. 
• They also have a PDF booklet called ‘Pelvic floor muscle exercises and advice for men’. This is a PDF and may not be compatible with screen readers.  Listen to the PDF on pelvic floor exercises for men