Side effects of womb cancer radiotherapy

Some people might have urine leakage or difficulty controlling their bladder. Learning pelvic floor exercises, re-training your bladder or following lifestyle changes can help. Speak to your doctor or specialist nurse. They can refer you to a physiotherapist.

Radiotherapy can inflame the lining of your bladder. This might get worse as you go through your course of treatment. But it should get better within a few weeks or months of finishing. 

Symptoms of bladder inflammation include:

• a burning feeling or pain when you pass urine

• feeling that you need to pass urine more often than usual

• feeling that you haven't finished passing urine when you have

• feeling as though you need to pass urine again as soon as you've been

You might also get an infection in your urine, which can make your urine look cloudy or smell strongly.

It helps to drink plenty of fluids. Some people think that cranberry juice can help. Cranberry juice can interact with some medicines, so talk to your doctor or pharmacist before taking it.

You might find that some drinks increase your symptoms, such as tea and coffee. You can experiment for yourself and see what works for you. Don’t take potassium citrate, which is an old fashioned remedy for cystitis. This drug can be very harmful if taken in large amounts.

Tell your doctor or nurse if you have any bladder problems. They can prescribe medicines to help.

During your treatment the skin in the treatment area might become quite sore and red. This might include your vulva and the area around your back passage.

Use a moisturiser on the skin in the treatment area every day. This will help to keep the skin hydrated and more comfortable. Your radiographers will tell you which cream you should use. Don't use any other type of cream or lotion.

The skin reaction can look and feel like a burn, but it is inflammation due to the radiation. It usually starts about 5 to 7 days into treatment and continues for about 10 days after your last treatment. It then starts to improve.

Ask your radiographers for advice on how to manage the sore skin. There are things you can do to make yourself more comfortable.

Read more about radiotherapy and your skin

After internal radiotherapy, you may have some bleeding from the vagina. This is usually when your doctor removes the applicators. Bleeding should clear up within 48 hours (2 days).

Tell your radiotherapy doctor or nurse if the bleeding becomes heavy or goes on for longer than this.

Your vagina may become irritated and sore during radiotherapy. You may also notice an increase in vaginal discharge.

Tell your nurse or radiographer if the discharge becomes heavy or is smelly. You may need antibiotics. They can give you painkillers if your vagina is very sore.

Generally, radiotherapy can make body tissues tighter and less elastic. Doctors call this fibrosis. It can have some lasting effects, depending on the part of the body being treated. For example, it can cause skin thickening in the treatment area. 

Your skin might always be slightly darker in the area of treatment.

After your treatment, your vagina can become narrower and shorter. You might also have vaginal dryness. This can affect your sex life.

Your doctor will need to do a physical examination of your vagina during your follow up appointments. Using dilators can help to ensure you can still have sex and vaginal examinations comfortably. Dilators can help to prevent or minimise narrowing and stiffening of the vaginal tissues. So, it is important to start using them after your radiotherapy treatment. Your radiotherapy team will tell you how and when to start using dilators and suggest suitable lubricants.

Dilators

Dilators are tube shaped objects, made of plastic or metal. They come in different sizes. You gently put the dilator into your vagina for 5 to 10 minutes about 3 times a week. This stretches the vagina and helps to stop it from narrowing. It is important to be gentle and not force this. 

You could switch to a smaller size if you find it difficult to get the dilator in. You might find it easier with a water soluble lubricant such as Astroglide, Durex lube or KY jelly. Some people may find an oil based lubricant such as Yes OB better. Unfortunately, these are not available on prescription. You can buy them directly from the company or shops.

You can use the dilator in the bath if you prefer. You can also use a moisturiser such as Replens 2 or 3 times a week. 

If you find the dilator you have been using is getting a tighter fit, you may need to use it more often. You can talk to your doctor or nurse about this. You may have slight bleeding or spotting after using your dilator. This is normal.

However, it isn't normal to have heavy bleeding or pain. Contact your doctor or nurse If you have either of these.

You usually start using your dilator around 4 weeks after your radiotherapy ends. This varies depending on your radiotherapy centre. Your doctor might advise you to use the dilators for 2 years or more, even if you are sexually active.

Some people may experience changes to the bladder, causing:

• the bladder wall to become less stretchy, so you have to pass urine more often

• fragile blood vessels to form in the wall of your bladder, causing blood in the urine

• difficulty passing urine because the tube from the bladder to outside your body narrows

Speak to your doctor if you are worried about any symptoms.

'Just can’t wait' card

You can get a card to show to staff in shops, pubs, etc. It allows you to use their toilets without them asking awkward questions. You can get the card from the Bladder and Bowel Community. Toilet Map UK has a map of all the public toilets in the UK.

Disability Rights UK can give you a key for disabled-access toilets, so you won't have to ask for one when you're out.

Rarely, you may have more frequent or looser poo (stools) in the long term. This can be all the time. Or it may come and go.

Your doctor can give you medicines to slow down the bowel and help control the diarrhoea. You might need to avoid high fibre foods. 

Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes cancer doctors, digestive system specialists, bowel surgeons, dietitians and specialist nurses.

The team can carry out tests to see what is causing the problem. Then they can give you treatment to control it.

'Just can’t wait' card

You can get a card to show to staff in shops, pubs, etc. It allows you to use their toilets without them asking awkward questions. You can get the card from the Bladder and Bowel Community. Toilet Map UK has a map of all the public toilets in the UK.

Disability Rights UK can give you a key for disabled-access toilets, so you won't have to ask for one when you're out.

Radiotherapy to the pelvic area can include the lymph nodes. This may affect the flow of lymphatic fluid around your body. The fluid may build up and cause swelling in one or both legs, or rarely the genital area. The swelling is called lymphoedema. The risk of developing lymphoedema is greater if you've also had surgery to remove lymph nodes in the area.

You are at risk of developing lymphoedema any time after treatment, even years afterwards. Your nurse will give you information about how to reduce your risk of this happening.

Tell your doctor or nurse if you notice any swelling.

Read more about lymphoedema

Occasionally, radiotherapy to the pelvis can cause bleeding. This will show up in your bowel movements or urine, or from your vagina. It is usually caused by an increased growth of small blood vessels in that area after the treatment.

If you notice this, tell your doctor. Your doctor may call this problem telangiectasia (pronounced teel-an-gee-ek-tay-zee-a).

Some people with piles may find that their piles come back after radiotherapy.

Radiotherapy to the pelvis can damage the bones in the pelvic area. The bones can become weaker. This can cause pain and also increases the risk of breaks (fractures) of the pelvis or hip.

Tell your doctor if you have any hip or pelvic pain.

There is a small risk of developing a second cancer in the treatment area years after radiotherapy. But the benefits of treatment far outweigh this risk. You doctor will talk to you about this.