What side effects might I experience?

While radiation therapy is great at killing cancer cells, it can also affect healthy cells — meaning that many patients experience side effects from radiation treatment.

Here, we’ll go into common side effects that some patients experience, and give you some tips on how to manage them. Side effects vary depending on which type of radiation treatment you’re getting.

We will cover side effects from:

• External radiation
• SBRT
• Y90

External radiation

Although you won’t feel anything during the actual radiation treatment, you may begin to notice side effects as your treatment progresses. Most patients begin to experience side effects within a few days, but most are temporary and will go away within a few weeks of your treatment finishing. However, some patients develop late side effects months, or even years after treatment ends.

Side effects can include:

• Bladder problems
• Bowel problems
• Fatigue
• Skin changes
• Bone changes
• Changes in sexual health and fertility

Bladder problems

Radiation can irritate the lining of the bladder, which can cause urinary changes — such as needing to go to the bathroom more frequently, or a burning sensation when you pee. These side effects often go away within several weeks of finishing treatment, but in the meantime, you can manage them by:

• Drinking plenty of water. 8 to 12 glasses per day is a good goal
• Avoiding anything that can further irritate your bladder, such as alcohol, caffeine or spicy foods
• Talking to your doctor if you are experiencing this side effect, as they may be able to prescribe medication to help

Bowel problems

This is probably one of the most common side effects of pelvic radiation. Many people develop diarrhea and experience some level of discomfort while pooping. It’s common to feel cramping. You may need to go to the bathroom more frequently, and with greater urgency. You might also feel like you need to go, but not be able to poop. 

These symptoms should go away within 2 to 4 weeks after finishing treatment, so it’s important to talk to your doctor if you’re experiencing these symptoms longer than that.

Here are some tips:

• Drink more liquids. 8 to 12 glasses of water a day is a good goal. Be sure to add some type of rehydration fluid, such as Pedialyte, if you’re experiencing diarrhea. This helps keep you from getting dehydrated
• Take Imodium to help with diarrhea
• Limit liquids that have caffeine or alcohol, and avoid any foods that irritate your bowels
• Eat food low in fiber, fat and lactose
• Take a warm bath
• Try a sitz bath. Fill a basin or tub with warm water, and sit in it for 15 to 20 minutes after each bowel movement. This can help relax the anal sphincter and provide relief from cramps
• Try a stool softener, such as Miralax, to help make it easier to poop
• If you’re still in pain, your doctor should be able to prescribe pain medication. However, keep in mind that many pain meds can be constipating — so you may need to increase your dose of stool softeners too

Fatigue

Many people feel tired and fatigued during radiation, although this should go away within several weeks of finishing treatment.

Here are some tips:

• Try to notice patterns of specific days, or times of the day, that you feel more energetic or tired. Use this to help plan your day so high-energy activities are scheduled when you tend to feel best
• Make sure to get a good night’s sleep, at least 8 hours per night
• If you feel tired during the day, take a short nap. Even if you can’t nap, sit down and relax
• Some people find that light exercise, such as going for a walk, can help improve energy levels
• Ask friends and family to help with tasks such as cleaning, shopping, cooking, childcare, and housework
• Talk to your doctor if you’re struggling to manage your fatigue, or if it persists for more than a few weeks after treatment ends

Skin changes

Many patients experience changes to the skin in the area treated with radiation. Your skin may change color, become dry, itchy, or flaky — or even blister or peel. These changes should go away within a few weeks of treatment ending.

Here are some tips:

• Keep your skin clean. Use warm water and a gentle soap to clean the area. Pat gently, and don’t scrub, as that can irritate the skin
• Moisturize your skin. Use a good moisturizer, such as Aquaphor, to keep the radiated area moist. If over-the-counter creams are not working, talk to your doctor for a prescription. Some people experience discomfort if they moisturize before radiation therapy, so don’t apply any cream to the area before treatment
• Avoid irritating the skin. Wear loose-fitting, breathable clothing. Avoid scented creams, chlorine, sun exposure, and shaving

Bone changes

Pelvic radiotherapy can cause bones in the pelvis to weaken, and can cause small, hairline cracks to form. These cracks are called pelvic insufficiency fractures, and can occur some time after treatment ends.

This can cause pain when walking or going up stairs. If you’re having bone or pelvic pain several weeks after finishing treatment, talk with your doctor. Your doctor can prescribe medications to help with pain and strengthen bones.

Your doctor may need to schedule a DEXA scan to check bone density. It may be a good idea to see if you can get a density scan before treatment, so they can note any changes. You may need periodic DEXA scans after treatment is complete. 

Changes in sexual health and fertility

Pelvic radiation can affect your fertility and sexual health, for both men and women.

Women

Pelvic radiation causes scarring and damage to the vaginal walls, which can affect sexual health. The most common symptoms women experience are loss of libido, vaginal dryness, pain during penetration, and a narrowing or shortening of the vagina (called vaginal stenosis).

Pelvic radiation will often cause infertility, and may induce menopausal symptoms in women that are premenopausal. Some young women with rectal cancer go into menopause after radiation therapy. 

Do not assume that your doctor will bring up these concerns. Make sure to discuss anything you are concerned about prior to starting treatment. If you’re experiencing symptoms after treatment that are affecting your quality of life and relationship with your partner, talk to your doctor. 

Here are some tips on how to cope:

• For young women who have not had children, ovarian transposition (where the ovaries are temporarily moved above the field of radiation) can help protect fertility and reduce the chances of early menopause. If this is something you’re interested in, talk to surgeons who specialize in this procedure
• If you are concerned about becoming infertile, speak to your doctor about options for preserving fertility before starting treatment. Common treatments include embryo freezing, egg freezing, or ovarian tissue freezing
• Using vaginal moisturizers can help with dryness
• Using a lubricant during sex can help ease discomfort
• Using a vaginal dilator during radiation treatment can help reduce symptoms. If this is something you want to consider, talk with your radiation oncologist
• Using a vaginal dilator after treatment ends can help prevent the formation of scar tissue, stretch the vagina, and prevent narrowing
• Talk to your partner about how you are feeling, and the symptoms you are experiencing. Try to get creative and find ways to be intimate that are comfortable and enjoyable for both of you
• Look for a support group where you can connect with other patients in similar situations
• Try pelvic floor physical therapy. This can help with improving urinary, bowel and sexual function after treatment. Start physical therapy early, before you experience difficult side effects
• Remember that regaining sexual function takes time!