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Bowel changes after pelvic radiotherapy
Bowel changes caused by pelvic radiotherapy can show as a variety of symptoms. These may be uncomfortable and inconvenient, or even painful and distressing.
We hope the information on this page helps explain why you might have bowel symptoms and how to manage them. We are also here if you need some extra support or aren’t sure where to start.
About bowel changes
Pelvic radiotherapy uses radiation to destroy cancer cells in that part of the body. It may also damage healthy cells and tissues in that area, which can include the bowel.
Bowel changes are common after pelvic radiotherapy for any cancer. In fact, about 5 in 10 (50%) patients say they have experienced bowel changes that have had a big impact on their quality of life. We know from talking to our community that this is also true specifically for those who have had cervical cancer.
Symptoms of bowel changes
The most common bowel symptoms caused by pelvic radiotherapy include:
- needing to poo more often
- needing to poo urgently or in a rush
- loose or runny poo (diarrhoea)
- finding it hard to poo (constipation)
- bowel or stomach cramps, bloating or pain
- leaking from your bottom or having accidents where you cannot control your bowels (faecal incontinence)
- bleeding from your bottom
- blood or clear, sticky mucus in your poo
- difficulty emptying your bowels
- feeling that your bowels haven’t been completely emptied
- feeling gassy or passing a lot of wind.
This list doesn’t cover every possible bowel symptom. If you have a symptom that isn’t on this list, it is still important to speak with your healthcare professional about it.
Medical treatments for bowel changes
All of these symptoms can be unpleasant to deal with and may have a major impact on your day-to-day life. You may also find them embarrassing to talk about, although it can help to remember that lots of people have bowel changes – even those who haven’t had cervical cancer treatment.
Speaking with your healthcare professional
It is important that your healthcare professional tries to diagnose the underlying cause of the bowel symptoms, rather than simply treating the symptom itself.
You can speak with:
- your GP
- your clinical nurse specialist (CNS)
- your cancer doctor (consultant).
It can help to speak to a healthcare professional you already know, trust and who has an understanding of your medical history.
You might be having this conversation years after you have finished your treatment, so it is a good idea to be clear about what is happening. You could:
- tell them that these bowel changes started after pelvic radiotherapy treatment
- tell them when the symptoms started
- tell them how long the symptoms have lasted for
- explain the impact the symptoms are having on your life – be prepared to give all the details.
It may be helpful to write down what you experience day-to-day or keep a diary of when the bowel changes flare up.
Read more about getting a diagnosis >
Possible underlying causes
Although bowel changes can present as a specific symptom – for example, diarrhoea – they may be happening because of a different condition caused by pelvic radiotherapy. It is important that this underlying cause is tested for. We spoke with experts who told us they sometimes see patients with PRD who have these conditions:
The body uses bile to digest fats in food that we eat. The bile helps break down the fat and absorb it into the body. Pelvic radiotherapy can damage the small bowel and make it harder for the body to absorb bile. This is called bile acid malabsorption (BAM) and symptoms include diarrhoea.
BAM can be treated with medicines and changes to diet. The charities GUTS UK and BAD UK have more information and support for BAM:
The small bowel should have almost no bacteria in it. But after pelvic radiotherapy, bacteria can start to grow in the small bowel. This is called small intestinal bacterial overgrowth (SIBO). Symptoms include pain and diarrhoea.
SIBO can be treated with antibiotics . It is best to talk to your GP or healthcare team if you have symptoms of SIBO.
An enzyme is a protein in the pancreas that helps you to digest food. Pelvic radiotherapy can damage the pancreas, so it cannot make enzymes properly. If the pancreas is not able to make enough enzymes, this is called exocrine pancreatic insufficiency (EPI). Symptoms include pain, diarrhoea and feeling uncomfortably full.
EPI can be treated with pancreatic enzyme replacement therapy (PERT). This is taken as tablets or capsules.
Pelvic radiotherapy can damage the tissue in the small bowel. This can cause symptoms including pain, needing to poo more often or urgently, and diarrhoea. This is known as radiation enteritis.
Sometimes lifestyle changes are enough to manage radiation enteritis, but there are also medicines that can help. It is best to talk to your GP or healthcare team if you have symptoms of radiation enteritis.
Possible treatments for symptoms
As well as treating any underlying causes, it is also possible to treat the symptoms of bowel changes.
Some of the treatment options we talk through below may be prescribed by your GP or healthcare team in the hospital. For more severe or persistent problems, you should be referred to a gastroenterologist – a doctor that can diagnose and treat bowel problems.
It is also worth finding out if your hospital has a dedicated PRD or late effects service. If it does, you usually have to be referred by your cancer doctor or gastroenterologist.
Treatments will depend on your individual symptoms, but could include:
An enema involves a liquid being injected into your bowel via a tube that is placed inside your bottom. This liquid coats the lining of your rectum, to prevent bleeding and pain when you are pooing.
There are medicines available that can:
- seal the blood vessels in the bottom and stop bleeding
- slow down the bowel, reducing the urgency with which you need to get to the toilet
- prevent diarrhoea
- reduce gas or wind.
You may also be offered:
- soluble fibre to bulk up your poo, if you have diarrhoea
- laxatives to make pooing easier.
Hyperbaric oxygen (HBO) therapy involves breathing in oxygen in a pressurised chamber. This helps tissues that were damaged by pelvic radiotherapy to heal.
HBO therapy may be an option if you are suffering from blood in your stools or bleeding from your bottom. However, it is still a new therapy for these symptoms and more evidence is needed to show how effective it is . You can speak to your healthcare team to find out if it’s available in your area.
In rare cases, surgery may be offered. This might be necessary if, for example:
- part of the bowel needs to be removed – this is called a bowel resection
- a new opening for the bowel needs to be created – the surgery is called a colostomy and the new opening is called a stoma.
The Crohn’s and Colitis Foundation and the NHS have more detailed information about bowel resection and colostomy:
Lifestyle changes for bowel changes
You can make some changes to your lifestyle to help reduce or manage bowel changes. A healthy lifestyle is also good for overall health and wellbeing. This includes:
- eating a balanced diet
- maintaining a healthy weight
- exercising regularly.
Diet
It is important to speak with your GP or healthcare team before changing your diet. Any changes will be based on your individual medical history and symptoms. The section below is for guidance only.
General guidance on diet includes managing your fibre intake, limiting the amount of fatty and sugary foods you eat, and getting plenty of fluids.
Having fibre in your diet is important for a healthy digestive system. Choosing foods that are rich in fibre can help to prevent constipation by bulking up and softening poo, which makes it easier to pass. However, having too much fibre can also cause issues, such as constipation or diarrhoea, so it’s important to get the balance right.
Good sources of fibre include:
- wholegrains, such as whole-wheat cereals or pasta, brown rice, and wholemeal or granary breads
- fresh or dried fruits
- vegetables like broccoli, carrots and sweetcorn, as well as peas, beans and pulses
- potatoes with their skin on
- unsalted nuts and seeds.
Drinking enough water is also really important for keeping your bowel healthy and helping with any symptoms. You should aim to drink around 2 litres of water per day. Try to drink more in hot weather or when you are exercising. A warm drink with breakfast can also help with going to the toilet regularly.
There is some limited evidence that reducing fat, sugar and the sugar found in milk (lactose) may help to improve bowel symptoms of PRD .However, more evidence is needed to confirm this.
Smoking cigarettes and drinking alcohol can also cause bowel symptoms. If you smoke, stopping can help. You may also choose to reduce the alcohol you drink.
You might find it useful to download The Bladder & Bowel Community’s bowel diary. You can track your symptoms and identify any food or drink that might be making them flare up.
Exercise
It’s important to practise regular, moderate exercise, such as:
- walking
- swimming
- yoga
- Pilates.
It is also worth looking into exercises that are specifically designed to improve your bowel control.
Pelvic floor exercises strengthen the muscles that support your bladder and bowels, and can help to alleviate incontinence.
The anal sphincter is a ring of muscle at the end of the rectum. Exercising this muscle can help increase bowel control.
If you are constipated, changing how you sit on the toilet can help make pooing easier. You can try some different postures, along with the other suggestions on this page, to see if it works for you.
Read about toilet posture on the Bladder & Bowel Community website >
Practical management of bowel changes
While lifestyle changes and medical treatments can help to improve your symptoms, we know that bowel concerns can be really difficult to manage. This is especially true when you are away from home. Not having easy access to a toilet can be a huge source of anxiety when you have bowel changes. It’s always worth checking where the nearest toilets are when you’re out, to reassure yourself and avoid any accidents.
The impact of COVID-19
Accessing public toilets may be more difficult at the moment, as local restrictions are put into place due to the COVID-19 pandemic. The website Lockdown Loo has a list that shows public toilets around the UK that are currently open.
Visit the Lockdown Loo website >
Disabled toilets and emergency access
As some shops, restaurants and leisure venues reopen after COVID-19 restrictions are lifted, it’s worth remembering that many of these will have customer toilets available.
There are a number of toilet cards you can apply for. The cards discreetly explain that you have a medical condition that means you need to use the toilet urgently. You can order a free toilet card from:
You can also buy a Radar Key from Disability Rights UK. This master key is part of the National Key Scheme (NKS). It gives you access to more than 9,000 locked disabled toilets around the country, including in shopping centres, department stores, pubs and cafes.
Changing Places also have a list of accessible toilets and rooms that can be used if you need a more private space. Some of them are free to access and some of them need a Radar Key. You can search for your nearest Changing Places toilet to find out more about it.
See the Changing Places toilet map >
Emergency bag
It is a good idea to prepare and carry an emergency bag, in case of any accidents. You could include:
- a spare pair of underwear
- a change of clothes
- a waterproof bag that you can seal
- wet wipes
- hand sanitiser
- a pack of tissues
- any toiletries you might want for a quick freshen up.
You could leave the emergency bag in the boot of your car, in the bottom of your usual bag, or near the front door, so you remember to take it with you.
If you struggle with leaking from your bottom, you can get anal inserts to help control this. The single-use inserts are made of silicone, which means they are flexible, and act as a plug for any leaking. In England, you can get them on prescription. They may be a useful addition to your emergency bag.
You may not ever need the emergency bag, but knowing that you are prepared may ease any anxiety and help you to feel calmer about going out.
Getting support for bowel changes
We understand that bowel changes can impact the practical side of your day-to-day life, as well as your emotional wellbeing and confidence. It can feel like a big step to talk to a healthcare professionals about any symptoms you have, but it’s important that you get support based on your individual situation.
If you are not sure where to turn, you can give our free Helpline a call on 0808 802 8000. Our trained volunteers can talk through your options or simply listen to what’s going on.
Check our Helpline opening hours >
Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.
If you have general questions about PRD, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.
Use our Ask the Expert service >
Useful organisations
Bladder & Bowel Community
A UK-based network providing information and support for bladder and bowel problems. Offers a free ‘Just Can’t Wait’ toilet card.
GUTS UK
A UK charity providing information about and raising awareness of gastrointestinal problems.
Pelvic Radiation Disease Association (PRDA)
A UK charity providing information about PRD. Has an online community as well as hosting national and local events for people with PRD.
Action Radiotherapy
A UK charity dedicated to improving radiotherapy treatments. Provides information about radiotherapy, including side effects.
Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.
References
- Jo’s Cervical Cancer Trust (2017). Long term consequences of cervical cancer and its treatment. Web: https://www.jostrust.org.uk/sites/default/files/final_ltccc_2017_report.pdf. Accessed October 2020.
- Bennett, M. et al (2016). Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews. 4; Art. No.:CD005005.
- Stacey, R. and Green, J. (2014). Radiation-induced small bowel disease: latest developments and clinical guidance. Therapeutic Advances in Chronic Disease. 5;1. pp.15-29.
- NICE (2013). Bile acid malabsorption: colesevelam: Evidence summary. Information for the public. Web: https://www.nice.org.uk/advice/esuom22/ifp/chapter/What-is-bile-acid-malabsorption. Accessed October 2020.
- Dukowicz, A. et al (2007). Small Intestinal Bacterial Overgrowth: A Comprehensive Review. Gastroenterology & Hepatology. 3;2. pp.112-122.
- Olopade, F. et al (2005). A modified Inflammatory Bowel Disease questionnaire and the Vaizey Incontinence questionnaire are simple ways to identify patients with significant gastrointestinal symptoms after pelvic radiotherapy. British Journal of Cancer. 92;9. pp.1663-70.
We write our information based on literature searches and expert review. For more information about the references we used, please contact info@jostrust.org.uk.
"Bowel damage from treatment has meant I have had to go onto a special diet."
Read Michelle's story Date last updated:
29 Oct 2020
Date due for review:
29 Oct 2022