It is fairly common for the short-term side effects to continue to get worse for a couple of weeks after the treatment, before they get better. They then usually improve gradually over a few weeks.

Radiotherapy can make you feel tired, and the tiredness may increase towards the end of the course of treatment. It may last for weeks or sometimes months after the treatment has ended.

Sometimes tiredness can be minimised by carefully planning your day, getting help with jobs in the house and making sure you sleep well. It is important to take time to allow yourself to recover after the treatment and not try to do too much. However, if you are able to gently exercise, this can help you to feel less tired. This may be the last thing you feel like doing. You may feel so tired that doing any exercise seems ridiculous. But sometimes, the less you do, the less you feel like doing. Just a short walk everyday can help. You can try to increase the distance you go each time. Your doctor, nurse or radiotherapist can give you information about exercise.

Radiotherapy can cause a skin reaction and you may find that your skin gets very sore. This is more likely to be a problem in the skin folds of the groins and the cleft of the buttocks. In some situations the skin may become broken.

Skin care

It is important to keep the area of the body that is being treated clean during treatment. Wash the area with lukewarm water only and use unperfumed soaps. The area should be patted dry with a clean towel. Talcum powder and other scented products should not be used as they can irritate the skin. It is helpful to wear loose clothing to prevent any friction on the skin. Your radiotherapy department will advise you how to look after your skin during treatment and the doctor can prescribe a cream, such as an aqueous cream, to ease any soreness. Always check with the radiotherapy department staff before using any creams on your skin.

Hair loss

Radiotherapy will make the hair fall out in the area being treated. Other body hair is not affected. The hair should begin to grow back again within a few weeks of the treatment finishing but hair loss can be permanent for some people.

Bladder irritation

Radiotherapy can cause inflammation of the lining of the bladder. You may find that you have some of the following:

• need to pass urine often (frequency)
• a burning sensation when you pass urine (similar to cystitis)
• can’t wait when you need to empty your bladder (urgency)
• blood in your urine (haematuria).

It is usually possible to reduce or control these effects. Let your doctor know if you have any problems passing urine. They may give you a urine test to make sure you haven’t got an infection. Medicines such as anti-inflammatory drugs, antibiotics and painkillers can be prescribed if needed.

The following may help:

• Avoid caffeine This is in tea, coffee, cola, and some painkillers. Caffeine stimulates the nerves of the bladder.
• Avoid alcohol Alcohol may make symptoms worse for some people.
• Drink normal amounts of fluids You may be tempted to drink less so your bladder does not fill up so quickly. However, this can make symptoms worse as the urine becomes more concentrated and irritates the bladder lining. Aim to drink normal amounts of fluids each day. This is usually about two litres of liquid a day – about 6–8 cups of fluid

Other urinary problems

Some women may find that they have mild incontinence for a few months after the treatment. It may be possible to deal with this by using incontinence pads which you can get from the radiotherapy department or your chemist. You can get advice about coping with incontinence from Cancerbackup, a specialist nurse or a continence advisor at the hospital.

If you are having difficulty passing urine, let your doctor or nurse know.

Just can’t wait 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 get a card to show to staff in shops, pubs and other places. The card allows you to use their loos without them asking awkward questions. You can get the cards from Incontact, RADAR or the Continence Foundation.

If the radiotherapy area includes the small bowel (ileum), this may cause inflammation and irritation of the bowel. This may cause watery diarrhoea and cramping pains in your abdomen (belly). If you already had diarrhoea, it can make the problem worse. Your doctor or radiotherapist can give you advice and may prescribe anti-diarrhoea medicines (such as Imodium) to help control it. Drugs to reduce spasms or cramps (antispasmodics or muscle relaxants) can also be prescribed. It is helpful to drink plenty of fluids to replace those lost through diarrhoea. A dietitian can give you advice about your diet, although there is currently no evidence that changing your diet during pelvic radiotherapy (for example, taking less fibre) can prevent diarrhoea.

Radiotherapy to the large bowel can make you feel that you need to have your bowels open. This can be controlled with steroid suppositories or ointments which also contain an anaesthetic (such as Scheriproct®). Anti-constipation medicines may also help. Occasionally, the radiotherapy may cause some bleeding from the back passage. If you notice any bleeding, let your doctor know.

It is fairly common for women having radiotherapy for cervical or womb cancer to have some vaginal discharge towards the end of their treatment. The discharge may be blood stained. Washing regularly can help to prevent infection. Douching with warm water may help to reduce the discharge. If the discharge continues or becomes heavier, let your nurse, radiographer or doctor know.

When having external radiotherapy, it is fine to continue sexual activity if you want to and if you are not too sore.

Pelvic radiotherapy usually stops the production of sex hormones by the ovaries. Hormone levels generally start to lower over about three months from the start of treatment. Your periods will gradually stop and the symptoms of the menopause may then occur. Your doctor or specialist nurse can talk to you about the effects radiotherapy are likely to have on you. In some women it is possible to surgically move the ovaries up out of the radiotherapy area before the treatment starts, to avoid an early menopause.

An early menopause due to radiotherapy can cause more severe menopausal symptoms than a natural menopause. The symptoms will pass but they may take a couple of years.These can include:

• hot flushes and sweats
• vaginal dryness
• passing urine more often
• lower interest in sex
• tiredness and difficulty sleeping
• dry skin
• aches and pains
• mood swings, poor concentration, lower confidence and changes in memory.
• All of the above effects may affect your sex life in some way.

Contraception

If you have an early menopause and are no longer producing eggs, you will not be able to become pregnant. It usually takes about three months after the radiotherapy finishes to stop producing eggs. During this time it is important to use effective contraception, but after this time contraception is not needed.

Dealing with early menopause

You can discuss with your specialist at the hospital whether you can have hormone replacement therapy (HRT). HRT can help to control the menopausal symptoms. If you have had breast cancer or some gynaecological cancers you may need to avoid taking HRT which contains oestrogen. However, you can talk to your doctor about other medicines which can help to control menopausal symptoms, such as low-dose progesterone treatment. Some post-menopausal women also have hot flushes after radiotherapy.

Some women find complementary therapies such as evening primrose oil, acupuncture or herbal remedies helpful. Having low sex hormone levels at a young age can increase the risk of weakening of the bones (osteoporosis) as women get older. HRT and other medicines can help the bones to stay stronger.

After pelvic radiotherapy you will not be able to have children. This is because of the effect that radiotherapy has on the womb. It can feel devastating to know that you will not be able to have children. Infertility is very hard to come to terms with, especially if you were planning to have children in the future or to have more children to add to your family. The sense of loss can be very painful and distressing. Sometimes it can feel as though you have actually lost a part of yourself. You may feel less feminine. Before your treatment starts you may want to talk to your doctor about egg collection or ovarian tissue storage. The eggs or ovarian tissue can be used later as part of fertility treatment. However, these procedures are very experimental and are not likely to lead to a successful pregnancy. We can send you information about the options for having a baby (such as adoption or surrogacy).

Emotional effects

People vary in their reactions to infertility. Some women may come to terms with it more quickly and feel that dealing with the cancer is more important. Others may find that they accept the news calmly when they start treatment, and find that the impact doesn't hit them until the treatment is over and they are sorting out their lives again. There is no right or wrong way to react.

Your partner will need special consideration in any discussions about fertility and future plans. You may both need to speak to a professional counsellor or therapist specialising in fertility problems. They can help you to come to terms with your situation.

Your doctor may be able to refer you to a fertility specialist or you can be put in touch with one directly by contacting the organisations in the fertility section. The nurses at Cancerbackup can discuss problems you may have and they can also help you to find a counsellor who can give you help and advice.