Radiotherapy and the Bowel

Pelvic radiotherapy is used to treat gynaecological, bladder, prostate and rectal cancer.

During treatment inflammation to the back passage and colon results in a burn which can cause cramping abdominal pain; diarrhoea; incontinence from the back passage with leakage and/or soiling; excessive wind; a sensation of repeatedly having to move the bowels (tenesmus); and the passage of blood and/or mucus. More than three quarters of patients receiving pelvic radiotherapy experience these acute symptoms.

After treatment it may take several months for the bowel function to settle. Most patients will notice that their bowel function never fully returns to normal. However, one in five will have long-term problems. Some of these include loose stools or diarrhoea; the need to open the bowels more frequently; having to rush to the toilet; incontinence or leakage; tenesmus; excess wind; bleeding from the back passage (radiation proctitis); and other less common problems such as bowel narrowing,  obstruction, ulceration and abnormal communication (fistula formation) with other organs (bladder, vagina).

At SCI we see many patients who are referred with troublesome symptoms following pelvic radiotherapy.  Colonscopy should always be carried out to exclude other serious conditions which can co-exist. Providing there are no other problems treatment is focussed at controlling the specific symptoms which the patient experiences. Antidiarrhoeal medications, barrier creams, pelvic floor exercises and numerous other modifications to a patient's lifestyle can often improve symptoms and quality of life. For troublesome rectal bleeding and mucous discharge from the back passage we have found sucralfate enemas to be very effective (download our information sheet on the SCI sucralfate enema technique).