Pelvic Radiation Disease

Dr Shameer Mehta is a Consultant Gastroenterologist at The Royal London Hospital and a Honorary Associate Professor at University College London. He has a specialist interest in clinical nutrition, inflammatory bowel disease and long-term gut symptoms after cancer treatments, including for prostate cancer.

Patients with prostate cancer are often treated with radiotherapy. This treatment, either alone or in combination with surgery or chemotherapy, is becoming more successful, meaning that patients are living for longer than ever before. Whilst this is fantastic news, it also means that patients are increasingly suffering with long term gut complaints due to bowel damage from previous radiotherapy. This can even occur some years after the treatment has ended.

Other organs, beyond the gut, can also be affected. These include the bladder and pelvic bones. The collective term for symptoms arising from damage to pelvic organs from previous radiotherapy is pelvic radiation disease (PRD).

Bowel symptoms during radiotherapy treatment are very common but these usually settle within weeks. However, nearly 1 in 5 patients can also develop long term gut complaints after radiotherapy for prostate cancer. Whilst these are not usually due to serious underlying problems, they can negatively affect patients’ quality of life. Unfortunately, awareness of PRD amongst healthcare professionals remains variable. Patients are often not told that their symptoms can be improved by seeing a clinician with an interest in this field.

Almost any gastrointestinal symptom can occur after previous pelvic radiotherapy. Patients can experience a change in their bowel habit (diarrhoea, constipation or a change in colour/consistency), abdominal pain, faecal incontinence (inability to control bowel movements), bloating or bleeding from your bottom. These can vary from being mild to more impactful and can either start gradually or more suddenly.

Your medical team will usually assess you for other causes of bowel symptoms initially. This might include discussing your symptoms in more detail, examining you and performing some simple blood and stool tests. If no other cause is found, simple lifestyle advice (for example around diet) and over-the-counter medications can be helpful for many people.

Unfortunately, radiotherapy damage of the bowel wall is currently irreversible. However, radiotherapy can also lead to a number of changes in the functioning of the gut and may result in other ‘secondary bowel syndromes’. These are entirely non-serious, benign conditions and include bile salt malabsorption (a condition where your intestines don’t absorb bile salts properly), slow transit (where food and waste travel slowly through the gut) and bacterial overgrowth. Treatment depends upon the underlying problem identified and is usually effective at helping symptoms and improving overall quality of life.

If you start experiencing gut symptoms after radiotherapy, the first thing to do is to see your GP for assessment. You can also report your symptoms to your oncology team, including a nurse or doctor, so that an appropriate referral can be made.

The Pelvic Radiation Disease Association (PRDA) is a patient charity dedicated to improving the care of patients with PRD. The website provides useful information for patients suffering with symptoms, including practical help and an online community. The PRD Best Practice Pathway Toolkit has just been launched which provides support for healthcare professionals and a general guide for patients.

Macmillan, another charity, also have information on late effects from pelvic radiotherapy available on their website.