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 every day 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 groin 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 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 iritation

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

• need to pass urine often (frequency)
• a burning sensation when you pass urine (similar to cystitis)
• a feeling that you 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

After radiotherapy for prostate cancer, it is common to need to pass urine frequently and not to be able to hold urine for very long (urgency). This may be due to irritation of the urethra and swelling of the prostate gland. It may continue for several months and then usually improves gradually. Your doctor may prescribe a type of drug called an alpha blocker: tamsulosin (Flomax®), terazosin (Hytrin BPH®) or doxazosin (Cardura®) that may help to reduce these effects.

Some men may find it difficult to pass urine and may need to have a tube (catheter) put into their bladder for a short while. Some men find that they have mild incontinence for a few months once the catheter is removed, but this is very rare. It is 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. Let your doctor or nurse know if you are having difficulty passing urine.

Just can’t wait card

If you need 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 toilets, 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 rectum 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.

Some men have a sharp pain when they ejaculate. This happens because the radiotherapy can irritate the tube that leads along the penis from the bladder (the urethra). The pain should ease off a few weeks after treatment finishes. If you are having external radiotherapy treatment, it is fine to have sex if you want to. If you have had brachytherapy (seed implantation) for prostate cancer, it is advisable to use condoms during intercourse for the first few weeks after treatment in case a seed becomes misplaced and is present in the semen, but this is very rare.

Pelvic radiotherapy may make you unable to father children (infertile). Your doctor or specialist nurse can talk to you about the effects radiotherapy are likely to have on you.

Many men find that losing their fertility can be very difficult to come to terms with. For some men, it may be possible for their sperm to be collected before the treatment starts. The sperm can then be stored for use in the future. It is important to talk to your doctor or nurse before your treatment starts. They can advise you about sperm collection and storage. We can send you information about fertility and cancer treatments.

Contraception

As you may still be producing sperm for some time after the treatment, you will be advised to use condoms during sex. Some doctors recommend using contraception for six months and others for up to two years after treatment. This is because sperm produced after treatment may still be fertile but could be damaged. This could cause abnormalities in a child conceived soon after pelvic radiotherapy.