Pain in the pelvic area after radiotherapy can be caused by a number of different things. It is important to see your doctor quickly if you are in pain. The possible reasons for pain are outlined here with a description of the type of pain and other symptoms that may occur in each case.

Bladder infections can cause pain and are more common after radiotherapy. The pain is usually worse when the bladder is full and may be at its worst when you are passing urine or just afterwards. Your urine may be cloudy or smelly or have small amounts of blood. You may also feel ill, have a high temperature or feel sick. Your urine will need to be tested to find out which type of infection you have so that the correct antibiotic can be prescribed.

Spasm of the muscles lining the bowel can cause pain and is made worse when you have your bowels open. The pain in this situation is cramp-like and may come in waves. Constipation or an anal stricture can cause pain. Sometimes the pain may be due to a split in the skin of the anus (fissure) and this causes a very sharp and intense pain when you have your bowels open.

To find out whether there are any changes in the bowel, you may be asked to have an examination of the bowel with a flexible sigmoidoscopy. This test is usually done by a gastroenterologist.

Pelvic radiotherapy can sometimes cause tiny cracks in the pelvic bones some time afterwards. The tiny cracks are called pelvic insufficiency fractures and the pain in this case can be quite severe. It usually gets worse if you move around or do exercise and gets better when you sit still or rest. This type of pain normally goes away overnight and does not stop you from sleeping well. You may be asked to have x-rays, a CT scan or an MRI scan (or a combination of these) to see if there are any fractures in the pelvic bones.

Pain can also be caused if the cancer has come back and this is what many people who get pain worry about most. Your doctor can discuss with you the chance of your cancer coming back. If the pain is caused by cancer, it may:

• be there constantly and not go away when you rest
• get worse when you exercise or move around
• also be there at night and keep you awake.

The pain may not be very bad and may go away if you take mild painkillers. However, if you have this type of pain, your doctor should examine you and arrange for you to have x-rays, a CT scan or an MRI scan (or a combination of these) to find the cause.