to the Pelvis
You will be receiving four to six weeks of radiation to the pelvis (the area between your hips).
Some of the common side effects from radiation to the pelvis include diarrhea and fatigue.
Rectal and bladder irritation can also occur. Side effects can begin roughly 2-3 weeks after the
start of treatment. They can last for two to four weeks after the treatments end. Some may occur
at different times. It also depends on the area of the rectum which is being radiated. For tumors
high in the rectum, more diarrhea is seen and less skin toxicity. For low lying tumors, more skin
toxicity is seen. Not everyone has side effects.
Positioning for Your Treatment
Each day, right before your treatment, you
will be asked to get into position on a
treatment table. The radiation therapists will
help you get into the correct position. Some
patients are put into “molds.” These molds
are made during the treatment planning
Tiny dots or marks may also have been put
on your skin. These marks relate to your
treatment field. They look like tiny freckles
and will not be easy to see. Oil based skin
markers or a dye may be used to make these
If these marks fade, they will be remarked.
After your radiation therapy is finished, you
can allow the marks to fade. You can also
gently remove them using soap and water or
baby oil. These marks may rub off on your
clothes. If this happens, spray the stains
with hair spray or Spray'N'Wash before
you wash your clothes.
Radiation Skin Reaction
Most radiation goes through the skin into
body tissues. Even so, the skin in treatment
sites can become red and irritated. It can
also become dry and itchy. Sometimes, the
skin will peel and become moist. This
happens most often in skin folds and curves.
The radiation therapists will tell you which
sites to watch.
Watch your skin closely and report any
changes you notice. Use the skin care
products as directed. As your skin reaction
develops, we will also watch it closely. We
may tell you to change the way you care for
your skin. Some skin reactions can be
painful. Tylenol or ibuprofen is usually
helpful. If you need something stronger or
help with skin care, let us know.
If you have questions or concerns after your
treatments end, call the Radiation Oncology
Clinic (open 8am–5pm) at (608) 263-8500
and ask to speak to a nurse. If the clinic is
closed, your call will be transferred to the
answering service. Give the operator your
name and phone number with the area code.
The doctor will call you back.
Skin Care during Treatment
In order to protect your skin during
treatment, you should follow the guidelines
listed below. You will need to follow these
guidelines during and after your treatment,
until your skin has fully healed.
Remember: Your skin needs to be clean
and dry before each treatment. Lotions
and creams can be applied 2 – 4 times per
day to help your skin feel better. If your
treatment is late in the day, you may
apply a skin care product before your
treatment if it will be fully absorbed by
the time your treatment is given.
1. You may bathe or shower as usual using
lukewarm water. If you need soap, use
one that is meant for dry or sensitive
skin. Examples of mild soaps include:
Aveeno®, Dove®, Basis®,
Neutrogena®, Cetaphil®, Ivory®. Rinse
skin well and gently pat it completely
dry. Do not rub the skin in treatment
2. Avoid heat--heating pads, very hot
water in the bath or shower, and hot
3. Avoid cold. Do not allow the skin to
become chilled from exposure to ice or
very cold water or air.
4. Avoid sunlight or sunlamps on the skin
in the treatment site. When you are
outside, keep the area covered with
clothing. If clothing does not completely
cover the area, use a sunscreen with SPF
of 30 or higher.
5. Avoid rubbing or using friction on the
skin exposed to treatment. Do not rub or
scrub the treated area. Wear
comfortable, loose, cotton based clothing
that will allow good air flow. Avoid
clothing made of nylon or synthetics
because they hold moisture next to the
skin. Clothes that bind can cause further
irritation to the radiated skin.
6. Avoid the use of tape on skin in the
7. In most cases, nothing should be applied
to the treated skin unless approved of by
your doctor or nurse. This includes bath
oils, perfumes, talcum powders, and
lotions. If a skin reaction is expected,
we will suggest a skin moisturizer. Use
it each day as instructed.
Skin Care after Treatment
1. Although rare, late effects may occur.
These late effects may occur months to
years after the end of treatment. Treated
skin may continue to be dry. It may also
darken in color, or become firm and
tough. It may help to apply skin
moisturizer or Vitamin E oil.
2. The skin in treatment areas may always
be extra sensitive to sunlight. When
outdoors, use a sunscreen of SPF 30 or
higher on treated skin exposed to the
sun. This is because treated skin is at
higher risk for a certain type of skin
Diarrhea, or loose bowel movements, can
occur with radiation to the abdomen. This is
because the lining of the bowel is very
sensitive to radiation. How severe diarrhea
becomes depends on the amount of bowel in
the radiation field. It also depends on the
total dose of radiation. When diarrhea
develops, it most often begins during the 3rd
or 4th week of treatment.
If you do not have diarrhea, you may
continue to eat your normal diet. Try to eat
foods high in protein such as meat, fish,
milk, cheese, eggs, and peanut butter.
If you do get diarrhea, be sure to let us know.
You may be instructed to take some medicine,
such as Imodium®. You may also need to
change your diet.
These are some guidelines to follow.
1. Decrease the amount of fiber and fat in
2. Avoid foods that cause gas or cramps
such as beans or cabbage.
3. Drink at least 8 – 12 glasses of liquids
per day to replace fluids lost.
4. Eat foods rich in potassium such as
bananas, cantaloupe, tomato juice, and
orange juice (pulp-free).
5. Eat foods rich in protein such as meat,
fish, cheese, peanut butter, and milk
Eating Hints for Diarrhea
Listed below are foods to choose and foods to avoid.
Choose These Foods
Avoid These Foods
Proteins: Two or more servings per day
Lean meat, pork, veal, poultry, fish, eggs,
or cottage cheese
Fatty or fried meats
Legumes (peas and beans)
Fruits: Two or more servings per day
Banana, melon, cooked or canned fruits (no
skin or seeds), juices, or nectars
Most fresh fruits, dried fruits, and prune
Vegetables: Two or more servings per day
Cooked or juiced vegetables
Raw vegetables, dried peas or beans,
gassy vegetables (such as cabbage,
cauliflower, broccoli, and onions)
Starches: At least four servings per day
Enriched white bread and rolls, pancakes,
cereals, rice, macaroni, noodles, spaghetti
Whole grain breads or cereals, bran,
granola, wheat germ, oatmeal
Fats: Small amounts
Margarine, oil, butter, and cream
Fried or fatty foods, rich sauces
Desserts: Small amounts
Sweets, ice cream, puddings, Jell-O ,
Nuts or seeds, “sugar free” products
made with sorbitol, spicy foods, large
amounts of carbonated beverages
Dairy: At least two servings per day
Whole, low fat, or skim milk, cheese, or
Liquid or powdered food supplements add protein and calories to your diet. These supplements
can be found in grocery, drug, and health food stores. Some brand names include: Carnation
Instant Breakfast , Boost , Ensure , Sustacal , Osmolyte , and Skandi-Shake . Persons with
diabetes may use Glucerna or Choice products. GNC (a health food store) also carries a
supplement called Gainer’s Fuel by Twinlab. Many stores carry generic brands of these
supplements. Canned liquid supplements are easy to use. Just pop the can and drink. Powders
can be mixed into fluids or foods.
If your pelvis is in the treatment field, you
may develop a sore rectum. This is a short-
term side effect. Rectal irritation develops
because the lining of the rectum is very
sensitive to radiation. Diarrhea may also
worsen rectal irritation. If you have a
history of hemorrhoids, they may worsen or
flare up during radiation. Rectal symptoms
include burning, itching, and small amounts
of bleeding. These symptoms can occur
both inside and outside of the rectum.
Rectal symptoms may be mild. They may
also be severe and require treatment.
Hemorrhoid medicines with hydrocortisone
(Preparation H , Anusol HC , or generic)
may relieve rectal symptoms. Discuss rectal
symptoms with your doctor or nurse.
Bladder irritation (cystitis) is a swelling or
soreness of the bladder lining. It may occur
if your pelvis is in the treatment field. It is a
short-term side effect. Symptoms of bladder
irritation include feeling as if you need to
urinate suddenly. It can also include feeling
as if you need to urinate often. It can be
signaled by burning or pain on urination.
Tell your doctor or nurse if you have any
bladder symptoms. Be sure to drink plenty
of liquids. Bladder symptoms may also be a
sign of an infection. You may be asked to
provide a urine sample. Sometimes,
medicine is prescribed for bladder irritation.
Feeling tired (fatigue) during radiation
treatment is a common side effect. The
severity of fatigue varies from person to
person. Fatigue does not mean that your
tumor is getting worse. Some people feel no
fatigue and are able to keep up with their
normal routines. Others feel the need to take
an extra nap each day. Still others change
their routines, working only part time, for
example. Some people don’t do anything
that requires a large amount of energy.
Fatigue can begin right away, or it can occur
after 1 – 2 weeks of treatment. It can go on
for several weeks to months after treatment
has ended. Rarely, it can last for up to a
Low blood counts may also cause you to feel
tired. Your bone marrow makes blood cells.
If a lot of bone is in your radiation field,
your production of blood cells may be
slowed down for a time. This is a short term
side effect. Your doctor may order a blood
test from time to time to check your blood
Here are a few tips that may help with
1. Listen to your body and rest when you
need to. A short nap during the day or
sleeping a little longer may help.
2. Make time for activities you enjoy.
Take a walk in the fresh air, visit with a
friend, or pursue a hobby during the
times that you feel most energetic. Do
things that help you feel good.
3. Stop smoking and do not drink alcohol
to excess! Do something healthy for
yourself. If you need help with this, talk
with your doctor or nurse. There are
ways we can help.
4. If you work you may want to keep
working. Some people are able to
maintain a full time job. Others find it
helpful to work fewer hours. Many
employers understand and will agree to
part time work. We can schedule your
treatment times to fit in with your work
5. Plan regular active exercise – daily
walks, riding an exercise bike, or any
mild exercise. Go at your own pace.
Never exercise to the point of fatigue.
A good rule of thumb is that you should
feel less tired after the exercise than you
did before the exercise.
6. Take advantage of emotional outlets.
Pent-up emotions can add to fatigue.
Talk with family or friends. Having a
good cry or laugh can be helpful.
7. Eat well. Keep foods around that need
little effort to prepare – cheese, yogurt,
or slices of meat. When you feel well,
prepare and freeze meals to eat later
when you are tired. Extra calories and
protein are needed to maintain energy
while getting treatments. They also help
repair normal skin cells damaged by
your treatment. Speak with a clinic
nurse if you have problems eating.
8. Drink lots of fluid – 8 to 12 glasses per
day. The water will help to flush some
of the by-products of your cancer
fighting treatment out of your body.
9. If you need help with your basic daily
needs, ask your nurse or the social
worker to help you contact your local
resources. You may be able to receive
help with meals, housekeeping, personal
care, transportation, support groups, and
10. Accept offers of help from family and
friends. If friends ask if they can help,
accept it! If they ask you to call if you
“need anything,” they may need specific
ideas from you. Often people want to
help but don’t know what things you
need the most help doing. Things like
mowing the lawn, baking a casserole or
watching the kids, can help both you and
your friends feel good.
11. Visits from family and friends can be
pleasant, but also tiring. You do not
need to be the perfect host or hostess.
Let family and friends fix dinner, and
get the drinks and snacks for you!
12. Some people may have pain from cancer
or other causes. Pain can be very tiring.
Your doctor and nurse can work with
you to achieve good pain control. Let
them know about any discomfort you
have during treatment.
Effects on Fertility
Radiation to the pelvis can affect sexual and
Women: Women having radiation in the
pelvic area may stop menstruating. They
may also have symptoms of menopause.
Treatment can also result in vaginal itching,
burning, and dryness. Report these
symptoms to your nurse or doctor.
A woman in childbearing years should
discuss birth control measures with her
doctor. You should not become pregnant
during treatments. If you are pregnant
before starting radiation treatments or
suspect you may be, please tell your nurse
or doctor right away.
Men: Radiation to an area that includes the
testes can reduce both the number of sperm
and their ability to fertilize. This does not
mean that conception cannot occur. You
will need to follow birth control practices.
Discuss your concerns with your doctor or
Effects on Sexuality
Sometimes, when you have cancer and are
going through treatment for cancer your
sexual drive will decrease. The lessened
interest in sex will most likely go away
when the treatment ends. It helps to tell
your partner your needs and feelings. If you
have questions or concerns, feel free to
discuss them with your doctor or nurse.
Women: You may continue to have
intercourse throughout your treatment unless
you doctor advises you not to. Intercourse
may become uncomfortable due to the
shrinking and the drying of vaginal tissues.
These symptoms may be reduced through
the use of vaginal lubricants and changes in
position during intercourse. Your doctor
may suggest using a vaginal dilator during
and after treatment to prevent vaginal
tightness. Your nurse will instruct you on its
Radiation to the pelvis causes ovarian
function to stop. If you have not gone
through menopause, you will do so at this
time. You may or may not have symptoms
of menopause. Symptoms of menopause
may include: hot flashes, mood changes,
vaginal dryness, tingling, and insomnia.
Your doctor will talk with you about ways
to manage these symptoms. This may or
may not include hormone replacement
Men: Radiation to the pelvis may affect
your ability to obtain or maintain an
erection (impotence). Most of the time, this
is a short-term side effect. Rarely, it can be
a permanent side effect caused by a
toughening of the nerves and blood vessels
in the penis. If you have any questions or
concerns, please discuss them with your
doctor or nurse.
Both Men and Women: Radiation can
cause a thinning of pubic hair. It begins
about 2-3 weeks after treatment has started.
It can be a short term or permanent side
effect. How long this side effect lasts
depends on the total dose of radiation given.
A diagnosis of cancer brings concerns other
than the need to manage the acute side
effects of treatment. Often, it affects many
other areas of your life. Patients feel its
impact on their emotions, marriage, family,
jobs, finances, thoughts and feelings about
the future, and many other important areas
of life. The nurses and social workers can
help you cope with these issues. They can
suggest support services and resources. Feel
free to speak them at any time.
Cancer Resource Services
There are many resources for cancer patients and their families.
Gilda’s Club offers support, education, community in a warm welcoming place. It is a free
support community for everyone living with cancer.
608-828-8880 or email email@example.com
Cancer Information Service is a nationwide telephone service of the National Cancer Institute.
It has information about local cancer care as well as care available in other parts of the United
States. The toll-free number is 1-800-422-6237.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 2/2017. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#4617.