Managing side effects

Bladder control may change after surgery or radiation therapy. You may find that you need to pass urine more often or in a hurry. Or you may leak a few drops of urine when you cough, sneeze, laugh, strain or lift. This is called urinary incontinence and there are ways to manage it.

• Strengthening the muscles needed to control urine can help manage urinary incontinence.
• Using continence pads can help you manage any leakage and prevent any loss of dignity.
• See a continence nurse or physiotherapist. They can develop a bladder training program for you – ask your doctor for a referral, or contact the National Continence Helpline on
  1800 33 00 66 or at continence.org.au.

The blood vessels in the bladder can break more easily after radiation therapy. This can cause blood to appear in urine or faeces (poo), even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment.

Download our booklet ‘Exercise for People Living With Cancer’ for a guide to exercising the pelvic floor muscles

Changed bowel movements – After surgery or radiation therapy, you may notice changes in your bowel habits. You may have constipation or diarrhoea, or feel pain in your abdomen from trapped wind.

Radiation proctitis – Radiation therapy can damage the lining of the rectum, causing inflammation and swelling known as radiation proctitis. The risk of developing radiation proctitis is low and your treatment team will try to reduce this risk. Radiation proctitis is usually a short-term side effect but may be ongoing in a small number of people. It can cause a range of symptoms including blood in bowel movements; frequent passing of loose, watery faeces (diarrhoea); the need to empty the bowels urgently; and loss of control over the bowels (faecal incontinence). You may develop some of these symptoms for other reasons. Let your treatment team know if you develop any of these symptoms. If you have ongoing bowel problems, you may be referred to a gastroenterologist.

The blood vessels in the bowel can break more easily after radiation therapy. This can cause blood to appear in urine or faeces (poo), even months or years after treatment. Let your doctor know if this occurs so you can be given the appropriate treatment.

Tips for managing bowel changes

• Drink peppermint or chamomile tea to reduce abdominal or wind pain.
• Drink plenty of water to replace fluids lost through diarrhoea or to help soften faeces if you are constipated.
• See a women’s health physiotherapist for information about exercises to strengthen your pelvic floor and anal muscles. These exercises can help you control your bowels.
• Talk to your doctor or a dietitian about what to eat, or ask about suitable medicines. They may suggest you take a soluble fibre supplement to help with any changes and improve bowel control.

It is common to feel tired and lack energy during and after treatment, particularly if you’ve had both radiation therapy and chemotherapy. The tiredness may continue for several months, or even a year or two, after treatment has finished.

Feeling tired is not only a side effect of the treatment itself. Travelling to hospitals and clinics for treatment can be exhausting. If you work during your treatment or if you have a family to care for, this can make you feel especially tired.

It may be frustrating if other people don’t understand how you’re feeling.

Tips for managing fatigue

• Gentle exercise during and after treatment has been shown to boost energy levels and reduce fatigue. Even a walk around the block can help. Ask your doctor about the amount and type of exercise that is right for you.
• Plan your day. Do things at the time of day when you feel less tired.
• Rest regularly. Keep a journal to track your “good times”.
• Talk with your family and friends about how you’re feeling and discuss things they can help you with, e.g. housework and shopping.
• Limit daytime naps to 30 minutes so they don’t make it hard to sleep at night.
• Don’t expect to be able to instantly do everything you used to do right away. Your body is still recovering and it will take time for your energy levels to return.

Download our fact sheet ‘Fatigue and Cancer’

If your uterus is removed or you have radiation therapy to the uterus and cervix, you will not be able to conceive children or carry a pregnancy. Before treatment starts, ask your doctor or a fertility specialist about what options are available to you.

Being told that your reproductive organs will be removed or will no longer work can be devastating. Even if your family is complete or you did not want children, you may still feel a sense of loss and grief. These reactions are common. Speaking to a counsellor or gynaecological oncology nurse about your feelings and individual situation can be helpful.

Ways to preserve fertility

• If you have not already been through menopause, ask about ways to preserve your fertility. One option may be to store eggs or embryos for use in the future. These can be implanted in your body, if you still have a healthy uterus, or into a surrogate.
• Having a trachelectomy, where only the cervix is removed, may be an option for some women. It will still be possible to become pregnant after this procedure, but you will be at higher risk of having a miscarriage and having the baby prematurely. Your doctor can discuss these risks with you.

Download our booklet ‘Fertility and Cancer’

Surgery or radiation therapy to the pelvic area can stop lymph fluid from draining normally, causing swelling in the legs or genital area. This is known as lymphoedema. Lymphoedema may appear during treatment or months or years later.

It is important to look after your skin, avoid injury or infection to the lower limbs, and manage lymphoedema symptoms as soon as possible. Mild lymphoedema is usually managed with exercise, skin care and a compression stocking or sleeve. A physiotherapist trained in lymphoedema management can give you further advice.

To find a practitioner who specialises in the management of lymphoedema, visit the Australasian Lymphology Association’s website and click on “Find a Practitioner”.

Download our fact sheet ‘Understanding Lymphoedema’

If your ovaries have been damaged by radiation therapy or chemotherapy, or they’ve been surgically removed, your body will no longer produce the hormones oestrogen and progesterone. When this happens, periods stop. This is called menopause. Menopause is a natural and gradual process that usually starts between the ages of 45 and 55.

The symptoms of menopause caused by cancer treatment are usually more severe than during a natural menopause, because the body hasn’t had time to get used to a gradual decrease in the hormone levels. Symptoms can include hot flushes, mood swings, trouble sleeping (insomnia), tiredness and vaginal dryness. Menopause may cause other changes in the body over time, such as:

• low libido – you may be less interested in sex
• osteoporosis – this is when your bones become weak and brittle and may break more easily
• high cholesterol – cholesterol is a fatty substance found in the blood; having high levels can increase your risk of heart disease and stroke.

Menopause hormone therapy (MHT), previously known as hormone replacement therapy (HRT), is medicine that replaces the hormones usually produced by the ovaries. It has been shown to treat menopausal symptoms and help prevent osteoporosis. There are also non-hormonal drugs that can help. Talk to your doctor about the risks and benefits of MHT, and other ways to deal with the symptoms of menopause.

Tips for managing symptoms of menopause

• Talk to your doctor about having a bone density test or taking medicines to prevent osteoporosis.
• Regular exercise will help keep your bones strong. For more information, call 1800 242 141 or visit healthybonesaustralia.org.au.
• Ask your doctor to check your cholesterol levels. If they are high, regular exercise and a balanced diet may help reduce them. If levels don’t improve, talk to your doctor about cholesterol-lowering drugs.
• Your doctor can suggest dietary changes and suitable exercises.
• If you smoke, talk to your doctor about quitting or call the Quitline on 13 7848.
• Try meditation and relaxation techniques to help reduce stress and lessen symptoms. Listen
  to our Finding Calm During Cancer podcast.
• If you have ongoing symptoms, ask your doctor for a referral to a specialist menopause clinic.

Having cervical cancer can affect your sexuality in physical and emotional ways. The impact of these changes depends on many things, such as your treatment and its side effects, whether you have a partner, and your overall self-confidence.

Low libido – A lack of interest in sex or loss of desire is common during and after treatment. This may be because of the worry of having cancer and the side effects of treatment. If you do not feel like having sex, or if you find it uncomfortable, let your partner know.

It normally takes some time for sex to be comfortable again. You can also try other ways to be intimate, such as massage and cuddling.

Vaginal changes – The main side effect of treatment for cervical cancer will be to the vagina. If the ovaries have been affected by surgery or radiation therapy, they will no longer produce oestrogen. This will cause your vagina to become very dry and it may not expand easily during sexual intercourse. Radiation therapy to the pelvic area can also cause vaginal tissue to lose its elasticity and shrink, narrowing the vagina. This is known as vaginal stenosis.

If vaginal changes make sexual penetration difficult or painful, you may have to explore different ways to orgasm or climax. If you need more support resuming sexual activity, ask your doctor for a referral to a sexual therapist or psychologist.

Managing changes in your sex life

Sexual changes

• Give yourself time to get used to any physical changes.
• Talk to your doctor about ways to manage side effects that change your sex life. They may suggest
  using hormone creams and vaginal moisturisers to help with vaginal discomfort and dryness.
• You can get a prescription for hormone creams from your doctor or buy vaginal moisturisers over the counter from pharmacies.
• Discuss changes to your libido with your partner so they understand how you’re feeling. You may both need to be patient.
• Consider touching, hugging and kissing. This is a chance to feel close to your partner without expectations of sexual penetration.
• Explore other ways to climax, such as caressing the breasts, inner thighs, feet or buttocks.
• Use water- or silicone-based vaginal lubricants without perfumes, oils or glycerines.

Changes to the vagina

• Try to keep the vagina open and supple. This will make sexual intercourse more comfortable. Even if you don’t plan to be sexually active, it also makes it easier for your doctor to do regular cervical screening tests, as well as vaginal examinations to check whether the cancer has come back.
• Your doctor or nurse may suggest you use a vaginal dilator to help keep the walls of the vagina open and supple.
• Dilators are tube-shaped devices made from plastic or silicone. They are designed to gently stretch the vagina. They come in different sizes – it is important to seek advice from a health professional about the correct size.
• Wait until any soreness has settled before you start using a dilator. This is usually 2–6 weeks after your last session of radiation therapy.
• Used with lubricant, the dilator is inserted into the vagina for short periods of time.
• Using a dilator can be challenging. Your doctor or a physiotherapist can provide practical advice on how to use them.
• Having regular gentle sexual intercourse can also help widen the vagina. Use a lubricant to prevent discomfort caused by vaginal dryness.

Download our booklet ‘Sexuality, Intimacy and Cancer’