During and after womb cancer treatment, it is common for patients to experience difficulties with their bowels and bladder.
It may be that changes to your bowel and/or bladder habits were symptoms you noticed prior to your diagnosis that initiated further investigations. Cancer treatments including surgery, chemotherapy and radiotherapy can then affect them further. Here we discuss these, considering possible causes of the change and management strategies.
Bowel concerns
It is important to note that everyone’s bowel habits are different and to recognise what is normal for you. Changes to that normal can result in significant discomfort whether that be constipation, loose bowels or diarrhoea. You may also experience significant bloating, loss of appetite, abdominal cramps and pain associated with the changes.
A cancer diagnosis and then subsequent treatments can have a significant impact on your bowels. Stress and anxiety can affect your bowels along with reduced appetite. Surgery and anaesthesia, pain relief medication and inactivity can result in changes. Infections and antibiotics can also result in diarrhoea.
Chemotherapy can cause changes to bowel habits as it can disrupt the growth of cells involved in digestion. In most instances the symptoms appear in the first few days of treatment and will resolve post treatment.
For patients that undergo pelvic radiotherapy as part of their treatment, changes to bowels are a common side-effect. Constipation, loose stools, increased frequency and diarrhoea can be experienced, in most cases these side-effects are temporary.
In a small number of women these changes can last long after treatment or be permanent, they can also develop long after treatment has finished. This can have a significant impact on quality of life and it’s important to discuss your symptoms with your clinical team as they may be able to offer advice and support such as medication. Post radiation support is also available through Pelvic Radiation Disease Association UK .
Managing symptoms
Constipation can build up gradually and can result in significant abdominal pain and discomfort. Drinking plenty of fluids each day can help keep your stools soft and maintain a normal bowel habit. Eating a diet high in insoluble fibres which includes raw fruit and vegetables, nuts, seeds and dried fruit can help but it is important to check this with your clinical teams, as in some cases where treatment has affected the bowel a high fibre diet is not recommended.
Medication such as laxatives or stool softeners are often prescribed and recommended by your clinical team. It is often advised that you take these if you are taking strong opioid based pain killers to counteract the side effect of constipation these often have.
If you feel well enough, light exercise can also have a positive impact on your bowels by supporting gut motility (movement) and increasing blood circulation.
In relation to loose stools and diarrhoea, drinking plenty of water to replace the loss is extremely important. Soluble fibres such as apples without the skin can help slow your digestion down, sticking to plain foods and small amounts often we also help.
If symptoms of constipation or loose stools persist, please discuss these with your clinical team or GP as it can result in complications or require further investigation.
Bladder concerns
Bladder concerns, including urinary incontinence, urgency, increased frequency, difficulty passing urine and not fully emptying your bladder are all common following treatment for womb cancer.
Having a general anaesthetic and often a urinary catheter post-surgery can result in your bladder slowing down but in most cases this is short-term. Major abdominal surgery can cause weakening in your pelvic floor muscles which in turn can impact your bladder and continence.
The menopause can result in bladder symptoms including incontinence, vaginal dryness and urinary tract infections. This is due to reduced levels of oestrogen.
Pelvic radiotherapy can result long-term bladder issues due to the impact of radiation on the bladder and surrounding tissues. It can cause changes to bladder tissue, such as inflammation, reduced elasticity, or damage to blood vessels, which can also lead to blood in the urine (also known as haematuria).
As with bowel concerns, the impact of bladder symptoms on your quality of life can be very significant and understanding the cause and exploring management strategies, such as medication, pelvic floor exercises, or lifestyle adjustments, can greatly improve comfort and quality of life.
Managing symptoms
Regular pelvic floor exercises can significantly improve the strength of pelvic and bladder tissues and you can find excellent guidance. You may find the following Peaches videos useful:
Essential core and pelvic floor exercises.
Pre and post surgery exercises.
Restoring function after gynaecological surgery.
When possible, drink at least 1 to 2 litres of fluid daily. Spread this regularly throughout the day and increase accordingly if you are taking on exercise or if it is a hot day. Drinking more fluids will help to reduce bladder irritation, reduce urine infection risk, and train your bladder to hold more urine. Drinking the right fluids is also important as some drinks can irritate the bladder and make symptoms worse. Where possible try and reduce/avoid:
- alcohol
- caffeinated drinks
- fizzy drinks
- acidic drinks, such as fresh orange juice
Medication known as antispasmodics can be explored in some cases for increased frequency or urgency and incontinence. This would require a discussion with your clinical team or GP as they are not always suitable. Vaginal oestrogen or other forms of HRT can also be considered to help improve symptoms but again these may not be suitable for all and would need to be considered on an individual basis weighing up risk and benefit with your clinical team.
Referral to your Urogynaecology team may also be recommended to allow for further investigations and management options.
