On the first day as your area of treatment is planned, you will have skin marks (made with a colored dye) on the pelvis area. As the days of treatments progress, the radiation therapists may place some tiny tattoos that will replace the skin marks. Do not attempt to refresh or wash these marks off your skin. Using warm water, you may shower or bathe as usual but avoid vigorous scrubbing in the treatment area.

Gentle soap and water running over the treated skin will usually cause no harm; in fact, keeping this area clean is beneficial. It is also important to keep the perineum clean. This is the region between the thighs and the anus. Gently cleansing this area well after passing urine with a front to back motion will assist you to feel fresh. To wash the area being treated, use a small amount of soap on your hand and gently wash. Rinse well and gently pat dry with a soft towel,

Do not apply any powders, creams, lotions or deodorants to the skin of the treatment area while undergoing therapy except as directed by the health care team. Dry cornstarch may be applied during the day in the creases of the groin area. This helps to keep the area friction free and reduce irritation and itching. The irradiated skin may become sensitive and we ask that you avoid additional heat sources such as sunbathing, heating pads, hot water bottles, hot tubs and heat producing ointments.

A point to remember is that the radiation treatment affects only the area we are treating. The area being treated and the amount of radiation being given will determine the kind of skin changes, if any, you may experience. Skin changes vary from no changes to a dry, pink color, to a bronzed appearance. Unless the abdomen is obese, you probably will probably not experience a marked skin change. In the case of an obese abdomen it is important to keep skin areas clean under folds of skin.

Skin changes may not occur, but their occurrence is not unusual. Skin reactions do not mean that your treatments are going poorly or that the cancer is spreading. Skin reactions may become more severe if you are receiving chemotherapy and radiation at the same time. Skin changes are more likely to occur in areas with skin folds.

Sensitive treatment areas respond well to pure cotton underclothing and the avoidance of tight, restrictive clothing such as jeans, slacks, and pantyhose.

The bladder may lie in the treatment field and irritation of the lining may occur. Irritation of the lining of the bladder may result in increasingly frequent urination, or discomfort with urination. This irritation can be minimized by drinking sufficient fluids. Feel free to drink Kool Aid, soups and juices. Cranberry juice may help.

Please inform your health care team of any symptoms you may develop with voiding, such as increased frequency, burning or cloudy urine.

The technologists may ask you to come to the department for treatment with a full bladder. When the bladder is full, it helps push small bowel out of the irradiated field. The goal is to have a noticeably full bladder at the time of treatment, but not significant discomfort. This can usually be accomplished by urinating two hours before treatment, and drinking a tall glass of water. Everyone’s system is different however, and you may need to make adjustments in the time and amount you drink before treatment to achieve a full bladder. It is not necessary to have a full bladder for all treatments. If you are significantly uncomfortable with a full bladder shortly before treatment, you may void. This will not compromise the effectiveness of having a full bladder during many or most of the treatments. If there is to be a change in instructions, your health care team will instruct you.

Often, after receiving between eight to twelve treatments, there may be a tendency toward increased bowel activity and increased gas production. The bowels have a varying effect to the radiation and it is difficult to predict the amount of diarrhea, if any, you may experience. Changes in the diet may be necessary. Imodium may be used (available over the counter). Please alert the health care team if loose stools or diarrhea occur.

The rectum or gluteal fold may become irritated as a result of the radiation and/or diarrhea. Please inform us of any symptoms you may be having, such as rectal discomfort, hemorrhoidal problems, skin irritation, etc.

Radiation therapy to the female pelvis can result in irritation of the vaginal tissues and can decrease mucous production. The result can be eventual dryness and narrowing of the vaginal canal. It is important to keep the vaginal canal from narrowing for future examinations and for your comfort.

The vaginal area should be routinely stretched 2-3 times per week by sexual intercourse and/or use of a vaginal dilator. If you are not sexually active, a vaginal dilator should be used. The use of additional lubrication such as K-Y jelly (do not use petroleum products such as Vaseline) may promote comfort. Gentle douching once daily with a mild vinegar solution (2 tablespoons white vinegar to 1 quart warm water) may be indicated. Warm sitz baths using the same mild vinegar solution can be soothing to inflamed tissues, especially to external tissues such as the rectum and vaginal opening.

As a result of the treatment to the pelvis, you may temporarily lose your pubic hair, which may or may not completely regrow.

Menstruation usually ceases completely by the end of therapy or within several months after treatment because the ovaries are very sensitive to the effects of radiation. Do not rely on radiation therapy as a means of future birth control without first discussing this with your physician.

The importance of maintaining an adequate and nutritious diet cannot be stressed enough. Dieting with substantial weight loss is discouraged at this time. In order for normal cells to recuperate from the daily treatment, they require appropriate nutrients each day. You will be weighed regularly during radiation therapy to help insure that you are eating adequately.

Symptoms you should report to the health care team are: