Managing PRD

Also in this section:

• Symptoms of PRD >
• How having PRD might make you feel > 
• Getting diagnosed >
• Lifestyle changes >
• Tips for managing your PRD >
• Useful links >

Pelvic radiation disease (PRD) is a very complicated condition. It can have a wide variety of symptoms affecting many different organs and tissues within the pelvis, as well as effects to your mood and wellbeing. Many women also suffer from several different symptoms at once. This can make PRD hard to identify and diagnose, as well as treat [1]. However, there are methods available to treat and manage PRD, which include:

• Medications or medical treatments
• Lifestyle changes that can help
• Tips for managing symptoms that cannot be treated

Medications/medical treatments

There are several medications and treatments available for the gastrointestinal (those affecting the bowel) and bladder symptoms of PRD, the sexual symptoms (both physical changes to the vagina and hormonal changes causing early menopause) and the effects to the bones that some women have. 

These vary a lot depending on your individual symptoms, but can include the following [2][3]:

• Bowel:
• Enemas (when a liquid is put into the bowel by placing a tube up the bottom) to coat the lining of the rectum to stop bleeding and pain while emptying the bowels
• Medications to seal the blood vessels in the bottom and stop bleeding
• Taking soluble fibre to bulk up stools (poo) or laxatives to make emptying your bowels easier
• Medications to slow down the bowel to reduce urgency
• Medications to prevent diarrhoea
• Medications to reduce wind
• In rare cases surgery may be required if, for example, a part of the bowel needs to be removed (bowel resection) or a new opening for the bowel or bladder (stoma) needs to be created.
• Bladder:
• Medications to relax the bladder to help with frequency and urgency
• Surgery is sometimes an option to help strengthen the support around the urethra (the tube where urine comes out) to help prevent urine leaking out
• Medications to help reduce bleeding 
• Sealing off blood vessels with heat (cauterisation) to stop bleeding.
• Bowel and bladder:
• Hyperbaric oxygen therapy might be available to you if you are suffering from blood in your urine or stools (poo), or bleeding from your bottom. This treatment works by increasing the amount of oxygen entering the tissues that were damaged by your radiotherapy. This can encourage new blood vessels to grow and it may help the healing process in the damaged tissues [4]. The treatment is not available everywhere in the UK, so talk to your medical team about the treatment if you would like to know more.
• Early menopause:
• For most women hormone replacement therapy (HRT) can relieve many of the symptoms of menopause by replacing the hormones that your body is no longer producing.
• Vaginal changes:
• Using oestrogen creams to help with vaginal dryness and thinning of the vaginal walls 
• Using dilators, which are plastic tubes shaped like tampons that you insert into the vagina. They come in many sizes, including very small ones, and are recommended to help prevent narrowing of the vagina after radiotherapy treatment. 
• Bone pain/fractures:
• Medications to help strengthen the bones
• Pain killers to ease bone pain
• Calcium and vitamin D supplements to strengthen bones (your doctor will advise you on which supplements and dosages). 

References

1. Teo MTW et al, 2015. Prevention and management of radiation-induced late gastrointestinal toxicity. Clinical Oncology 2015, 1–12.
2. Andreyev HJN et al, 2015. Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease. Frontline Gastroenterology 0, 1–20.
3. Macmillan, 2015. Managing the late effects of pelvic radiotherapy in women. http://be.macmillan.org.uk/Downloads/CancerInformation/CancerTypes/MAC13826pelviclateeffectswomenE2cover20150119TRlowres.pdf. Accessed: 04.04.2016.
4. Ouaïssi M et al, 2014. Pelvic radiation disease management by hyperbaric oxygen therapy: prospective study of 44 patients. Gastroenterology Research and Practice 2014 (108073), 1–5.