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Nerve damage after pelvic radiotherapy

Pelvic radiotherapy can damage the nerves in the pelvis, legs and lower back. 

We hope the information on this page helps explain why you might have symptoms of nerve damage. We are also here if you need some extra support or aren’t sure how to begin a conversation with your healthcare professional.

Get support > 

About nerve damage

The nervous system is a part of the body that controls movement, including movement of the arms, legs and muscles. 

Pelvic radiotherapy uses radiation to destroy cancer cells in that part of the body. It may also damage healthy cells and tissues in that area. As this heals, it can cause swelling and pain (inflammation), which can damage nearby nerves.

There is limited evidence about nerve damage after pelvic radiotherapy. Sometimes the symptoms can be similar to other conditions, which may lead to misdiagnosis.

Symptoms of nerve damage

Symptoms of nerve damage caused by pelvic radiotherapy include:

  • pain
  • weakness in your legs
  • cramps or aching in your legs or pelvis
  • tingling in your legs or pelvis
  • numbness in your legs or pelvis
  • changes to mobility.

Other symptoms of pelvic radiation disease (PRD) can also be related to nerve damage, including bowel changes.

Read about other PRD symptoms > 

Medical treatments for nerve damage

These symptoms can be difficult and worrying to deal with, and may have a major impact on your day-to-day life. Nerve damage can get worse as time goes on, so it is important to get any symptoms checked out as soon as possible.

Speaking with your healthcare professional 

It is important that your healthcare professional tries to diagnose the underlying cause of the symptom, which may be nerve damage, rather than simply treating the symptom itself.

You can speak with:

  • your GP
  • your clinical nurse specialist (CNS)
  • your cancer doctor (consultant).

It can help to speak to a healthcare professional you already know, trust and who has an understanding of your medical history.

You might be having this conversation years after you have finished your treatment, so it is a good idea to be clear about what is happening. You could:

  • tell them that these symptoms started after pelvic radiotherapy treatment
  • tell them when the symptoms started
  • tell them how long the symptoms have lasted for
  • explain the impact the symptoms are having on your life – be prepared to give all the details. 

It may be helpful to write down what you experience day-to-day

Read more about getting a diagnosis > 

Possible underlying causes

Although nerve damage can present as a specific symptom – for example, weakness – they may be happening because of a different condition caused by pelvic radiotherapy. We spoke with experts who told us they sometimes see patients with PRD who have these conditions:

After pelvic radiotherapy for a gynaecological cancer, over 1 in 10 (14%) patients have pelvic insufficiency fractures. We need more research to know the exact numbers for cervical cancer patients. 

Pelvic insufficiency fractures can happen when radiation is focused on a specific spot and damages the bone. The pain that these fractures can cause in the pelvis and back is sometimes mistaken for nerve damage.

If you have pain in your pelvis or legs, it is worth talking to your healthcare team about checking for fractures. They can do this by assessing your medical history and may suggest you have an x-ray or bone scan.

Read about bone changes >

Peripheral neuropathy can develop when nerves in the outer parts of the body, such as the hands or feet, are damaged. We need more research to understand the numbers affected by and impact of radiation-induced peripheral neuropathy (RIPN), but the evidence we do have suggests it’s rare. It can cause symptoms including numbness, weakness and pain.

There are treatments being researched, so it is important to speak to your GP or hospital healthcare team if you have symptoms.

Read more about peripheral neuropathy on the NHS website >

Some members of our community have been diagnosed with radiation induced lumbar plexopathy (RILP). The lumbar plexus is a collection of nerves that relate to the back, stomach and legs. Pelvic radiotherapy can damage these nerves and cause symptoms including pain, weakness and changes to mobility over time. Research shows that RILP is very rare after pelvic radiotherapy. 

We need more research to understand RILP, as well as find effective ways to treat or manage it. If you are experiencing symptoms, it is worth asking your healthcare team to rule it out. The sooner you seek help for any symptoms, the sooner your healthcare team can offer you the right support.

Possible treatments for nerve damage

If you’re experiencing pain and discomfort in your day-to-day life, you may be recommended one of the following:

A physiotherapist works with you to make movement easier and less painful. If nerve damage is affecting your mobility, this type of support may be useful for you. Your GP or hospital healthcare team should be able to refer you to a physiotherapist.

In some cases, surgery may be suggested to:

  • free nerves that are trapped or squeezed by scarring caused by pelvic radiotherapy
  • repair damaged nerves.

You can speak to your hospital healthcare team about whether this option is suitable for you.

A counsellor is an expert who can help to manage your thoughts and feelings around nerve damage and its impact on your life. They will listen to you and help you explore next steps, both emotionally and practically. 

Your GP or hospital healthcare team can refer you to a counsellor. Counselling is not always available quickly on the NHS, but it is worth checking what is available in your area.

Getting support with nerve damage

It can feel like a big step to talk to a healthcare professionals about any symptoms you have, but it’s important that you get support based on your individual situation. Accessing support for nerve damage may be more difficult at the moment because of the coronavirus pandemic. If you are not sure where to turn, you can give our free Helpline a call on 0808 802 8000. Our trained volunteers can talk through your options or simply listen to what’s going on.

Check our Helpline opening hours > 

Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. It even has a section dedicated to relationships. You can read through the messages or post your own – whichever feels most comfortable.

Join our Forum > 

If you have general questions about PRD or nerve damage, our panel of medical experts may be able to help. They can’t give you answers about your individual situation or health – it’s best to speak with your GP or healthcare team for that.

Use our Ask the Expert service > 

Useful organisations

Pelvic Radiation Disease Association (PRDA)

A UK charity providing information about PRD. Has an online community as well as hosting national and local events for people with PRD.

www.prda.org.uk

Action Radiotherapy

A UK charity dedicated to improving radiotherapy treatments. Provides information about radiotherapy, including side effects.

www.actionradiotherapy.org 

Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it. 

References

  • Sapienza, L. et al (2020). Pelvic Insufficiency Fractures After External Beam Radiation Therapy for Gynecologic Cancers: A Meta-analysis and Meta-regression of 3929 Patients. International Journal of Radiation Oncology*Biology*Physics. 106;3. pp.475-484.
  • Ramlov, A. et al (2017). Risk Factors for Pelvic Insufficiency Fractures in Locally Advanced Cervical Cancer Following Intensity Modulated Radiation Therapy. International Journal of Radiation Oncology*Biology*Physics. 97;5. pp.1032-1039.
  • Delanian, S. et al (2012). Radiation-induced neuropathy in cancer survivors. Radiotherapy and Oncology. 105;3. pp.273-282.
  • Doo, A. et al (2018). Radiation-induced neuropathic pain successfully treated with systemic lidocaine administration. Journal of Pain Research. 11. pp.545–548.
  • Bourhafour , I. et al (2015). Lumbosacral plexopathy: A rare long term complication of concomitant chemo-radiation for cervical cancer. Gynecologic Oncology Research and Practice. 2. pp,1-12.
  • Pabari, A. et al (2014). Nerve Conduits for Peripheral Nerve Surgery. Plastic and Reconstructive Surgery. 133;6. pp.1420-1430.

We write our information based on literature searches and expert review. For more information about the references we used, please contact [email protected].

Read more about how we research and write our information >

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Date last updated: 
29 Oct 2020
Date due for review: 
29 Oct 2022
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