Long-Term Swallowing, Bowel, Bladder, and Sexual Effects

Treatment can change how you swallow. It can change how your bowel and bladder work. It can change how sex feels. All of this is common. All of it is under-reported.

Two beliefs keep people quiet. One is that this is too embarrassing to raise. The other is that it is permanent, so why bother.

The second belief is usually wrong. Most of what follows has real treatment, and specialists who do nothing else.

Trouble or pain when you swallow is called dysphagia. It is a known effect of cancer of the head, neck, or food pipe, and of the treatment for it.

The National Cancer Institute lists these lasting mouth and throat problems:

• Dry mouth, known as xerostomia.
• Trouble swallowing.
• Changes in taste or smell.
• Mouth sores and infections.
• Pain or swelling in the mouth. This is called oral mucositis.
• Tooth decay.

NCI gives the cause. Radiation to the head and neck can harm the glands that make spit. It can harm the lining of the mouth too. Some chemo and some immune drugs harm cells in the mouth, throat, and lips.

Dry mouth is not a small thing. Spit starts digestion. It guards your teeth. It makes food go down. Losing it changes every meal.

What helps. MedlinePlus states that swallowing treatment with a speech-language pathologist can help. Ask for that job title by name. A referral moves faster when you name the specialty.

A dietitian matters too. MedlinePlus notes that a swallowing problem makes it hard to take in enough calories and fluid.

See a dentist. NCI advises visiting your dentist for a cleaning and check-up before treatment starts, telling them about your cancer treatment, and finishing any dental work first. During treatment, NCI suggests rinsing your mouth through the day with a solution of warm water, baking soda, and salt, and using a very soft toothbrush or cotton swabs. Ask your nurse to write down the rinse recipe recommended for you.

Get seen fast if you cough or choke when you eat or drink. Same if food sticks, or if you are losing weight. Food going the wrong way can cause a chest infection.

Radiation to the pelvis can leave lasting bowel changes.

NCI describes radiation proctitis. That means damage to the lining of the rectum. NCI says radiation for rectal, prostate, and cervical cancers is the most likely cause.

There are two forms. The early form starts soon after treatment begins. It settles a few weeks after treatment ends. The long-term form is different. NCI describes it as rectal pain and bleeding, and not being able to control your bowels.

Signs to know:

• Loose stools.
• A frequent or constant urge to go.
• Belly pain or cramps.
• Blood or mucus in the stool.
• Loss of bowel control.

Radiation to the belly or pelvis can also harm healthy gut tissue. NCI calls that radiation enteritis. Chemo, some immune drugs, targeted drugs, transplant, and gut surgery can all cause loose stools too.

When to call. NCI grades this by how many extra stools you have above your normal. Up to six extra a day is often managed at home. Seven or more extra a day can be life-threatening. It may need hospital care. The danger is dehydration.

Ask for a gut specialist if bleeding or leaking goes on. Ask for a dietitian too. NCI suggests small frequent meals, low-fiber foods, and foods high in sodium or potassium.

NCI lists four urinary problems after cancer treatment:

• Radiation cystitis. This means the bladder lining is irritated.
• Urine infections.
• Leaking urine.
• Trouble emptying the bladder fully.

NCI gives three causes. Radiation to the pelvis. Some chemo and immune drugs that affect bladder and kidney cells. And surgery. Prostate removal, bladder surgery, and removal of the womb can all leave urinary effects.

Radiation cystitis brings pain or burning when you pass urine. It can bring blood in the urine too.

This is the urgent one. NCI warns that a urine infection can turn into a serious condition that needs care right away. Watch for a fever of 100.5 degrees Fahrenheit — 38 °C is 100.4 °F; act at 100.4 °F —, or 38 Celsius, or higher. Watch for chills and fatigue with it. Call your team. Do not wait for morning.

For leaking or retention, ask for a urologist. Ask for pelvic floor physical therapy as well. These therapists retrain the muscles that control bladder and bowel. They treat men as well as women.

NCI lists these after cancer treatment:

• Vaginal dryness.
• Vaginal stenosis. The vagina becomes less stretchy, narrower, and shorter.
• Vaginal atrophy. The muscles weaken and the wall gets thin.
• Itching, burning, and swelling.
• Vaginal sores.
• Pain during sex.
• Hot flashes, and periods that are odd or absent.
• Loss of interest in sex.

NCI gives the causes. Chemo can lower estrogen and stop the ovaries working early. Hormone therapy lowers estrogen too. So can radiation to the pelvis. Surgery for gynecologic cancers plays a part. So do drugs such as opioids.

What helps. NCI names vaginal gels and creams, lubricants, moisturizers, estrogen cream, and dilators. A dilator is a smooth device used on a set schedule. NCI describes it as a way to help prevent or reverse scarring where radiation therapy or graft-versus-host disease has affected the vagina. Ask about it directly. It often goes unmentioned.

NCI lists three main effects. Trouble getting or keeping an erection. Dry orgasm. And less interest in sex.

NCI gives the causes. Radiation to the prostate or pelvis can harm blood vessels or nerves. Pelvic surgery can affect the nerves. Hormone therapy lowers testosterone, which lowers sex drive. NCI notes that if the prostate is damaged, you may have a dry orgasm.

What helps. NCI describes drugs that raise blood flow to the penis. It also describes an implant, a firm rod or inflatable device placed in the penis.

Name the specialty out loud. Referrals move faster that way:

• Speech-language pathologist, for swallowing.
• Dietitian, for weight, calories, and food texture.
• Dentist, for dry mouth and decay.
• Gut specialist, for bleeding, urgency, or bowel control.
• Urologist, for leaking, retention, or blood in the urine.
• Pelvic floor physical therapy, for bladder and bowel control, and for pain with sex.
• Sexual health or menopause clinic, for dryness, pain, and desire.
• Survivorship clinic, if your center has one.

One sentence gets you started: "I have a late effect I have never mentioned, and I would like a referral for it."

• Late Effects of Cancer Treatment — NCI
• Mouth and Throat Problems — NCI
• Radiation Proctitis — NCI
• Diarrhea and Cancer — NCI
• Urinary and Bladder Problems — NCI
• Sexual Health Issues in Women — NCI
• Sexual Health Issues in Men — NCI
• Swallowing Disorders — MedlinePlus