This page is for patients who are receiving radiotherapy to the bladder. It explains what the treatment involves, describes side-effects you may experience during and after treatment, and how best to cope with them.
We understand this is a worrying time for patients and their families, and we hope this page can help to answer any questions you have. If you have any questions about the treatment or the information here, please speak to the team looking after you.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves. Staff will explain all the risks, benefits and possible alternatives before they ask you to sign a consent form.
If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.
During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality and personal preferences. Your care will be managed and given by therapeutic radiographers, doctors and nurses. You will meet both male and female healthcare professionals during the course of your treatment. If you have any concerns about this, please talk to the radiographers about it.
We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.
- You will see a clinical oncologist who will explain your diagnosis and discuss treatment options with you.
- You will be consented for radiotherapy. Radiotherapy for bladder cancer is used:
- As an alternative to surgery
- In combination with chemotherapy
- In advanced disease to control symptoms, e.g., when passing a large amount of blood
- Radiotherapy treatment planning appointment - You will have a planning CT scan using intravenous contrast dye if required.
- First treatment - You will start treatment about three weeks after the planning scan. Each appointment will take approximately 30-40 minutes.
- Review clinics - You will be reviewed once a week during treatment by your specialist nurse. This will either be face-to-face or via phone.
- Treatment complete - You will be reviewed by your clinical oncologist, as an outpatient, four to six weeks after your treatment course has completed. This may be a telephone consultation, or if face-to-face, will be held in the UCLH Macmillan Cancer Centre.
Radiotherapy appointments: All take place in the Radiotherapy Department, basement floor, main UCH hospital building.
Radiotherapy is the specialised treatment of cancer (and some other diseases) using high energy radiation beams. Radiotherapy works by damaging cancer or tumour cells in the part of the body being treated. The radiation stops the cells from dividing and growing.
Radiotherapy can also damage nearby normal cells. The normal cells are more likely to recover from the effects of the radiation than the cancer or tumour cells. Doctors take great care to reduce the radiation dose to a person’s healthy cells.
Radiotherapy does not hurt, and it will not make you radioactive. You will be completely safe to be around family, friends and pregnant women. You will feel nothing from the treatment and the machine will not touch you. It is rather like having an ordinary x-ray. The most important thing is for you to lie very still for treatment.
Treatment is given daily Monday to Friday, including Bank Holidays. A course of treatment will last four to eight weeks. Your treatment schedule will be decided by your doctor or consultant urology radiographer and confirmed on your first treatment visit to the radiotherapy department.
Some patients will be given drug treatment (chemotherapy) before and/or during their radiotherapy. The chemotherapy increases the activity of the radiotherapy against the cancer cells. If this applies to you, it will be discussed in detail.
Patients receiving chemotherapy in addition to radiotherapy may experience additional side effects to those listed here depending on the drug regime used. The use of chemotherapy may cause worsening skin reactions, increase the likelihood of nausea and may also cause small ulcers in your mouth. The doctors will discuss these issues with you.
Smoking is a major cause of bladder cancer. If you are a smoker, we strongly advise you to quit. Continuing to smoke during radiotherapy may worsen the side effects that you may experience.
Smoking has also been proven to decrease the effectiveness of radiotherapy. Help and support to quit is available, free of charge, from your specialist nurse, your GP or local pharmacy.
Before beginning radiotherapy, your treatment must be carefully planned. Your first visit will be to the radiotherapy pre-treatment department. At this appointment you will have a CT scan, to gain information of the area to be treated whilst you are lying in the treatment position.
You can eat and drink normally before you come for your planning CT scan. You will you need to have an empty bladder for your planning and treatment. This is so we can try to keep the area to be treated to a minimum and reduce the side effects of treatment as much as possible. Just before your scan we will ask you to go to the toilet to empty your bladder as much as possible. Try to empty your bladder using your normal amount of force and time. Do not strain to empty every last drop of fluid.
We may also ask you to use a small micro-enema to empty your rectum (back passage). This is so we can try to keep as much of your bowel out of the treatment field and reduce the side effects of treatment as much as possible. Your doctor will discuss this with you if it needed and give you a prescription.
When it is time for your scan the radiographers will take you in to the CT scanner room. You will be asked to change into a hospital gown and remove all clothing from the waist down apart from your underwear. The radiographers will place support pillows under your head and legs to support them and to ensure you are in the correct position. They will then place a modesty cover over your pelvic area and lower your underwear.
Using a felt-tip pen, the radiographers will place some temporary marks on your skin and take some measurements. These are for reference only and can be removed when you go home. The radiographers will then leave the room to perform the CT scan.
You will feel the bed move in and out of the scanner. You will pass through the scanner a number of times. The radiographers will be watching you the entire time. When the scan is done, and the radiographers have checked the images they will re-enter the room. The radiographers will then mark several specific points (also called tattoos) on your skin. These are alignment marks to ensure each treatment is accurate. The marks are permanent and are done by placing ink on the skin and then gently scratching the surface of your skin with a fine needle.
You won’t feel anything during the scan. All we ask is that you lie still and breathe normally. After the scan is completed, you will be free to leave. Before you go, you will be given an appointment card with the date and time for your next visit, which will be your first treatment.
During the scan you may be given an injection of a contrast agent that will help us see your organs and vessels more clearly. The doctor will use these images alongside other scans you will have had to decide on the exact area for treatment.
Patients will normally receive their treatment as an outpatient. Treatment is every day, Monday to Friday, including Bank Holidays. Your clinical oncologist will have already told you how many treatments you will be having. The treatment radiographers will explain the procedure to you and answer any questions you may have.
Before each treatment session the radiographers will ask you to empty your bladder and use a micro-enema if you have been prescribed them. The radiographers will ask you to change into a hospital gown and remove all clothing from the waist down apart from your underwear.
The radiographers will position you on the treatment couch with specialised pillows under your head and legs and ensure you are in the correct position. The radiographers will place a modesty cover over your pelvic area and lower your underwear.
They will ensure you are in the correct treatment position by aligning the tattoo marks on your pelvis with laser lights.
They will then move the treatment machine and couch into position using your personal treatment plan. When final verbal checks have been made, the radiographers leave the room. To give you the best treatment you will be treated from several different angles. The treatment machine will move around you but will not touch you. You will not feel anything. All we ask is that you keep still. The radiographers will be watching you at all times on a closed-circuit television.
Each session takes approximately 15-20 minutes. Every day, the radiographers will need to take X-ray pictures to check you are in the correct position. Once your treatment has finished, the radiographers will come back in to the room and help you off the couch. You will then be free to get dressed and leave the department.
Although you will not feel anything during treatment, there will be some side effects which will gradually start during your radiotherapy or shortly after completing radiotherapy and usually resolve within two to three months of finishing radiotherapy. These effects will vary from patient to patient.
The risk and severity of side effects occurring will depend on the dose of radiotherapy given and the exact area which receives the radiotherapy. Your doctor will discuss the risks of treatment with you before you sign a consent form. However, there will still be plenty of opportunity to talk about anything that you feel needs further discussion.
Skin changes
The skin in the area being treated may gradually change colour. Your skin may gradually become pink /red or darker, depending on your skin colour. You may get some dry peeling of the skin in the treatment area, which may become itchy. You may notice the skin around your back passage or vulva becoming red and sore. During treatment, we advise that you wash using warm water and the soap products you would normally use. It is not advisable to sit and soak in a hot bath. Gently pat your skin dry with a soft towel. Gently press the towel around your pelvic area. Radiotherapy skin reactions cannot be prevented, but to minimise any skin irritation we recommend using a moisturiser of your choice.
Use the moisturiser frequently and gently smooth it on to your skin until it is absorbed. You do not need to wipe the moisturiser off before treatment, but please do not apply moisturiser immediately before treatment. If your skin becomes irritated or peels, stop using the moisturiser. You will be referred to the radiotherapy review team for appropriate skin care.
If you do not currently use a moisturiser, then speak with your radiotherapy team and they will be able to suggest some options for you.
Hair loss
Radiotherapy will cause hair loss in the treatment area, but this usually grows back several months after treatment has finished.
Bladder changes
You may find that you have to pass urine more often both day and night and have urinary urgency (having a sudden urge to pass urine). Try reducing your fluid intake a few hours before going to bed. You may have a slower flow compared to normal. You may have a burning sensation when you do pass urine. This is called radiation cystitis and is caused by the radiotherapy inflaming a small area of your bladder. If you experience a burning sensation, please inform the radiographers or radiotherapy review team. They will ask you to produce a urine sample to check that it is radiation cystitis and not an infection. It may help if you drink plenty of fluids. Drinks such as cranberry juice have been found to help, whilst drinks such as tea and coffee can make the bladder worse. Experiment for yourself and see what works for you. Reducing drinks that may irritate the bladder such as fizzy drinks, alcohol, and drinks containing caffeine (tea, coffee and cola) may also help.
In the unlikely event that you are unable to pass urine, also called urinary retention, you should seek urgent medical attention. You should attend your local emergency department. You may require a urinary catheter to be fitted. If you notice an increase in blood in the urine, seek medical attention immediately.
Bowel changes
About three to four weeks into treatment you may experience some discomfort and pain on opening your bowels. This is called proctitis. Very occasionally, this may be associated with a feeling of wanting to strain (whether or not you actually need to pass a bowel movement). This is called tenesmus.
There may be some blood and mucus (slime) in your stools. Inform the radiographers or nurses if you experience such a problem as medication can be given. You may also experience abdominal pains or colicky or wind pains. Your stools may become loose as you progress through treatment. This may lead to diarrhoea. We advise that you continue to eat a normal diet and try to drink plenty of fluids (at least eight glasses or one to two litres per day).
If the diarrhoea becomes persistent, please inform a member of staff as soon as possible as medication can be prescribed. If you have piles (haemorrhoids) or have had these treated in the past, they may get worse during treatment. Please inform a member of staff as your doctor can prescribe medication to help.
Tiredness
Tiredness is a very common side effect of radiotherapy. You may feel more tired than usual and have less energy, both during and after treatment. Do not worry, this is normal. It is usually a combination of travelling to hospital every day, the side effects of treatment, coping with a diagnosis of a tumour and continuing with normal life.
We recommend that you listen to your body. Do as much as you feel you can and rest when you need to. However, gentle exercise has been found to improve fatigue levels in patients and we would recommend walking as a good form of exercise. Please tell us if you are finding things difficult, as we will be able to offer practical advice and information.
Appetite
It is important that you try to eat a healthy balanced diet during radiotherapy to help you feel stronger and more able to cope with treatment. It is also important to drink plenty of fluids, up to two litres a day. This can include water, squash or hot drinks.
Sexual activity and contraception
You can continue to be sexually active while you are having radiotherapy. However, the side effects of radiotherapy can cause temporary discomfort in the pelvic area. You may find that intercourse is uncomfortable, or you have no desire for sex. If so, try to talk to your partner and explain how you feel.
If you are sexually active and conception is a possibility, it is important to use contraception while you are having radiotherapy. It is very important that you should not be or become pregnant at any time throughout your course of radiotherapy and for up to four months afterwards. You should avoid getting pregnant while receiving radiotherapy, as radiation is harmful to the unborn child. If you are unsure of this issue or if you think you may be pregnant at any time during your treatment, it is extremely important that you discuss this with your radiotherapy doctor, the radiographers or radiotherapy review team immediately.
At your first treatment appointment the radiographers will discuss the treatment with you and explain any possible side effects you may experience. They will see you every day and ask how you are and how you are feeling.
During treatment you will be assessed on a weekly basis by your specialist nurse who will monitor your side effects and review your progress.
Late side effects incurred during treatment can appear to develop months or years after radiotherapy has finished.
They are the hardest to predict accurately and, unfortunately, when they do occur, they are usually permanent. Your doctor will not be able to tell you before you are treated whether any of the long-term side effects will happen to you. The frequencies are approximate. The effects may include:
Bowel changes
Between 10%-20% per cent of people notice permanent changes in their bowel habits. This is often looser, urgent or more frequent motions than they were before treatment. Sometimes medication may be needed to regulate your bowel on a longer-term basis. It is quite common to experience a straining feeling (proctitis).
Very rarely (less than 1%) scar tissue may develop which can affect the bowel and add to the problems of diarrhoea. Very occasionally, however, after surgery and radiotherapy the tissue surrounding the bowel can stick together (adhesions) causing a blockage, and this can sometimes require further surgery to correct. This is a very rare problem, but please do speak to your doctor if you are worried.
Difficulty passing urine
Some patients find that they have to pass urine more frequently than before radiotherapy (10%-50% of patients). Very rarely (less than 10%) some experience difficulty passing urine. This is because the treatment causes a narrowing of the tube, also called the urethra, which takes urine from the bladder. This is called a stricture.
In extreme cases you may not be able to pass urine at all. This can be treated by stretching the stricture under an anaesthetic. It is important to inform your doctor if you experience difficulty passing urine.
Very rarely (less than 1%) some patients may experience leakage of urine (urinary incontinence) after radiotherapy, and in the majority of cases this improves over time. If you are worried about this, please discuss it with your doctor. They will be able to refer you to a continence advisor at the hospital or in the community.
Bleeding
About a year after the treatment is complete small blood vessels can occasionally form within the rectum and bladder. These vessels are more delicate than normal and can break down producing minor bleeding in the bowel motion, or urine. This is not usually serious. However, if you notice any bleeding it is important to let your GP, specialist nurse or specialist doctor know as they may wish to arrange further tests.
Female sexual function
Radiotherapy to the bladder is likely to cause permanent infertility and may bring on an early menopause in pre-menopausal women. These symptoms may develop soon after completion of treatment. If the symptoms of the menopause affect you, discuss this with your medical team.
Radiotherapy can affect the cells that produce the natural lubricant in your vagina. And you may experience vaginal dryness. This can make sexual intercourse uncomfortable. This can be helped by using a vaginal moisturiser and/or lubricant.
Radiotherapy can affect the muscles of the vagina. They can become stiff and not stretch as well as they previously would have, and so the vagina feels smaller and tighter. This may lead to discomfort during intercourse. If your doctor thinks you may be at risk of this, you will be referred to your specialist nurse who can offer advice about vaginal dilation. Please ask if you have any questions or concerns.
Male sexual function
Radiotherapy can damage the nerves that control getting an erection, and it can take up to two years after your radiotherapy treatment for the damage to appear. About four out of ten men treated with radiotherapy find that their potency (ability to get an erection) declines after treatment. The risk increases further still if you had any potency difficulties prior to treatment. There may also be changes and a reduction in ejaculate.
Sexuality
Continuing to have an active sex life during and after radiotherapy to the bladder can be difficult for both you and your partner. You may lose interest or have less confidence, or it may be that there are other things going on in your life which you feel are more important. Talk to your partner to help share your feelings and work through this time together.
You may find it difficult and embarrassing to talk about sexual issues. Please do not hesitate to ask for help as you can be referred to specialist services to discuss treatment options.
Second malignancy
The use of radiotherapy does carry a small risk of inducing a new different cancer in the treated area. This is something that may happen many years later, but it is a very small risk for most patients- less than 1%.
This page deals with the physical aspects of your treatment, but your emotional wellbeing and that of your family is just as important. Having treatment can be deeply distressing for some patients.
Within the radiotherapy department there will be access and support from your consultant radiographer, specialist nurse, the radiotherapy review team, the Macmillan radiotherapy information and support team and the treatment radiographers. However, if you feel you require further medical or emotional support you can be referred to a variety of health professionals who can help with any worries or difficulties you may be having.
Toilet cards are available, which may make it easier to access toilets in places where there are no public toilets. These are available from Macmillan Cancer Support, but we do keep a stock in the department. Please ask a member of staff if you would like one.
The bladder cancer support group provides a safe space to talk to others, share experiences or simply listen. The group is facilitated by a support and information specialist and a clinical nurse specialist. The group meets on the 3rd Tuesday of each month, from 2pm to 4pm. You can join either in person, at the Macmillan Support and Information Service, or online (on Zoom).
For more information or to book your place:
- call 020 3447 3816
- email uclh.supportandinformation@nhs.net (please include your full name, hospital number and the group you'd like to join in your email)
- visit the Macmillan Support and Information Service, on the ground floor of the Macmillan Cancer Centre.
All staff are here to make sure your treatment goes as smoothly as possible and to support you through this difficult period. We will try to help you with any questions or problems you may have.
The side effects you are experiencing will continue after treatment has finished. It is common to experience a worsening of the skin reactions for about 10-14 days after radiotherapy. You will be reviewed by your medical team 4-6 weeks after completing your radiotherapy. This may be a telephone or face-to-face appointment.
Face-to-face appointments will be held in the UCLH Macmillan Cancer Centre. Please feel free to contact the radiotherapy department, or your specialist nurse if you are worried about your treatment side effects
My Uro-oncology clinical nurse specialist (CNS) is:
t: 020 3447 7151
For advice about treatment side effects
Radiotherapy review team (via radiotherapy reception)
t: 020 3447 3700/01
For any other question about your condition
Uro-oncology CNS team
e: uclh.
For information about appointments
Radiotherapy reception
t: 020 3447 3700/ 020 3447 3701
For information, support, or any other queries
Macmillan support and information team
t: 07816 096619
e: uclh.
Out of hours oncology advice number (available 24 hours)
t: 07947 959020
If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
t: 020 3447 3042
w: www.
Action Bladder Cancer UK
t: 0300 302 0085
e: info
w: www.
Fight Bladder Cancer
t: 01844 351621
e: info
w: www.
Continence Foundation
e: info
w: www.
Maggie’s (Providing cancer information and support in centres across the UK and online)
w: maggies.org
Live Though This (cancer support for LGBTIQ+ community)
w: www.
Shine Cancer Support (cancer support for adults in their 20s, 30s and 40s)
t: 07804 479413
e: hi@shinecancersupport.org
w: shinecancersupport.org
Trekstock (for young adults in their 20s and 30s with cancer)
t: 020 4541 7601
e: hello
w: www.
Life After Cancer
w: www.
Macmillan Cancer Support
t: 0808 808 0000
e: cancerline
w: www.
Cancer Research UK
t: 0808 800 4040
w: www.
Carers UK
t: 0808 808 7777
e: adviceline
w: www.
NHS Choices
w: www.
UCLH cannot accept responsibility for information provided by other organisations.
Page last updated: 14 October 2024
Review due: 30 September 2025