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Bowel Problems After Prostate Radiation

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What Are The Dangers Of Radiotherapy Prostate Cancer Treatment

Radiation Therapy Side Effects for Prostate Cancer Patients

Radiotherapy is considered effective for treatment of cancer with a success rate of above 90%. But is it safe for prostate cancer treatment? Does it cause any side effects? And if yes, are radiation therapy side effects reversible?

Well, radio frequency is pain-free and considered safe for prostate cancer treatment. To help you understand the safety of this procedure we shall look at both the short and long-term side effects resulting from this treatment.

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Will My Faecal Incontinence Get Better

There is no doubt that your poo related problems are having a significant impact on your life and mental strength. You may have noticed it negatively affecting your personal relationships, social life and desire to do the things you love. On top of this, much of your time getting out of the house will be spent with concern and meticulous planning around toilet visits. These factors can quickly take their toll on your quality of life and others around you, which makes it much more important to best prepare yourself and minimise its impact.

Unfortunately there is a degree of uncertainty regarding your ability to recover normal bowel control after radiotherapy due to the complexity of side effects and the reaction from each individual. With the research showing that symptoms can begin and persist long after treatment, it can seem like a doom and gloom scenario. Despite the scary statistics, you need to take a position of strength and control the things you can to combat faecal incontinence. Fortunately, the positives are that radiotherapy techniques are becoming more effective at treating the cancer and reducing its side effects.

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Why People With Cancer Receive Radiation Therapy

Radiation therapy is used to treat cancer and ease cancer symptoms.

When used to treat cancer, radiation therapy can cure cancer, prevent it from returning, or stop or slow its growth.

When treatments are used to ease symptoms, they are known as palliative treatments. External beam radiation may shrink tumors to treat pain and other problems caused by the tumor, such as trouble breathing or loss of bowel and bladder control. Pain from cancer that has spread to the bone can be treated with systemic radiation therapy drugs called radiopharmaceuticals.

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Bowel Dysfunction After Prostate Cancer Treatment

The broad term of bowel dysfunction includes:

  • Diarrhea or frequent stools

  • Fecal incontinence or the inability to control bowel movements

  • Rectal bleeding

All of these side effects are far more common following external beam radiotherapy than any other primary therapy, but as techniques and dose planning strategies improve, even these rates have been dropping.

How To Manage Bowel Changes

Figure 1 from Minimal Rectal Toxicity in the Setting of Comorbid Crohn ...
  • Ask your doctor about suitable medicines for diarrhoea. Take as directed.
  • Check with your treatment team before taking any over-the-counter or home remedies, as taking them with anti-diarrhoea medicines may cause unwanted effects.
  • Drink peppermint or chamomile tea to reduce abdominal or wind pain.
  • Eat or drink as well as you can to give your body the nutrients it needs.
  • Do some gentle exercise, such as walking, to encourage healthy bowel movements. Check with your doctor about the amount and type of exercise that is right for you.
  • Avoid alcohol and cut down on coffee, cola and other drinks that contain caffeine.
  • Drink plenty of clear liquids when you first notice symptoms of diarrhoea. This helps to avoid dehydration and replaces fluids lost through diarrhoea. Try apple juice, weak tea, clear broth, sports drinks and electrolyte-replacing fluids. It may also be worth trying a lactose-free milk.
  • Choose plain foods that are low in insoluble fibre . Talk to your dietitian about what else you can eat.
  • If you have diarrhoea, avoid high-fibre, fatty or fried foods pulses garlic and onion and rich sauces and gravies, as these can make diarrhoea worse.
  • Contact your treatment team immediately if there is blood in your bowel motions or if you have more than 56 bowel movements in 24 hours.

I had diarrhoea for a few weeks but it improved with medication.

Emma

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What Are Potential Side Effects

Typically, prostate-cancer patients tolerate radiation well.

During the first several weeks, side effects are minimal.

In the following weeks, you may begin to experience a few changes, including irritative urinary and bowel symptoms.

We manage those with changes to diet, or medication, says Dr. Yu. We have helpful clinical nutritionists who can help ease side effects related to treatment, and if a patient has severe side effects, its possible to suspend treatment for a week.

There is a small risk of a major medical problem, such as rectal bleeding, after radiation. In recent years, the precision of radiotherapy has helped to reduce such complications. Doctors track their patients regularly after treatment in order to catch any serious symptoms early.

Our urology group is also exploring focal salvage therapies that may be able to address residual cancer that returns after radiation treatment, says Dr. Yu.

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Bleeding From The Rectum

Bleeding from the back passage is common after pelvic radiotherapy.

Most people who have this side effect only notice bleeding occasionally. For a few people, bleeding can be heavy and needs treatment.

Even if you think you know the cause, always tell your doctor or specialist nurse if you have any bleeding from the back passage.

If you have a bowel control problem, you may have:

  • difficulty controlling when and how often you pass stools or wind
  • problems controlling your bowel, causing leakage or soiling , cramps, or bloating
  • diarrhoea or constipation
  • difficulty emptying your bowel completely.

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Outcome After Five Visits To The Clinic

  • Nausea resolved with promotility regimen and the use of intermittent sucralfate suspension.
  • Vomiting now infrequent
  • No retrosternal pain when eating
  • Early satiety managed with smaller, more frequent meals
  • Bowel frequency: 12×/day
  • Symptoms of early dumping only occurring when eating larger meal portions
  • Weight increasing

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Frequent Or Loose Poo

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Your bowel movements might be looser or more frequent than before your treatment.

You might need to take anti diarrhoea medicines, such as loperamide . Bulking agents, such as Fybogel might also help. Your doctor or nurse can prescribe these for you, talk to your doctor before taking these.

You might find that you need to avoid high fibre foods. Although we normally think that a high fibre diet is the most healthy, it might make long term diarrhoea worse. Some people find it best to avoid high fibre vegetables, beans and pulses .

Let your doctor know if you have ongoing problems with frequent bowel movements or bleeding. They can refer you to a specialist team. The team includes cancer doctors, digestive system specialists, bowel surgeons, dietitians and specialist nurses.

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Symptomatic treatment of an enlarged prostate usually involves a combination of medication and lifestyle changes. A diet rich in fruits and vegetables may be the best option if you suffer from chronic urination. It will help the body adjust to the increased size of the prostate. Also, taking regular urination intervals will help retrain the bladder to function properly. Inactivity also contributes to urine retention, and cold temperatures can increase the urge to urinate.

Invasive treatment of enlarged prostate includes medication that relieves the pressure on the urethra and bladder. However, if the condition is severe, it may require surgical intervention. If treatment is not successful, the enlarged prostate can become a potentially life-threatening disease. As the hormone levels in the body change, the enlarged prostate can lead to various complications, including urinary retention and even cancer. This is why it is critical to see a doctor for further evaluation.

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Low Dose Rate Brachytherapy Implants

The most common form of brachytherapy for prostate cancer, LDR involves surgically placing small radioactive pellets, about the size of a grain of rice, within the prostate. Once put in place, they remain there for life, but the radiation weakens over weeks or months, until it almost completely goes away.

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What Is Intermittent Adt

Researchers have investigated whether a technique called intermittent androgen deprivation can delay the development of hormone resistance. With intermittent androgen deprivation, hormone therapy is given in cycles with breaks between drug administrations, rather than continuously. An additional potential benefit of this approach is that the temporary break from the side effects of hormone therapy may improve a mans quality of life.

Randomized clinical trials have shown similar overall survival with continuous ADT or intermittent ADT among men with metastatic or recurrent prostate cancer, with a reduction in some side effects for intermittent ADT .

What Is A Side Effect Of Radiation To The Abdomen And Pelvis

External Beam Radiation Therapy for Prostate Cancer

The researchers used the PRO-CTCAE system to track the participants experiences with several potential side effects of radiation to the pelvic region, including pain in the abdomen, diarrhea, and fecal incontinence.

Can the prostate cause rectal bleeding?

What causes bleeding from the rectum after radiation?

Chronic rectal bleeding is one of the most common complications of radiation therapy for prostate cancer. The etiology of radiation proctitis is considered to be chronic mucosal ischemia caused by tissue fibrosis and obliterative endarteritis.

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How To Manage Urinary And Bowel Dysfunction

Its common to experience urinary dysfunction, bowel dysfunction or both after receiving radiation therapy to the prostate gland. Medication is usually the first treatment recommended for these issues, although there are also injections and surgical procedures that can be used to address these side effects should they persist.

External Beam Radiation Therapy

In EBRT, beams of radiation are focused on the prostate gland from a machine outside the body. This type of radiation can be used to try to cure earlier stage cancers, or to help relieve symptoms such as bone pain if the cancer has spread to a specific area of bone.

You will usually go for treatment 5 days a week in an outpatient center for at least several weeks, depending on why the radiation is being given. Each treatment is much like getting an x-ray. The radiation is stronger than that used for an x-ray, but the procedure typically is painless. Each treatment lasts only a few minutes, although the setup time getting you into place for treatment takes longer.

Newer EBRT techniques focus the radiation more precisely on the tumor. This lets doctors give higher doses of radiation to the tumor while reducing the radiation exposure to nearby healthy tissues.

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Treatment Options For Men With Urinary Symptoms After Radiation For Prostate Cancer

Many men benefit from medical treatment to help them with urinary symptoms during IMRT, CyberKnife, proton beam, or brachytherapy. These medications include alpha-blockers such as Flomax, alpha-reductase inhibitors such as finasteride or Proscar, and anticholinergic medications such as Detrol, or Vesicare.

When medical treatment does not provide sufficient benefit or of the symptoms persist, other treatment options offered at New York Urology Specialists include Urolift procedure, Rezum procedure, iTind for prostate, Greenlight laser of the prostate, Botox injections in the bladder, and TURP.

It should be noted that men with urinary symptoms after radiation therapy for prostate cancer should have a cystoscopy at a minimum to exclude urethral stricture disease and bladder tumors. Some men may also benefit from a urodynamic evaluation.

Did you know?Dr. Shteynshlyuger has performed over 1,000 surgeries and procedures for enlarged prostate, including Rezum, Urolift, prostate enucleation, laser ablation of the prostate, and TURP. He performs over 100 prostate procedures a year.

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Patient And Tumor Characteristics

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Two-hundred forty three patients were included in this study. Median follow-up was 20 months . Patient and tumor characteristics are presented in Table 1. Most patients were white with an ECOG 0 . Median age was 71 years . Median preradiation prostate-specific antigen was 6.1. There were 188 patients with cT1-2 cancers 230 patients had an MRI, with 27 revealing extraprostatic extension and 5 revealing seminal vesicle invasion.

Ten patients experienced rectal bleeding. All 10 were graded as CTCAE grade 2 and were considered late toxicities. Median time from end of radiotherapy to rectal bleeding toxicity was 8.8 months .

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Diarrhea Flatulence Or Painful Defecation

These symptoms usually occur after the second or third week of treatment. Symptoms will resolve after the treatment ends. During radiation, dietary modification usually helps reduce the frequency and severity of diarrhea. Try to avoid or reduce fried foods, greasy foods and highly spiced foods. Reduce foods with insoluble fiber, such as lettuce and cauliflower, and increase low-fiber and soluable-fiber foods, such as bananas, mashed potatoes, applesauce, white rice, canned or cooked fruits and vegetables.

Maintain your intake of lean proteins, such as turkey, chicken and fish, and increase your fluid intake to avoid dehydration. Using moist toilet paper, baby wipes or sitz baths may help relieve rectal irritation. Your doctor may recommend anti-diarrheal medications. Contact your doctor if you see blood in your stool, if the diarrhea worsens or if you become light-headed or dizzy.

Lower Rates Of Rectal Complications With Improved Brachytherapy Techniques

Rectal outcomes have improved as implantation and planning techniques have been optimized and as experience with brachytherapy has grown. Until the late 1980s, brachytherapy was performed with an open laparotomy approach. The second generation was developed using a transperineal approach under ultrasound guidance, as described and pioneered in the US by Blasko et al., Further generational improvements have emerged over the last decade with the use of ultrasound and computed tomography-based treatment planning systems and stranded seeds during implantation to improve seed placement and optimize dosimetry. This has led to a resurgence in the use of brachytherapy for localized prostate cancer, in which local control and biochemical outcomes are comparable to those observed with external-beam radiation therapy and radical prostatectomy., –

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What The Research Shows About Radiation Vs Surgery

The ProtecT trial was a 10-year, randomized clinical study designed to compare radical prostatectomy, external-beam radiotherapy and active surveillance for the treatment of localized prostate cancer.

The results, published in 2016, showed that the rate of disease progression among men assigned to radiotherapy or radical prostatectomy was less than half the rate among men assigned to active monitoring. However, there was no significant difference in survival at the median 10-year follow-up for radiation therapy, surgery or active surveillance.

If youre interested in directly comparing treatment outcomes by treatment method and risk group , the Prostate Cancer Free Foundation provides an interactive graph on its website with information from data obtained from over 129,000 prostate cancer patients over a 15-year period.

As discussed earlier in the sections on the side effects of radiation therapy and surgery, the researchers conducting the ProtecT trial also looked at side effects and quality-of-life issues and found that the three major side effects of these two treatment options that affect quality of life after prostate cancer treatment are urinary incontinence, sexual dysfunction and bowel health.

The trial found that urinary leakage and erectile dysfunction were more common after surgery than after radiation therapy. Gastrointestinal bowel problems were more common after radiation therapy.

What Are The Different Types Of Internal Radiation Therapy

Bowel Problems After Radiotherapy For Prostate Cancer ...

Brachytherapy and radiopharmaceuticals are both considered internal radiation therapies because they both work after being inserted inside the body, rather than being directed from outside. However, the similarities mostly end there. Brachytherapy works by implanting radioactive material into the prostate and is used for localized prostate cancer. Radiopharmaceuticals are injected into the bloodstream and are used for advanced, metastatic prostate cancer. Read on to find the details of each.

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Radiotherapy To The Prostate

Side effects during/soon after treatment

General Fatigue is quite common in the second half of treatment and is very variable between patients. It may be worse for men on both hormone therapy and radiation therapy. Fatigue can persist for a few weeks after treatment, but as for other early side effects, this has usually settled within 4-6 weeks after radiation therapy is completed.

Local All other side effects of radiation therapy come from the structures/organs in and just next to where the radiation is being targeted. For the prostate this means the bottom of the bladder, the urethra and the front part of the rectum . These can commonly cause the following side effects, which usually have fully settled by 4- 6 weeks after treatment is finished.

Bladder/urethra in weeks 3-4 of treatment it is common to start to get some or all of the following: increased frequency of urine, especially at night stinging or burning while passing urine a sense of not fully emptying the bladder a poorer stream than before. These symptoms are usually mild to moderate but can be worse if there were significant urinary problems before treatment.

Rectum Bowel motions may become more frequent in the second half of treatment or there may be a need to go more frequently or urgently to open the bowels. There may be some more mucous discharge, excess wind and/or discomfort on opening bowels. Diarrhoea is very uncommon.

What can help reduce side effects?

Side effects well after treatment

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