Bowel Problems After Radiotherapy For Prostate Cancer

Coping And Support For You And Your Family

Coping with the side effects of prostate cancer radiotherapy can be difficult. There are things you can do, and people who can help you and your family to cope.

• Prostate cancer: diagnosis and managementNational Institute for Health and Care Excellence , 2019. Last updated December 2021

• Long-term urinary adverse effects of pelvic radiotherapy.P Elliott, B Malaeb.World Journal of Urology, 2011. Volume 29, Pages 35-41

• Secondary malignancies following radiotherapy for prostate cancerPetros and others

How To Manage Fatigue

Many men feel exceptionally tired and forgetful during prostate cancer treatment. Its important to give yourself plenty of time to rest, but it can also be helpful to stay as active as possible. A counselor or social worker can provide you with tips for dealing with mental exhaustion and depression, which can compound the effects of physical fatigue if left unaddressed.

Disabled Toilets And Emergency Access

As some shops, restaurants and leisure venues reopen after COVID-19 restrictions are lifted, its worth remembering that many of these will have customer toilets available.

There are a number of toilet cards you can apply for. The cards discreetly explain that you have a medical condition that means you need to use the toilet urgently. You can order a free toilet card from:

• Bladder & Bowel Community >

You can also buy a Radar Key from Disability Rights UK. This master key is part of the National Key Scheme . It gives you access to more than 9,000 locked disabled toilets around the country, including in shopping centres, department stores, pubs and cafes.

Changing Places also have a list of accessible toilets and rooms that can be used if you need a more private space. Some of them are free to access and some of them need a Radar Key. You can search for your nearest Changing Places toilet to find out more about it.

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Proton Beam Radiation Therapy

Proton beam therapy focuses beams of protons instead of x-rays on the cancer. Unlike x-rays, which release energy both before and after they hit their target, protons cause little damage to tissues they pass through and release their energy only after traveling a certain distance. This means that proton beam radiation can, in theory, deliver more radiation to the prostate while doing less damage to nearby normal tissues. Proton beam radiation can be aimed with techniques similar to 3D-CRT and IMRT.

Although in theory proton beam therapy might be more effective than using x-rays, so far studies have not shown if this is true. Right now, proton beam therapy is not widely available. The machines needed to make protons are very expensive, and they arent available in many centers in the United States. Proton beam radiation might not be covered by all insurance companies at this time.

When Is Radiation Therapy Used

There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:

• As the first treatment of cancer, which is still confined to the prostate gland.
• It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
• After the reoccurrence of cancer in the area, it was before surgery.
• To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.

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Urethral Stricture As A Side Effect Of Radiation For Prostate Cancer

After radiation therapy to treat prostate cancer with external beam radiation including proton beam therapy and/or radioactive seed implants, the most common location of a urethral stricture is the membranous urethra. This is the part of the urethra just under the prostate and the urethra in this area is surrounded by a muscle called the external urethral sphincter, which is one of the sources of continence. An illustration of the urethra showing the location of this part of the urethra is found here.

When patients are referred to the Center for Reconstructive Urology with blockage of urine flow after treatment for prostate cancer, they often are not clearly aware of their specific diagnosis with regard to the urethral stricture location and stricture length, even if they underwent prior treatment . If they only had a cystoscopy it is not possible to know the length of the stricture. If imaging was performed and that imaging did not include both a film during injection of contrast and during voiding , there cant be a definitive diagnosis.

We evaluate the urethra using both cystoscopy and high definition accurate urethral imaging to first determine the exact stricture length and location. This comes before a discussion of all options .

With the gentle injection of X-ray contrast to fill the bladder , we can then obtain a film during urination called a voiding cystourethrogram

Symptoms Of Bowel Changes

The most common bowel symptoms caused by pelvic radiotherapy include:

• needing to poo more often
• needing to poo urgently or in a rush
• loose or runny poo
• finding it hard to poo
• bowel or stomach cramps, bloating or pain
• leaking from your bottom or having accidents where you cannot control your bowels
• bleeding from your bottom
• feeling that your bowels havent been completely emptied
• feeling gassy or passing a lot of wind.

This list doesnt cover every possible bowel symptom. If you have a symptom that isnt on this list, it is still important to speak with your healthcare professional about it.

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What Should Patients Know About Msks Approach To Treating Prostate Cancer

At MSK, we manage prostate cancer in a very comprehensive way, tailored to each patients disease and to the individual person. There is no one specific therapy that is best for everyone.

Our initial assessment includes a carefully evaluated biopsy and a very detailed MRI to show the location of the disease, the integrity or soundness of the capsule surrounding the prostate, and the amount of disease. Then, based on that information and with input from the urologist, the radiation oncologist, and the medical oncologist we can provide a comprehensive recommendation.

The radiotherapy we do here at MSK is state-of-the-art and unparalleled. We are the only center in the world to do MRI-based treatment planning. When we give brachytherapy, we use computer software that provides us with real-time information about the quality and accuracy of the seed implant during the procedure. This allows us to make adjustments while the patient is still under anesthesia, so that when the procedure is completed, we have been able to achieve ideal placement of the radiation seeds. This translates into improved outcomes.

For more advanced disease, we have ongoing studies in which we combine novel hormonal therapy agents with radiation to achieve better results. Even the way we follow our patients after treatment is unique, with carefully sequenced MRI checks that give us opportunities to monitor patients extremely closely.

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Getting Support For Bowel Changes

We understand that bowel changes can impact the practical side of your day-to-day life, as well as your emotional wellbeing and confidence. It can feel like a big step to talk to a healthcare professionals about any symptoms you have, but its important that you get support based on your individual situation.

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 whats going on.

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Why Are There Marks On My Skin

Your radiation therapist will make small marks resembling freckles on your skin along the treatment area. These marks provide targets for the treatment and are a semi-permanent outline of your treatment area.

Donât try to wash these marks off or retouch them if they fade. The therapist will re-mark the treatment area when necessary.

Radiation Effects On The Bowel

A study from Texas published in the June 2006 issue of the journal, Cancer, shows that lower gastrointestinal toxicity after radiation therapy for prostate cancer continues for at least five years and may be more common than previously reported.

External beam radiation, which targets higher doses of radiation at the tumour site while minimizing damage to healthy adjacent tissues, is an effective therapy for prostate cancer. However, this treatment can affect the nearby rectum, sigmoid colon, and bowel. The most common toxicity is rectosigmoid radiation proctitis, which often manifests as rectal bleeding or hemorrhaging. Studies have shown that higher doses of radiation may improve survival but at the cost of increased lower GI toxicity.

Researchers in Texas gathered information through the Surveillance, Epidemiology, and End Results Medicare database, which houses medical information on the American population. The study gathered information on 57,955 men, aged 66 or older diagnosed with localized or regional stage prostate cancer, from 1992 to 1999. They included those who had undergone external beam radiation , surgery , or neither treatment .

First published in the Inside Tract® newsletter issue 157 September/October 2006

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Bowel Changes After Pelvic Radiotherapy

Bowel changes caused by pelvic radiotherapy can show as a variety of symptoms. These may be uncomfortable and inconvenient, or even painful and distressing.

We hope the information on this page helps explain why you might have bowel symptoms and how to manage them. We are also here if you need some extra support or arent sure where to start.

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.

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What Is Radiation Recall

Radiation recall is a rash that looks like a severe sunburn. It is rare and happens when certain types of chemotherapy are given during or soon after external-beam radiation therapy.

The rash appears on the part of the body that received radiation. Symptoms may include redness, tenderness, swelling, wet sores, and peeling skin.

Typically, these side effects start within days or weeks of radiation therapy. But they can also appear months or years later. Doctors treat radiation recall with medications called corticosteroids. Rarely, it may be necessary to wait until the skin heals before continuing chemotherapy.

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Talking About Bowel Problems With Your Doctor

Bowel problems can be embarrassing and life changing. Because of this, its common for men to avoid talking about these struggles with their healthcare team or partners. By not talking about these issues, feelings of fear or inadequacy may build up and cause significant mental, emotional, or physical complications.

For this reason, it is critical to talk with your doctor about potential treatment options that may be right for you, or for specific tips on how to manage what is going on. How much you share about your bowel struggles is completely up to you, however, enlisting the support of an intimate partner, spouse, or close confidant may help ease the burden and set expectations or plans to be followed in the event that you need help managing your bowel struggles outside of your home.

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Bowel And Bladder Problems

Treatments for prostate cancer such as surgery, external radiotherapy and brachytherapy may cause damage or inflammation to organs near the prostate such as the bowels and the bladder. Men we interviewed described episodes of bleeding from the back passage, diarrhoea, constipation and damage to the bowel after radiotherapy.

How To Cope With Digestive Issues

Chemotherapy and radiation therapy can both cause nausea, vomiting and diarrhea. There are several medications, however, that can prevent and alleviate these digestive concerns. Additionally, making certain dietary changes can help ensure that you get the nutrients you need when dealing with digestive issues.

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Talk To Your Doctor Nurseor Care Team

If your bowel issues are bothering you and preventing you from doing your usual daily activities, speak to your doctor. This could be your family doctor, or doctor thatâs been treating the cancer . Your doctor may prescribe medications to help with either constipation or diarrhea. You can also speak with a nurse about getting help.

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Excluding Other Causes Of Gi Symptoms After Cancer Treatment

Different pathological processes can produce identical symptoms, for example diarrhoea has at least 13 different mechanisms.13 As demonstrated in the above case studies, GI symptoms after cancer treatment are complex and within a specialist setting, less frequently occurring diagnoses are made more commonly. However, other causes of GI symptoms and factors unrelated to cancer treatment, such as the psychological effect of a cancer diagnosis and its treatment, changes in diet, new GI disease or pre-existing underlying conditions, may also result in GI symptoms.79

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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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An Approach To Nausea And Vomiting

Chronic nausea and vomiting are not uncommon in the general population and a careful history and examination are required to eliminate common medical causes. In the cancer patient, disease recurrence must be considered. Small bowel bacterial overgrowth, gastric bile reflux or acid reflux are frequent benign causes of nausea, vomiting and retching after cancer treatment.13 Metabolic causes such as hyperglycaemia, hypercalcaemia, renal impairment, and Addisons disease need to be excluded. Gastroparesis and slow upper GI transit can exacerbate symptoms. Oesophageal motility disorders such as diffuse oesophageal spasm or ineffective motility can develop. Oesophageal strictures are another important cause.12

After oesophagectomy with gastric tube reconstruction, symptoms of reflux and nausea are often accompanied by early satiety, absence of hunger, inhibited passage of food due to high viscosity and impaired gastric emptying and postprandial dumping.4748 The surgical procedure itself can still influence nutritional aspects and lead to altered stool frequency for prolonged periods after surgery, so patients frequently struggle to maintain their body weight.48

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The Initial Causes Bowel Problems After Radiotherapy For Prostate Cancer

One of the first symptoms of prostate issues is pain or tenderness in the groin or lower back. This can be the result of a noncancerous condition called enlarged prostatic tissue, or it could be an infection of the bladder. In either case, its important to see a doctor as soon as possible. If youre suffering from prostate pain, you may want to consider reducing your caffeine intake.

Another symptom of a potentially enlarged prostate is difficulty starting a stream of urine, leaking, or dribbling. These symptoms are not serious, but theyre still alarming. Most men put up with an enlarged prostate for years before seeking medical attention, but they typically seek treatment as soon as they notice symptoms. Even if you dont have symptoms, its worth getting checked to determine if you have any prostate issues.

If you experience nightly bathroom runs, you may be experiencing an enlarged prostate. You may be having difficulty starting a stream of urine, or you may even be dribbling or leaking during the day. These problems arent life-threatening, but can become a nuisance. You should not ignore these signs and seek treatment as soon as you notice them. If you feel any of these symptoms, you should consult a doctor.

How Can I Reduce Skin Reactions

• Gently cleanse the treated area using lukewarm water and a mild soap such as Ivory, Dove, Neutrogena, Basis, Castile, or Aveeno Oatmeal Soap. Donât rub. Pat your skin dry with a soft towel or use a hair dryer on a cool setting.
• Try not to scratch or rub the treated area.
• Donât put any ointment, cream, lotion, or powder on the treated area unless your radiation oncologist or nurse has prescribed it.
• Donât wear tight-fitting clothing or clothes made from harsh fabrics like wool or corduroy. These fabrics can irritate the skin. Instead, choose clothes made from natural fibers like cotton.
• Donât apply medical tape or bandages to the treated area.
• Donât expose the treated area to extreme heat or cold. Avoid using an electric heating pad, hot water bottle, or ice pack.
• Donât expose the treated area to direct sunlight. That could intensify your skin reaction and lead to a severe sunburn. Choose a sunscreen of SPF 30 or higher. Protect the treated area from direct sunlight even after your course of treatment is over.

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