Overview

Intestinal disorders

Radiation used to treat prostate cancer can also irritate the rectal wall and cause inflammation of the intestines, strong cravings, diarrhea, blood in the stool, and fecal incontinence (loss of regular bowel control).

These effects are usually temporary, but in rare cases may be permanent. New imaging techniques and more precise radiotherapy methods have reduced the risk of these complications. Radial prostatectomies have a very low risk of rectal lesions.

Related symptoms

• Diarrhea
• Inflammation of the rectum and anus (proctitis)
• Pain
• Itching
• Spasms, cramps
• Hemorrhoids
• Occlusions or intestinal perforations (rare)

Bowel functions usually return to normal after treatment. However, some side effects, such as intestinal occlusion due to stenosis (narrowing caused by scar tissue or intestinal bleeding), can occur months or even years after radiation therapy. A medical assessment—checkups, exams, and blood tests—can also include the screening for colorectal cancer. The radiotherapy team can also suggest different ways to relieve diarrhea, itching, and hemorhoids.

Treatment options for rectal disorders

• Dietary changes
• Bowel retraining
• Anti‑inflammatory drugs, corticosteroids, or mediation to reduce spasms
• Treatments with argon laser
• Surgery, if the disorder is severe enough

Post‑radiation proctitis

What is proctitis?

Most men who undergo radiotherapy for prostate cancer develop proctitis. Proctitis is a condition caused by inflammation of the anus and rectal wall. Proctitis can cause alarming symptoms and discomfort almost immediately after starting radiation therapy or once treatments are completed.

Acute proctitis occurs within the first three months following radiotherapy, while chronic proctitis may last longer and symptoms may only occur several months (between 8 and 12 months on average) after treatment has stopped. Adequate treatment and measures can control symptoms in the majority of acute proctitis cases; however, treating chronic proctitis is more difficult.

Causes and risk factors

Proctitis associated with prostate cancer is attributable to radiation treatments to the pelvic region. During treatments, a high dose of radiation is focused on the area near the rectum that damages healthy tissues while also treating the cancer. Studies on external beam radiation have shown that incidences of proctitis vary greatly.

Clinical signs of rectal lesions caused by radiation can include diarrhea and tenesmus (the persistent need to empty the bowel or bladder, even if your bowels are empty). In addition to diarrhea and rectal pain, patients can also experience lasting complications like bleeding. Severe bleeding is linked to chronic changes in the rectal wall; blood vessels are fragile and in cases of minor lesions, can bleed easily.

Symptoms

Acute post­‑radiation proctitis is very common. For a small percentage of patients, the severity of symptoms necessitates an interruption of one’s treatment. Symptoms include:

• Need to empty the bowel or bladder
• Diarrhea
• Minor rectal bleeding
• Nausea
• Cramps

The majority of these symptoms will disappear within a few weeks of completing your radiation therapy. Five to ten percent of men undergoing radiotherapy develop chronic radiation proctitis. The symptoms compounded with the discomfort of chronic proctitis can have far greater consequences on the patient’s quality of life. In addition to those listed above, other symptoms include:

• Severe bleeding
• Fistulas
• Bowel obstructions
• Strictures
• Perforations

Treatment depends on the severity of symptoms

• In most cases, anti‑inflammatory tablets or suppositories are a good treatment for reducing inflammation and minimizing bleeding caused by proctitis.
• A stool softening laxative is also often recommended if the patient finds that his stool is hard or he is suffering from constipation. Both conditions increase the risk of painful defecation and irritation of the anus and rectum.
• Analgesics to relieve stomach or rectal pain and antidiarrhetics to control diarrhea may be recommended as needed.
• In some cases, small vessels can be burned with an argon laser or other more invasive treatments.

Change your diet

• Replace the loss of fluids by drinking plenty of water, juice, or clear broth to prevent dehydration in case of diarrhea.
• Avoid milk and dairy products. When the bowels are irradiated, it does not produce enough enzymes, particularly lactose. The body needs lactose to digest milk and dairy products. Ask your doctor if you can eat products containing lactose or use tablets or drops to help you digest it.
• A diet low in fat and fiber can help you control proctitis symptoms. Check out our Nutrition and healthy body section for more information.