Proctitis from RT

Hi JAW31,

First of all, I'm sorry to hear that you are experiencing Proctitis. I too, after a year out from 44 sessions of radiation, began rectal bleeding from proctitis. I went through the exams, including a colonoscopy, to rule out any major factors that could cause the rectal bleeding with a couple benign polyps being removed and an inflamed area in the rectum diagnosed as proctitis. The doctor prescribed a one month course of hydrocortisone suppositories, which seemed to help somewhat. After the hydrocortisone treatments, I would go 3-4 days without bleeding, then I would have a couple of days with blood in my stools. Some days were heavier than others. Last week, I had shoulder replacement surgery and the pain medication prescribed caused me to become constipated, as hard as tried to combat the constipation. Once the constipation dam broke, I had some significant bleeding. I have been working very hard at not consuming foods that can iritate the proctitis, such as raw vegetables, apples, nuts, corn etc. Keeping away from foods that iritate proctitis is difficult for me, because I live on a plant based diet. Also, I have been taking stool softeners. Anyway, this morning, I noticed that the bleeding has decreased significantly from 4 days ago. If by next week, the bleeding continues, I may give the doctor a call to see if there is some other medication that he can prescribe other than hydrocortisone. I have read that too much hydrocortisone can degrade the rectal tissue. I hope this information helps.

I wish you well and will answer any questions that you may have.

Ron (Boomer)

I had a combination of 25 IMRT fractions and two HDR brachytherapy procedures. Never had any proctitis and have had four colonoscopies by the same doc and each time he says no radiation damage. Reading, I find that 10-15% of radiation guys report bowel issues including proctitis over time.

As for Space Oar, I did not have it. My RO and urologist both said it really didn’t work and could cause complications. I understand it is seldom used anymore. In the last five years I have known at least a dozen men that have used RT for PCa and none had Space Oar and all have done fine with no treatment side effects.

So many of these complications are very specific to the individual and are based on genetics, the health and anatomy of the patient, and the delivery of the radiation. I don’t think any doctor can tell who will suffer from what side effects, thus they give is all the possibilities in our treatment counseling.

Jaw, it looks to me you are pursuing it well, especially with the colonoscopy. Have you visited with the RO to get their take based on their experience? Hope you get effective relief.

I too had proctitis. I had been bleeding two to three times a month for two years. It was always dark red whereas bleeding from hemorrhoids apparently is bright red.

After my first argon plasma coagulation treatment in Nov 2021, I had lots of pain each morning for about a month. Having 2 or 3 bm's each morning didn't help: the pain progressively got worse.

I wasn't prescribed anything so I resorted to OTC painkillers.

When the bleeding started again I called the doctor for another APC treatment. I made a point to tell him I suffered for weeks and felt that I made my case.

So when I went in for my second APC treatment in March 2022, the doctor stated there were 'no pain receptors' in the rectum however this time he did prescribe lidocaine.

Fortunately, I've had no further problems.

Once the proctitis was resolved my PSA started to fall. My PSA ranged from 0.66 to 0.59 a year before the APC. It is now 0.089. So, I'm wondering if inflammation immediately next to the prostate could have kept the PSA from falling.

The prior posts represent a good overview of what can happen after radiation. My experience is somewhere in the middle of those and don't shine any really new lights on the issue. Nevertheless, here is a summary:
As one can tell from my resume, a great many photons had visited my lower body. about a year later, I started to see blood in my stool. I wasn't too concerned because I had read that this was a not uncommon side effect of radiation therapy. The radiation oncologist who had treated me told me that the bleeding would probably go away given some time, and if that didn't happen to call again. I waited about a month, but the (relatively) mild bleeding hadn't stopped. I called again and the same rad oncologist arranged an appointment for a colonoscopy. The outcome of the latter wasn't surprising; I believe that about two 'wounds' were seen that were treated with the argon plasma coagulation instrument. Afterwards, the colonoscopy specialist told me that I might need more treatments in the future. But much to my luck, this turned out not to be necessary.

Post Edited (Sr Sailor) : 1/10/2024 8:23:04 AM (GMT-8)

Another gastro?

Seriously, if the one you are seeing cannot help, there is no harm done to seek a second opinion.

Also, your symptoms seem quite a bit broader than "just" proctitis. Proctitis, if I remember correctly, refers purely to internal difficulties. Your lower back, upper thigh and possibly even scrotal inflammation sounds like an "external" irritation, which would not be considered proctitis.

Could also be worth a talk with your radiation oncologist, who might know which specialists to see for each symptom set.

A little over two years ago I completed my RA treatment. Space OAR was used. I had a couple of weeks of urgency on the toilet with no blood in the stool. Currently there are still no issues with bleeding or stool issues. Keeping my fingers crossed that nothing changes. I have also read of complications using Space OAR as a block from RA reaching the rectum. However, it is FDA approved and my RO says that the negative effects are an outlier compared to the positive results. I feel for those of you that have had serious SEs from your RA treatments.
My best to all.
Jack

Healthy diet here - lots of fresh vegetables, whole grains, dairy, nuts and fruit, lots of variety. Coffee, mint tea, moderate alcohol and 86% chocolate. Like vomiting, constipation is disallowed here so lots of natural fiber - salads & steamed vegetables. I cook everything from scratch - very low salt no sugar or prepared stuff, minimal meats.

Vaped (Storz & Bickel Mighty+ vape) cannabis (completely legal here) for nausea and/or pain.

Unless you have cardiac issues and your heart doctor tells you to take baby aspirin, eliminate preventive baby aspirin, which can cause some internal bleeding. When my husband stopped taking baby aspirin, his rectal bleeding presumably due to radiation years before, pretty much went away.

https://www.uclahealth.org/news/daily-aspirin-no-longer-recommended-to-prevent-heart-disease#:~:text=A%20panel%20of%20disease%2Dprevention,a%20shift%20from%20earlier%20guidance.

Thanks for those two posts (spouse21 and Boomer). I now recall that when I had the (blood in stool) issue, my rad oncologist inquired about my use of aspirin. That was about ten years ago, and I had forgotten all about it.😒

Post Edited (Sr Sailor) : 4/1/2024 9:44:35 AM (GMT-8)

Glad I had Spaceoar before SBRT
I did however develop urinary stricture.
I guess it can't be protected from radiation since the beam kinda goes right through.
Dilation 11 months ago and holding up.
Good luck

Glen

I mainly deal with constipation and hemorrhoids which got worse after treatments.

There is a subset in the GI world of colon and rectal surgery doctors (formally know as proctologist) that might have more insight than the average GI doctor. I am sure Stanford has them.