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Rectal Bleeding after IMRT (Intensity Modified Radiation Therapy)

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Posted 6/8/2014 2:36 AM (GMT 0)
I am a new member and am hoping to learn of about other guys' experience with treatments for blood in the stool after radiation (IMRT) for prostate cancer.

The blood in my stools started approximately one year after completing 9 weeks of IMRT radiation. The treatments being discussed are 1) steroid suppositories and 2) Argon Plasma Coagulation (APC).

Does anyone have experience with these treatments?

Thanks,
Ballamerguy
Posted 6/8/2014 3:06 AM (GMT 0)
Welcome to HW, sorry you need to be talking to us.

How much bleeding are we talking about? A couple of drops in the toilet looks scary but it isn't that big of a deal. Have they done a sigmodoscopy to see what is bleeding?

I had internal hemorrhoids prior to RT and the radiation made them slight worse. In my case the bleeding is part of an anal fissure and the hemorrhoids. I've been doing the normal hemorrhoid home treatment routine to avoid needing the laser or other surgery which I am told is a little more complicated after radiation (possible but they need to be a bit more careful).

I've used the suppositories and they work but you shouldn't use them for more than a week or two as they will cause other problems. Other things they had me do is a sitz bath one to twice a day to help the fissure heal. Also I tend to be constipated which just tears things up worse so I now take a day stool softener and eat lots of fiber.

My doctors haven't wanted to the APC thing on me so I don't know anything about that.
Andrew
Posted 6/8/2014 3:13 AM (GMT 0)
My rectal bleeding started about 15 months after radiation and has continued for over a year. I tried the suppositories with steroids, Carafate enemas and bulk laxatives. Nothing really has worked. I have no pain and the bleeding does not effect my hemoglobin or hematocrit. My radiologist and gastroenterologist do not recommend the Argon treatment as of yet. They both believe that minor bleeding (Grade I) is best left untreated and eventually will go away.

Thanks
paul
Posted 6/8/2014 3:52 AM (GMT 0)
I've had hemorrhoids for years, and like Andrew, they were aggravated by the radiation. Sometimes there was a little bright red blood. (If the blood is dark and tarry, you may have more serious, unrelated problems.) I found a proctologist who injects phenol into them (it's an anesthetic - very soothing) and that clears them right up. Flare-ups can happen at any time. I see him about twice a year, and have had no further problems. I did see a gastroenterologist who wanted to use a green light laser or argon plasma, but I think he was just trying to make money.
Posted 6/8/2014 6:22 AM (GMT 0)
Hopefully, your rectal bleeding will partially resolve itself. A year after my imrt I had a colonscopy which broke my radiation proctitis open. My pants were soaked when I got out of the car after a 70 mile trip. My wife wanted to drive me to ER but I declined since I would have laughed at an internist trying to place a bandaid on the source of the bleeding. It decreased over the weekend and my RO recommended hyperbaric oxygen therapy but I declined due to the distance involved and the time for the therapy. If the truth be known I was a skeptic. A year later I had another colonscopy due to a questionable polyp found on the previous one. The gastroenterologist offered to cauterize the problem but I declined. This is probably the argon or apc treatment discussed.
looking at the report and slides the proctitis was too widespread to be treated; just my opinion.
Anyway, the bleeding is manageable and decreasing.
Good luck and don't freak out.
Bill: idea
Posted 6/8/2014 3:19 PM (GMT 0)
Guys
I'm having 38 sessions of SRT by IMRT/ IGRT at 68.2 GY to prostate bed after RP as a result of biochemical recurrence. Does SRT at lower strength have similar SEs as you describe?
Thanks.
Bob
Posted 6/8/2014 4:16 PM (GMT 0)
Yes it does, Bob, but everyone reacts differently. Most guys have very minor irritative symptoms that pass quickly, but others have extreme sensitivity. Radiation on top of surgery generally has worse urinary SEs, and radiation with ADT on top of surgery has worse sexual SEs. Most SEs can be managed/prevented to some extent with medications like alpha-blockers, ED drugs and mesalamine.

- Allen
Posted 6/10/2014 8:42 PM (GMT 0)
Hey guys!

I want to thank everyone for their opinions and advice. I saw my gastroenterologist yesterday and he has advised me to just watch and wait on the bleeding in the stool issue. For the last couple of days, I have had no blood in my stool. His take on the situation is that, if the bleeding returns on a regular basis, he would do a sigmoidoscopy and cauterize to stop the bleeding. In his opinion the steroid suppositories just don't work.

Thanks again,

Ballamerguy
Posted 6/11/2014 12:23 AM (GMT 0)
Long term use of steroid suppositories can make it worse because the steroid tears down tissue eventually. Mesalamine won't do that.
Posted 6/11/2014 6:10 PM (GMT 0)
My PCP and gastro have told me that the suppositories are good for hemorrhoids but not for bleeding. Also have been told to use them no more than one week in a month and only for really bad days. Generally, I find I get a flare up once every four to five months.

Sounds to me like your gastro know his business.

Andrew
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