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Post SBRT Hemorrhoid Flare-Up Help

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Posted 4/10/2018 5:57 PM (GMT 0)
about the only short term SE I am dealing with post SBRT is a bout of constipation followed by consequent aggravation of hemorrhoids I had before treatment. It got quite painful and I took a saline laxative to clean things out and get things moving. RO wants me to use Miralax and Senokok daily to keep everything smooth while they recover. I suspect I was wasn't too good about my liquid and fiber intake during treatment. Using OTC hemorrhoid products (hydrocortisone and Prep-H) but not looking forward to future trips to the toilet until they are really healed.

Has anyone else gone through this after RT? Any advice on managing it?
Posted 4/10/2018 6:04 PM (GMT 0)
I had some hemorrhoids. I got them from straining. There's a phenomenon called "tenesmus" that arises from radiation proctitis. It is a feeling of incomplete emptying. Inflammation of bowel tissue is sensed by the brain as if something is still in there. Anusol with hydrocortisone or mesalamine can reduce the inflammation. Probiotics can help things flow better. I went to a proctologist for the remaining hemorrhoids. He injected them with phenol, which is anesthetic and very soothing. That dried them up within a couple of days.
Posted 4/10/2018 6:48 PM (GMT 0)
Miralax, hydrocortisone suppositories 2x a day, sitz baths, and lots of water worked for me. I referred to it as, "The Terror of the Toilet." Salty or sugary foods as they tend to dry you out, avoid them.

Call the doc and get the prescription strength suppositories, they work much better.

I did end up with a bit of radiation proctitis and had to get a colonoscopy with a bit of laser treatment to clear it up. Likely, it will just clear up on it's own in a couple of weeks.

Andrew
Posted 4/10/2018 9:16 PM (GMT 0)
TA - I read a little about tenesmus and it sure sounds similar to what I am experiencing. The literature suggests that radiation proctitis after SRBT peaks at about one week following treatment and begins to subside after that and return to baseline by 3 months. Is that about what you experienced?
Posted 4/10/2018 11:42 PM (GMT 0)

T.S. Eliot said...
TA - I read a little about tenesmus and it sure sounds similar to what I am experiencing. The literature suggests that radiation proctitis after SRBT peaks at about one week following treatment and begins to subside after that and return to baseline by 3 months. Is that about what you experienced?

No, my reading and personal experience indicate that radiation proctitis often happens several months later (than three).
Posted 4/10/2018 11:53 PM (GMT 0)
My radiation proctitis was about 2 years after treatment.
Posted 4/11/2018 12:57 AM (GMT 0)
I'd ask your RO about those prescription hydrocortisone suppositories some of the other guys mentioned. You won't be his/her first patient with your problem. (S)He'll know just what you need and can fix you up.
Posted 4/11/2018 3:01 AM (GMT 0)
LOnger ago .....way pre PSa I had several docs tell me that the OTC products for Hemmies would probably just make things worse in the long run. So definitely get the real deal from the Docs. I also found that 300-400 mg of magnesium as in a gel cap also helps greatly with keeping the stool moist thus soft thus easier to pass.

Roger
Posted 4/11/2018 1:53 PM (GMT 0)
I had some similar issues post-SBRT. My doc prescribed some cream to apply to the “affected area” twice daily. Really made a difference. IIRC, it was betamethasone valerate.

For me, since I had intestinal issues before radiation, these things may be around for a long time. With the meds, though, it is manageable.
Posted 4/11/2018 8:30 PM (GMT 0)
the worst pain/ordeal of this all was my first year after the biopsy. My urologist, a young, first year doctor did something during biopsy to give me a fissure. Three doctors, including the general surgeon who does my colonoscopies, misdiagnosed it as internal hemorrhoids; and then I finally went to a gastro dr. and he gave me the right treatment.

It's no joke and takes a while to heal. He advised me to drink a glass of Citrucel or Metamucil every night. I'd recommend a real gastroenterologist if it lingers on, as those guys are much better than just a regular general practitioner. Just my $0.02.
Posted 4/11/2018 10:00 PM (GMT 0)
I had tenesmus toward the end of SRT by IMRT and addressed the bleeding with radio frequency ablation . Four years later I still have occasional bleeding . I use prescription strength hydrocortisone for hemmies and take stool softeners at bed time. I don’t think tenesmus ever heals completely.
Bob
Posted 4/12/2018 7:42 AM (GMT 0)
Bob-

Tenesmus is just the sensation one feels from rectal inflammation. It deceptively feels like incomplete emptying. It may cause hemorrhoids when one tries to push out what is not really there. It disappears in a few weeks for most guys as the inflammation subsides. Your RF ablation, however, can cause scarring that may not heal.
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