blood in stool 18 months after IMRT

[Karmaji]

need some guidance regarding some blood in stool after 18 months of IMRT 20 sessions...some days ok some days blood. No pain or no irritation so far...veg diet...lot of exercise....

I will appreciate any suggestions...thanks

[Tall_Allen]

They are just internal hemorrhoids or blood vessels breaking. It should come and go on its own. If it is copious or bothersome you can see a proctologist or a gastroenterologist to get rid of them or resurface the rectum. But the cure is probably worse than the disease.

[Karmaji in reply to Tall_Allen]

Thanks You assure me....

How come there is no pain or cramp or irritation

Should one use some light plant laxatives ....if need be

May be live with it if not bothersome ....

Any risk of this to change into rectum cancer...what symptoms ?

[Tall_Allen in reply to Karmaji]

Why should there be pain, cramps, or irritation? It's just blood vessels breaking.

It's a good idea not to strain, so laxatives are a bad idea. A stool softener if you need it is OK.

No, it doesn't become rectal cancer. Get a colonoscopy every 5 years or so.

[Pleroma in reply to Tall_Allen]

Totally agree with T_A's advice. Most likely radiation damage. So many of us get it.

I live with mine. Doc said colonoscopy every 3-5 years. There is blood if you strain hard to pass the stools. Just relax and let it flow out. I had my rectum "resurfaced", but it did not really work 100%. Still get small amounts of red blood about once a week.

If there is black, clotty blood, you really need to have it checked out. I agree with a colonoscopy if it has been 10 years since the last one.

[farmanerd in reply to Tall_Allen]

Although radiation induced rectal proctitis doesn't become cancer, we need to be aware of having a higher risk of rectal cancer due to having had RT:

ncbi.nlm.nih.gov/pmc/articl....

"The risk of developing cancer of the rectum after radiation therapy for prostate cancer is similar to the risk of having a first-degree relative with colorectal cancer. There is evidence that radiation shifts the patients from normal to moderate risk for rectal cancer."

[farmanerd in reply to Tall_Allen]

A better phrasing would be "they PROBABLY are" instead of the absolute "they are". My RO said to let her know if this occurred and she would advise on what to do. When it happened about one year after my RT, she prescribed internal hydrocortisone and recommended that I have a colonoscopy to see what was going on -- I had recently turned 60 and already had one scheduled in about a month on the Tuesday before Thanksgiving. Findings were mild radiation proctitis (photo caption was "Rectum: Vascular pattern Mucosa radiation proctitis"), no polyps. Although in my case, it was pretty much what TA describes it to be, Tango65's post covers why the colonoscopy might be good.

[Tall_Allen in reply to farmanerd]

I disagree. It is a well known and common side effect. Instrumentation - like a colonoscopy- can make it worse. If it gets worse- then do something about it. Otherwise, leave it alone.

[Tall_Allen in reply to Tall_Allen]

In fact, my RO who has treated thousands of men, told me that the only times that he has seen lasting damage due to radiation injury was when nervous patients insisted on instrumentation (colonoscopy or cystoscopy) too soon after radiation. The friable tissues were damaged by poking around and it caused irreparable fistulas. Sometimes time is the best healer.

[Karmaji in reply to Tall_Allen]

Thanks Allen...I agree that best is follow the evolution

of bleeding. If it is not regular ..does not affect QOL...just observe......

For how long? Well if goes away .nothing to do...

[Tall_Allen in reply to Karmaji]

If it is copious or increasing, then diagnose further. Or black, tarry stools, which indicates problems higher up.

[farmanerd in reply to Tall_Allen]

When is the appropriate time frame to wait for a colonoscopy? Please quantify "too soon".

[Tall_Allen in reply to farmanerd]

I'm sure it varies. I had a colonoscopy just before treatment so I wouldn't have to stick instruments up there for some time. I just had a colonoscopy, which was completely clear. I expected at least some telangiectasias but none were seen. The important thing is to know that transient bleeding is expected, and intervention should only be attempted as a last resort.

[Bacana in reply to Tall_Allen]

Tall-Allen, would this also be the case for IMRT to aortocaval lymph nodes? My husband will be completing 30 sessions this Thursday and has a cystoscopy scheduled for Friday.

[Tall_Allen in reply to Bacana]

No, I don't think that would affect his lower bowels, but check with his RO.

[Bacana in reply to Tall_Allen]

He did say as much, thank you for confirming!

[GeorgeGlass in reply to Tall_Allen]

I get some blood in my stool. About 4-5 times in the past 4 months. Today was one of them. It is usually at one location, semi attached to a piece of crap and has a mucus appearance with a blood piece (dark red) attached to the mucus area. I have had IMRT and high dose brachy. Is that what I would look like if it is just radiation damage?

[TEBozo in reply to Tall_Allen]

You could try steroid suppositories'.

[tango65]

If you have rectal bleeding you need to consult with a gastroenterologist. He /she could recommend an endoscopic study to determine the cause of the rectal bleeding and to indicate a treatment .

If you did not have a colonoscopy or if you had one and not polyps were found you may require a colonoscopy if it has been 10 years or more. Based on the findings of the new or first colonoscopy they will tell you when to schedule the next one.

There is some info here:

iffgd.org/other-disorders/r...

[j-o-h-n]

All good advice.......... try putting some lubricant down below (such as vaseline - NOT medicated type or A & D ointment) every time you finish wiping..........

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 01/09/2021 11:23 PM EST

[ck722]

Have a nice big bowl of oatmeal on the morning to keep things the right consistency. Also, a daily dose of home made or store bought live sauerkraut to re-invigorate the gut flora to get the needed K2 for clotting and possible anti cancer properties.

[Ben2]

I began to drop dark red clots about a year after IMRT. Colonoscopy revealed damage to colon. Gasto told me to wait for a while and not get one of the treatments offered. Clots went from every couple weeks, to once a week for a year, then gradually subsided completely in a couple years. None since.

[MateoBeach]

It is called late onset radiation proctitis. Probably a small area of radiation burn to the front (anterior) of the rectum just a few inches in where closest to the prostate bed. Causes superficial scarring with capillary blood vessels that are friable and bleed intermittently.

Can be easily verified by proctologist or Gastroenterologist via anoscope. Can be effectively treated by the topical application of a diluted solution of formaldehyde for 30 seconds or one minute.

I actually did this treatment on myself with good results. Though needed to it repeated one year later. Not painful, but awkward as a do it yourself! 😳🤭

[immunity1]

It is a condition that is ignored by RO and GI folk alike. I err on the 'sort it out' brigade. I have had radiation proctitis on and off for 10 years, increasing in intensity as the cumulative amount of palliative radiation has increased. I have spent considerable time manipulating my bowel 'behaviour'! Diet, laxatives etc which has been more or less successful. Recently a decent rectal bleed prompted more action and the result was treatment of the various bleeding sites using argon plasma coagulation (APC), probably the most recommended surgical intervention. Foramaldehyde is the most common medical alternative. They both work in a high percentage of cases. See review.

doi.org/10.1016/j.gie.2019....

Its a QOL issue, If its not such a hassle, manage it conservatively (can I say that in the current political environment). If not, sort it.

[Fightinghard]

Hyperbaric oxygen therapy could heal prior radiation damage. Low risk to try it.

ncbi.nlm.nih.gov/pmc/articl...

[db1966]

I think they call it radiation proctitis which based on my RO can occur months or years after. I was recently diagnosed with it but had blood and mucus which has finally settled down with some suppositories that helped significantly. (Non steroid)