Blood in stool after RT of prostate and Pelvis

[Karmaji]

I asked same question few months ago. I had IMRT in nov 2019 on prostate and pelvis , seminal vesicules: Prostate 60 GY in 20 fractions and pelvis 48 GY boost.

Technique IGRT dyamic arctherapy...

Starting January 2022, I started having occasional red blood spots on toilet paper. I have no constipation, no rectal irritation, no pain.

I went to see Gastro who did rectoscopy and recommended Betensol enema. I did 10 days but actually blood spots increased. I tried Mesalamine suppository...as suggested by TA...still it helped in negative sense. I took sucralfate suspension....

It seems that all these treatments actually increased stool blood....red with clots.

Now sometimes I get more episodes of Bleeding ...may be due to these treatments.

I am going to see another Gastro but I wonder what he may suggest.

I feel if I do not do any treatment, less irritation and les bleeding spots on toilet paper.

It will be very useful if our APC friends share their experience. Can it be handled by diet, aleo vera, coco nut water,Psyllium, or other natural pills papaya enzym as suggested by NAL.

It seems that best is do nothing and let it heal by itself with healthy diet.

Thanks for reading and commenting....

[Alice85]

Karmel-This is a question for you doctor.We patients have a lot of opinions, but your doctor is the best one to give advice.

[lowT163]

I just found out the same as you. I had one round of treatment and spent the next 3 months on the can. Finally got it under control with metimusel 3 times a day.

[Karmaji in reply to lowT163]

We wish our apc friends share their experience regarding blood in stool....I am sure many among us went thru this or going thru this...journey of each of us will very informative and positive...

[Karmaji]

Reading all the articles on radiation prostitis, one feels that there is no real direction treating this problem.Very confusing and contradictory. I feel gastroenterologists are completely lost. They prescribe treatment which has no certitude...like Betnesol enema, mesalamine, sucralfate etc....may do more damage.I would like to consult gastroenterologist who knows well radiation prostitis....

I feel best direction to take is thru the personal experience of each of us confronting this problem. Thesr is no one fit for all but I may be ables choose a direction knowing the experience of others.

May be best is let it take its course and do not use chemical treatment unless in bad shape.

Just work on life style, diet and do not panick.

[Janhpr]

We agree

[Cooolone]

I'm left to wonder what the Oncologist has said in regard to the side effects from treatment? And if those numbers you posted are correct, that's a lot of radiation given... I thought today's max for RT was somewhere in the upper 60 - mid 70 range for total... You had 60 in 20 sessions plus an additional 48??? I received 78gy total over 40 sessions (1.8gy per) using IMRT. I know everyone is different, but still. I believe you received a lot of radiation in a very short period of time.

Really would be talking to the Oncologist more than the Gastroenterologist first, just an opinion. But I do hope that better minds might be able to help more than my questions as I'm sure I've offered none. Apologies...

[Karmaji in reply to Cooolone]

As it seems 60 gy on prostate.... and 48 Gy on pelvis zone....Two different zones....May be it is crazy to do such parallel dose same time..... a patient is ignorant.

When I talked to RO about rectal bleeding, , he just replied go and see Gastro without giving any personal guidlines. It seems his job is radiation and side effects are not his baby....

That is how all medicine is....one may die of side effects and no doc ever mentioned to me.

we wish to share the experience of rectal bleeding therapy by different members. Each of us have a story to tell....

[Cooolone in reply to Karmaji]

I'm sorry to hear your RO has such a cavalier attitude toward you. Very unfortunate

I hope you may find someone who is more involved with their patients. Best of luck and wishes!

[Karmaji in reply to Cooolone]

Well c est la vie....My RO is very talkative and good listner....But he has limited himself to prostate radiation.....limited menatl capacity broken by routine...well lot of information I get on this forum

[binati in reply to Karmaji]

As mentioned by Cooolone the normal is 78Gy spread between Prostrate, Prostrate bed and Pelvic nodes. Yes even with this amount of radiation and the best control and targeting you will get some blood spotting from the rectum and some blood from the urethra. I have had only one episode of a blood clot from the urethra and a slight burning feeling for the past year. I had my RT in Nov/Dec 2019. This usually manifests itself after around 1 to 2 years. I have not taken any treatment or medication so far. The rectal bleeding has reduced a lot and is only occasional. I take care to have food with plenty of roughage and not so much of meat. If you can avoid constipation then there is less problem.

[BadNews4me]

Chronic Radiation Proctitis. For me it’s the gift that keeps on giving. Severe rectal bleeding started 12 months after EBRT of prostate and some lymph nodes. Tried APC, suppositories mesalamine and prednisone, hyperbaric for 40 sessions, APC again and all treatments unsuccessful. After a year of failed treatments in Florida went to Mayo, Rochester Mn. They tried APC unsuccessfully and then tried Formalin that stopped bleeding immediately. But not end of story. Formalin successfully treated the proctitis but also caused new ulcers that were bleeding. It’s been on and off (bleeding) for about 30 days. Hard stools (constipation) seem to open ulcers to bleed. QOL seriously affected when bleeding but hope and pray for improvement in near future.

Hope this helps someone find hope that tomorrow be a better day.

[doc1947g]

I am also 75 y.I. and had rectal proctitis a year later after a VMAT-RT 3Gy X 20 tx.I had a colostomy with Argon where they filled my colon then send a spark that activated the Argon and cauterize the bleeders.

One treatment and one more colostomy to check.

No more bleeding.

[BrazilianRO]

Argon plasma may be a good way to solve your problem. When the bleeding is sporadic and low volume, there is little chance it will impact negatively your health so you can probably learn to live with that and control it with diet.

[middlejoel]

Karmaji, your bleeding started more than 2 years after the treatment. You saw a gastro, what did he find? Scar tissue? You also say that it might be best to let it heal naturally. Heal what? FYI, Exactly one year ago, I had full pelvic radiation SBRT in 5 Fractions of 7.25 each for a total of 36.25. So far so good, keeping my fingers crossed. Good luck!

[Karmaji in reply to middlejoel]

Gastro saw some irritation on rectum 4 months ago.He prescribed Betnesol enema for 10 days followed by 3 times every week during 2 months. But it increased bleeding so I stopped after 10 days...

Now I will see another gastro.....

Bleeding is red comes comes sometime more in quatity...

It seems if it does not effect QOL just let it be....nature will take care...

Bleeding does not occur for every person..

Depends on health karma of each...

In my case may be I had pelvic radiation more exposed....

.I never had bowl problem before...

no piles...BMI 18 and healthy otherwise

[Hidden]

Guess I am confused; a Rectiscooe is used to examine the anal cavity and rectum. Was the Sigmoid Colon examined. Have you had a Colonoscopy? I bring this up as IMRT, etc can scar the colon. Depending the experience level of your Radiation Oncologist, scarring happens. Mine had very light scarring on the left side of my Colon. Gastroenterologists also have experience with cancer. Mine told me 17 years ago, enemas are bad. He prescribed suppositories. Mainly to deal with bleeding hemorrhoids.

GD

[Karmaji]

After reading and consulting gastros It seems that treatment for rectal bleeding due to RT is on wrong footing.The damage is due to radiation exposure like nuclear exposure.

We cant treat rectal bleeding in classical simplistic way, that is why it does not work..

The damage done by large GY

....1 gy is 100 rad...and 400 rad exposure is fatal...

So all cells damaged by radiation

has to be treated like nuclear exposure. DNA is damaged and lining of rectum is in bad shape.

We should look into therapies used for nuclear exposure damage. But whom to consult

Not classical gastro..who has no knowledge of mechanism of radiation damage to cells.

May our knowledgeable friends comment on this...

[lowT163]

My biggest help for my poor burned up rectum was simply taking Metimusil. I take 2 teaspoons with 8 ounces of water 3 times a day. Try it before the argon treatment. Wish I had.

[Karmaji]

Thanks...I consulted a Gastro whosaid that he had many patients of RT pelvic injuries since times of

savage radio therapy

He says we do not really understand the mechanism of damage. He laughed and said may

be wait and see...till Blood count falls...and watch iron deficiency.

He agreed to Psyllium, Curcuma liposomal , Aloe vera drink, vitamin C , diet, exercise....