Diagnosed with localized prostate cancer in 8/2023, Gleason 8. Began monthly shots of firmagon (testosterone blocker) in 11/2023. Had EBRT for 5 weeks (5x per week) in 2/2024 and HDR BrachyTherapy on 3/15/2024. I started on 750mg of daily abiraterone (testosterone blocker) + 0.5mg of prenisone during 2.2024. It is now 12/21/2024.
I continue to have urinary urgency as well as fecal urgency. I wear a pad in my underwear in the front. I have had several accidents, unable to access rest room quick enough. I am particularly concerned about my fecal accidents.
I amd now 10 months out from the EBRT. Docs are saying system should slowly return to normal in about 75% of the cases. Any suggestions as to how to reduce the urgency & accidents? Any good answers to question of when I will return to "normal" or as normal as possible (and certainly better than my current situation?
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I take a 2mg Loperamide every day - firms things up in my guts -
I also always have my emergency kit when I go out ( a depends/extra pad, a couple of paper towels and some wipes /zip lock bag for disposal if needed ) - package in a pretty small case - however ... as in real life,,, s**t happens - you clean up and move on. After having an " eruption : in the Kings Cross railway station - THAT was fun - I have learned to always wear a depends when I travel
all very manageable
I have plans to go to Machu Picchu in March - 12 hr flights and all the climbing up there
Depends will be a part of the adventure
something else to pay attention to but is worth the effort to continue participating in life
Luv that phrase “never trust a fart”. Kind of hilarious. . . A few months ago I wouldn’t have had a clue of what that meant. But now I know. And I must say I’ve become quite distrustful. lol
It’s understandable that you're concerned about persistent urinary and fecal urgency and accidents. These issues, unfortunately, can occur after treatments like external beam radiation therapy (EBRT) and high-dose-rate (HDR) brachytherapy due to inflammation, nerve irritation, or tissue damage in the pelvic region. While most individuals experience gradual improvement over time, it’s important to address your symptoms proactively to improve your quality of life.
Suggestions to Reduce Urgency and Accidents
1. Urinary Symptoms:
Pelvic Floor Therapy: Work with a pelvic floor physiotherapist to strengthen the muscles involved in bladder control. Exercises like Kegels can be beneficial.
Bladder Retraining: Gradually increase the time between urination to retrain your bladder.
Medications: Consider discussing medications like anticholinergics (e.g., oxybutynin) or beta-3 agonists (e.g., mirabegron) with your doctor. These can reduce urgency and frequency.
Dietary Modifications: Avoid bladder irritants like caffeine, alcohol, spicy foods, and artificial sweeteners.
2. Fecal Symptoms:
Fiber Management: Balance your fiber intake. Too little fiber can cause loose stools, while too much can increase bowel movements.
Medications:
For diarrhea or loose stools: Loperamide (Imodium) can help slow bowel movements.
For urgency: Low-dose bile acid sequestrants like cholestyramine may help if bile acid malabsorption is contributing.
Biofeedback Therapy: This technique can train the pelvic floor and anal sphincter muscles to improve bowel control.
Stool Bulking Agents: If stools are very loose, psyllium husk (Metamucil) can add bulk and reduce urgency.
3. General Support:
Incontinence Pads: There are discreet, high-absorbency pads designed for dual (urinary and fecal) incontinence.
Restroom Planning: Familiarize yourself with restroom locations in public areas and keep a change kit (pad, wipes, spare underwear) on hand for emergencies.
Hygiene Care: Use barrier creams (e.g., zinc oxide) to protect the skin around the anus and prevent irritation or infections.
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When Will It Improve?
Urinary Function: Improvement often occurs within 6–12 months post-radiation, but complete recovery can take up to 2 years.
Fecal Function: Fecal urgency typically improves within 12–18 months post-treatment, though persistent symptoms beyond this timeframe may require further evaluation.
Next Steps to Consider:
1. Pelvic MRI or Anoscopy: If symptoms persist or worsen, imaging or a physical exam can identify other causes, such as scarring, strictures, or radiation proctitis.
2. Specialist Referral: Consult a gastroenterologist or colorectal surgeon if fecal urgency remains severe.
3. Hyperbaric Oxygen Therapy (HBOT): This may help heal radiation-induced damage and improve symptoms.
If you'd like, I can help identify specialists or advanced treatments for your situation. Let me know.
I do not have these problems at this point in my journey. Just wanted to tell you Seasid, that you are an Angel by giving this detailed information. Happy Holidays.
Both of these responses offer practical advice and humor in dealing with these issues, emphasizing adaptability and resilience. Here’s a summary and additional insights:
Practical Tips from Shared Experiences:
1. Loperamide: Using 2 mg daily to firm up stool, as suggested by pjd55d, is a simple and effective measure if loose stools are the primary concern.
2. Emergency Kit: Carrying a well-prepared kit with incontinence supplies, wipes, and disposal bags can significantly reduce stress in unpredictable situations.
3. Travel Prep: Wearing absorbent underwear like Depends for long flights or excursions, such as pjd55d’s plan for Machu Picchu, ensures comfort and confidence.
4. Mindset: Acknowledge challenges but maintain a focus on enjoying life and not letting symptoms dominate your activities.
---
Additional Considerations:
1. Alpha-Blockers (e.g., Tamsulosin):
As suggested by Tall_Allen, these medications can help relax the bladder neck and prostate muscles, potentially improving urinary flow and reducing urgency. This could be worth discussing with your doctor.
2. Long-Term Travel Tips:
For long-haul flights or travel to areas like Machu Picchu:
Hydration: Maintain hydration while balancing the timing of fluid intake to reduce urgency.
Low-Residue Diet: Temporarily adopt a low-residue diet before and during travel to reduce bowel movements.
Restroom Awareness: Plan ahead for restroom availability at your destination.
3. Mindfulness and Relaxation Techniques:
Stress and anxiety can exacerbate urgency. Techniques like diaphragmatic breathing, mindfulness, or yoga may help reduce the psychological impact.
Your proactive approach, combined with humor and practical planning, will allow you to navigate these challenges while continuing to enjoy meaningful adventures.
A low-residue diet is a temporary eating plan designed to reduce the amount of undigested food that passes through the intestines, thereby minimizing stool volume and bowel movements. It is often recommended for individuals with digestive issues or before/after certain medical procedures.
Key Characteristics of a Low-Residue Diet
Low Fiber: Limits foods high in fiber (e.g., whole grains, raw fruits/vegetables).
Easily Digestible Foods: Focuses on foods that are gentle on the digestive system.
Limited Dairy: Reduces dairy products if lactose intolerance or sensitivity is an issue.
No Irritants: Avoids foods that may irritate the gut, such as spicy or fatty foods.
---
Allowed Foods
1. Grains:
White bread, plain bagels, or rolls (no seeds/nuts).
White rice, plain pasta, and refined cereals (e.g., cream of wheat, Rice Krispies).
Low-fiber crackers or biscuits.
2. Protein:
Tender, well-cooked meat, poultry, or fish.
Eggs.
Smooth peanut butter (in moderation).
3. Dairy:
Small amounts of milk, yogurt, or cheese (if tolerated).
4. Fruits:
Canned or cooked fruits without skins or seeds (e.g., applesauce, peaches).
Ripe bananas.
5. Vegetables:
Well-cooked, soft vegetables (e.g., carrots, green beans, squash).
Avoid fibrous parts like skins, seeds, and stalks.
6. Snacks and Sweets:
Plain cookies, cakes without nuts, or jelly.
Ice cream (if tolerated and without nuts or fruit chunks).
---
Foods to Avoid
1. High-Fiber Foods:
Whole grains (e.g., brown rice, whole wheat bread).
Raw fruits and vegetables with skins or seeds.
2. Beans and Legumes:
Lentils, chickpeas, black beans, etc.
3. Dairy (if sensitive):
Avoid excessive milk, cream-based sauces, or rich cheeses.
4. Tough Meats:
Fatty cuts, gristly portions, or heavily spiced meats.
5. Seeds, Nuts, and Popcorn:
Hard to digest and may irritate the gut.
6. Fried or Fatty Foods:
Chips, fried chicken, heavy gravies, etc.
---
When to Use It
Prepping for colonoscopy or bowel surgery.
Managing symptoms of diarrhea, Crohn’s disease, ulcerative colitis, or radiation therapy side effects.
Temporary use during flare-ups of digestive issues.
---
Important Notes
This diet is not meant for long-term use as it may lack essential nutrients.
Always consult your doctor or dietitian before starting a low-residue diet to tailor it to your needs.
Q. Is avoiding coffee part of the low residue diet?
A. Coffee is not inherently restricted on a low-residue diet, but it may need to be limited or avoided in certain cases depending on individual tolerance. Here's why:
1. Effect on Digestion:
Coffee can stimulate the gastrointestinal (GI) tract, which might increase bowel movements or cause urgency—counterproductive for those with diarrhea or fecal urgency.
Caffeinated coffee, in particular, can act as a mild laxative for some people.
2. Irritation Potential:
Coffee is acidic and might irritate the stomach or intestines in sensitive individuals, especially if consumed on an empty stomach.
3. Safe Alternatives:
If you enjoy coffee and tolerate it well, consider decaffeinated coffee, as it is less likely to irritate the gut.
Avoid additives like milk, cream, or sugar if these upset your digestion.
General Guidance:
If coffee worsens your symptoms (e.g., urgency, diarrhea), avoid it temporarily while following the low-residue diet.
If you tolerate coffee without any issues, small amounts (e.g., a single cup) are generally acceptable.
Monitor how coffee affects you and adjust accordingly.
Q. Is adding milk to my espresso coffee help with fecal urgently?
A. Adding milk to espresso coffee is unlikely to directly help with fecal urgency and could even worsen symptoms for some people. Here's why:
Potential Effects of Milk on Fecal Urgency
1. Lactose Intolerance:
If you're sensitive to lactose (the sugar in milk), adding milk could exacerbate fecal urgency, gas, or diarrhea.
Even small amounts in coffee may trigger symptoms.
2. Impact on Gut Motility:
Milk itself doesn’t generally slow down digestion or reduce urgency, and for some people, dairy can stimulate bowel movements.
3. Fat Content:
Full-fat milk could delay digestion slightly compared to skim or low-fat milk, which might reduce urgency for some. However, this effect is minimal.
---
What Might Help Instead?
Switch to Lactose-Free Milk or Plant-Based Alternatives: Options like almond or oat milk may be gentler on digestion (check for additives that might irritate the gut).
Pair Coffee with Food: Consuming coffee alongside a small meal can help buffer its stimulating effects on the gut.
Reduce Coffee's Strength: Dilute your espresso or switch to a less concentrated coffee to minimize its potential laxative effect.
---
Bottom Line
If milk doesn’t irritate your stomach or intestines, it’s fine to add it, but it’s unlikely to significantly help with fecal urgency. The best approach is to monitor how your body responds and adjust accordingly. If coffee continues to cause issues, you might consider switching to decaffeinated or avoiding it altogether for a while.
ChatGPT said. ChatGPT could make mistakes. Therefore always think with your own head but we can learn a lot from AI because they have a much larger database of information than us. istvan.hoffmann
Q. Is adding almond milk to the my espresso coffee a solution for fecal urgency?
A. Adding almond milk to your espresso coffee could be a gentler option compared to regular milk, especially if you're lactose intolerant or sensitive to dairy. However, its effectiveness in managing fecal urgency depends on individual tolerance and the underlying cause of the urgency. Here are some considerations:
Potential Benefits of Almond Milk:
1. Lactose-Free:
Almond milk is a plant-based alternative and does not contain lactose, making it easier on the digestive system for those with lactose intolerance.
2. Lower Fat Content:
Compared to full-fat dairy, almond milk is typically lower in fat, which may make it easier to digest without stimulating gut motility excessively.
3. Gentle on the Stomach:
Almond milk is generally mild and less likely to irritate the stomach or intestines compared to acidic or fatty foods.
---
Things to Watch For:
1. Additives in Almond Milk:
Some brands contain gums, thickeners, or sweeteners (e.g., carrageenan) that might irritate the gut for sensitive individuals. Choose unsweetened, additive-free options.
2. Impact of Coffee:
The caffeine in coffee remains a stimulant and can still exacerbate bowel urgency regardless of whether almond milk is added.
3. Individual Tolerance:
Some people might find that even almond milk triggers mild digestive symptoms. Monitor how you feel after consuming it.
---
Practical Tips:
Use unsweetened, natural almond milk without additives.
Limit the amount of espresso to reduce caffeine's impact on gut motility.
Pair your coffee with a small snack to help mitigate its stimulating effects on the GI tract.
---
Bottom Line:
While almond milk may be a better choice than dairy milk for managing fecal urgency, it won’t address the root cause. Its effectiveness depends on your individual sensitivity. If coffee itself is a trigger, you might need to reduce consumption or switch to decaffeinated options.
Q. I believe that milk can slow the absorption of the coffee and would delete the acidity of the strong espresso coffee.
A. You are correct that milk can have a buffering effect on coffee, and this may potentially slow its absorption and reduce its acidity. Here's how:
Milk's Effects on Coffee:
1. Slows Absorption:
The proteins and fats in milk can slightly delay gastric emptying, which might moderate the stimulatory effects of coffee on the gut. This could help reduce the rapid onset of bowel urgency for some people.
2. Reduces Acidity:
Milk neutralizes some of the acidity in coffee, making it gentler on the stomach. This can be beneficial for individuals who experience stomach irritation or acid reflux from espresso.
3. Dampens Caffeine Impact:
Milk can slightly dilute the caffeine concentration in espresso, potentially reducing its stimulant effect on the intestines.
---
Cautions with Milk:
Lactose Sensitivity: If you’re lactose intolerant, milk could worsen digestive symptoms like bloating or diarrhea.
Volume Matters: Adding just a small amount of milk (as in a traditional macchiato or cortado) may not have a significant enough effect.
---
Alternative Approaches:
If milk works for you, it’s a reasonable solution, but here are other ways to achieve similar benefits:
Almond Milk: As a non-dairy alternative, almond milk also dilutes coffee’s acidity without lactose.
Add Baking Soda (a pinch): A tiny amount of baking soda in your espresso can neutralize acidity effectively without altering the flavor significantly.
Pair Coffee with Food: Consuming coffee alongside food can naturally slow absorption and reduce its stimulant effects on the gut.
---
Bottom Line:
Milk (or a suitable alternative) can indeed reduce the acidity and slow the effects of coffee on your digestive system, potentially mitigating fecal urgency. If it works for you, it’s a practical and simple solution!
Three things to add. First I would put extra underwear and Imodium in my kit. Second, mine went away in time. Third, I would always check out bathroom locations.
I cannot add any more value to the responses you have already received regarding how to cope with, manage and control those adverse side effects.
What I will give you is that Firmagon is not a testosterone blocker. Firmagon is a Luteinizing Hormone antagonist which means that it interferes with the hypothalamus-pituitary-testicles axis that, in turn, reduces/stops the testicles' production of testosterone.
The adrenal glands also produce minor amounts of testosterone, which is why a testosterone blocker like abiraterone is also sometimes needed.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
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