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Rectal bleeding after salvage radiotherapy

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User
Posted 24 May 2022 at 13:05

After a prostatectomy, I have just received 20 treatments of salvage radiotherapy (finished last week). Since then, I have had the expected side effects, but I didn't expect the rectal bleeding every time I open my (loose) bowels. How long might this continue, I wonder. I was told by the RT team to expect the side effects to get worse before they get better, especially in the 2 weeks following the RT.

How normal is this? Is this proctitis? Will it settle down? Should I seek more advice from the RT team?

What has been your experience and advice?

Edited by member 24 May 2022 at 20:04  | Reason: spelling

User
Posted 24 May 2022 at 16:23

Bernster 

I did start seeing blood while passing soft and hard motions after salvage RT. I was also passing lots of blood clots and debris in my urine. 

I don't remember how soon I was seeing blood in the motions, but probably like you was told it may happen. It carried on for quite a while and around 14 months after SRT I had a virtual CT colonoscopy to check for bowel cancer. Nothing of any significance was found. I still got the occasion show of blood years after SRT. Piles seems to be mentioned as a possible cause. My bowels did settle down although my bowel habits are slightly erratic. 

The blood clots in urine was almost dismissed and urology blamed RT , Radiology blamed surgery. After over a year it was diagnosed as severe radiation cystitis, my bladder was beyond any help and I have a catheter for life. It does happen in less than 5 percent of RT patients.

Don't get fobbed off over any of the symptoms and get things checked out. Don't accept " that's normal"

Thanks Chris

User
Posted 24 May 2022 at 19:52
It takes ages and ages for the bowels to settle down after RT. At least 18 months in my case. Bladder irritation calmed down within a month of RT finishing, but bowel issues take far longer. I didn't have bleeding, but I was passing lots of green mucus and having the occasion "mishap" when what I though was just wind turned out not to be. I also had bouts of proctitis - an intense burning sensation inside the back passage which came and went. All these symptoms gradually subsided in frequency and then died out entirely. Now, three and half years after RT, things are pretty much normal but my bowel frequency is significantly greater than before treatment.

Cheers,

Chris

User
Posted 24 May 2022 at 23:17

Hi ...I am approx 7 months post RT now and experiencing a fair bit of blood with some movements at the moment; I mentioned this to the onco during our last chat and he referred me for a flexible sigmoidoscopy (less invasive version of the colonoscopy I believe) which is now scheduled in a couple of weeks time, just want to be sure its only a RT side effect and nothing more sinister (and hopefully get some kind of treatment for it ....). If it doesn't improve for you over the next few weeks it would certainly be worth you having a chat with your Onco about it (or your RT Team).

Edited by member 24 May 2022 at 23:18  | Reason: Not specified

User
Posted 25 May 2022 at 00:56

Bleeding can be made worse with hard stools. If this is applies in your case I suggest you ask your GP to prescribe medication that will keep your stools softer. It is early days for you but if the bleeding continues without lessening after say 3 moths post RT, I would ask to be referred back to your Oncologist. In a very few cases an operation may be required.

Edited by member 25 May 2022 at 18:52  | Reason: Not specified

Barry
User
Posted 25 May 2022 at 10:03

I hadn't really noticed it until a few weeks ago, so prob a late side effect of the RT. 

User
Posted 26 May 2022 at 01:05

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

Bleeding can be made worse with hard stools. If this is applies in your case I suggest you ask your GP to prescribe medication that will keep your stools softer. It is early days for you but if the bleeding continues without lessening after say 3 months post RT, I would ask to be referred back to your Oncologist. In a very few cases an operation may be required.

Waiting 3 months to make a move, seems a very long time! By then, further damage can be done eg anaemia.

Well that depends how bad the bleed is and whether this is overall decreasing. That is why I said "say" three months.  If blood loss is severe you could of course seek the early advice of your GP who could be shown,  make a judgement and advise you. Women of a certain age and not pregnant lose blood every month, some heavily, to the extent they are severely affected, some requiring a D&C. So small amounts of blood loss for men should not be a major concern. Efforts are made to minimise radiation to bowel and rectum but a relatively small number of men experience some bleeding each time passing stools or intermittantly.  RT can damage a vein which can become fragile and release blood when passing a motion at any time.  In severe cases or rare cases, as for example where a fistula forms, a following surgical procedure may be done.

However, many men experience what I call 'wet farts' and mucus with each motion and this gradually reduces over time until it ends, the latter about 6 months post RT in my case.

Edited by member 26 May 2022 at 01:07  | Reason: Not specified

Barry
User
Posted 26 May 2022 at 07:23
You'd have to be losing blood by the pint for anaemia to be an issue. The amounts of blood involved in rectal bleeding are very small. Teaspoons-full at worst.

Chris

User
Posted 07 Jul 2023 at 17:11

Clive , a few minutes before my colonoscopy it was cancelled due to an oversight by the hospital staff. I insisted on having the virtual CT version instead of the Colonoscopy. I still had a probe up the back passage but only just inside,you still need the prep to clean the bowels out. One disadvantage is if they find things you may still need to have colonoscopy

They found nothing with my scan.

Thanks Chris 

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User
Posted 24 May 2022 at 16:23

Bernster 

I did start seeing blood while passing soft and hard motions after salvage RT. I was also passing lots of blood clots and debris in my urine. 

I don't remember how soon I was seeing blood in the motions, but probably like you was told it may happen. It carried on for quite a while and around 14 months after SRT I had a virtual CT colonoscopy to check for bowel cancer. Nothing of any significance was found. I still got the occasion show of blood years after SRT. Piles seems to be mentioned as a possible cause. My bowels did settle down although my bowel habits are slightly erratic. 

The blood clots in urine was almost dismissed and urology blamed RT , Radiology blamed surgery. After over a year it was diagnosed as severe radiation cystitis, my bladder was beyond any help and I have a catheter for life. It does happen in less than 5 percent of RT patients.

Don't get fobbed off over any of the symptoms and get things checked out. Don't accept " that's normal"

Thanks Chris

User
Posted 24 May 2022 at 17:31

Thanks Chris.

I hate to think that the blood in your motions continued for 14 months after SRT! Perhaps it was less? Was it a continuation of blood appearance that led you to believe it may be bowel cancer? Three years ago I had a colonoscopy and a polyp was found, which was removed. I have not requested another colonoscopy since that time.

I guess I'm learning about the side effects of SRT, while waiting to see if my psa has reduced in about 2-3 months time.

I appreciate the time you have taken to share your experience.

Bernster

User
Posted 24 May 2022 at 18:06

Bernster, I still do occasionally get blood in my motions but sometimes after a bout of constipation and it is fairly infrequent. I did have a fissure 45 years ago and it is not the same as that. My SRT was five years ago.  I didn't particularly think it was bowel cancer, I had been having the bowel screening kits for a number of years. It was my GP suggested the colonoscopy. My conventional colonoscopy got cancelled 5 minutes before the procedure.

Thanks Chris

 

User
Posted 24 May 2022 at 19:52
It takes ages and ages for the bowels to settle down after RT. At least 18 months in my case. Bladder irritation calmed down within a month of RT finishing, but bowel issues take far longer. I didn't have bleeding, but I was passing lots of green mucus and having the occasion "mishap" when what I though was just wind turned out not to be. I also had bouts of proctitis - an intense burning sensation inside the back passage which came and went. All these symptoms gradually subsided in frequency and then died out entirely. Now, three and half years after RT, things are pretty much normal but my bowel frequency is significantly greater than before treatment.

Cheers,

Chris

User
Posted 24 May 2022 at 23:17

Hi ...I am approx 7 months post RT now and experiencing a fair bit of blood with some movements at the moment; I mentioned this to the onco during our last chat and he referred me for a flexible sigmoidoscopy (less invasive version of the colonoscopy I believe) which is now scheduled in a couple of weeks time, just want to be sure its only a RT side effect and nothing more sinister (and hopefully get some kind of treatment for it ....). If it doesn't improve for you over the next few weeks it would certainly be worth you having a chat with your Onco about it (or your RT Team).

Edited by member 24 May 2022 at 23:18  | Reason: Not specified

User
Posted 24 May 2022 at 23:31

Can you say if the bleeding was there close to the end of your RT (as in my case) or came later, as an after-effect of RT and its effect on the rectum?

User
Posted 25 May 2022 at 00:56

Bleeding can be made worse with hard stools. If this is applies in your case I suggest you ask your GP to prescribe medication that will keep your stools softer. It is early days for you but if the bleeding continues without lessening after say 3 moths post RT, I would ask to be referred back to your Oncologist. In a very few cases an operation may be required.

Edited by member 25 May 2022 at 18:52  | Reason: Not specified

Barry
User
Posted 25 May 2022 at 10:03

I hadn't really noticed it until a few weeks ago, so prob a late side effect of the RT. 

User
Posted 25 May 2022 at 19:31

Originally Posted by: Online Community Member

Bleeding can be made worse with hard stools. If this is applies in your case I suggest you ask your GP to prescribe medication that will keep your stools softer. It is early days for you but if the bleeding continues without lessening after say 3 moths post RT, I would ask to be referred back to your Oncologist. In a very few cases an operation may be required.

Waiting 3 months to make a move, seems a very long time! By then, further damage can be done eg anaemia.

User
Posted 26 May 2022 at 01:05

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member

Bleeding can be made worse with hard stools. If this is applies in your case I suggest you ask your GP to prescribe medication that will keep your stools softer. It is early days for you but if the bleeding continues without lessening after say 3 months post RT, I would ask to be referred back to your Oncologist. In a very few cases an operation may be required.

Waiting 3 months to make a move, seems a very long time! By then, further damage can be done eg anaemia.

Well that depends how bad the bleed is and whether this is overall decreasing. That is why I said "say" three months.  If blood loss is severe you could of course seek the early advice of your GP who could be shown,  make a judgement and advise you. Women of a certain age and not pregnant lose blood every month, some heavily, to the extent they are severely affected, some requiring a D&C. So small amounts of blood loss for men should not be a major concern. Efforts are made to minimise radiation to bowel and rectum but a relatively small number of men experience some bleeding each time passing stools or intermittantly.  RT can damage a vein which can become fragile and release blood when passing a motion at any time.  In severe cases or rare cases, as for example where a fistula forms, a following surgical procedure may be done.

However, many men experience what I call 'wet farts' and mucus with each motion and this gradually reduces over time until it ends, the latter about 6 months post RT in my case.

Edited by member 26 May 2022 at 01:07  | Reason: Not specified

Barry
User
Posted 26 May 2022 at 07:23
You'd have to be losing blood by the pint for anaemia to be an issue. The amounts of blood involved in rectal bleeding are very small. Teaspoons-full at worst.

Chris

User
Posted 28 May 2022 at 10:26

Originally Posted by: Online Community Member

Hi ...I am approx 7 months post RT now and experiencing a fair bit of blood with some movements at the moment; I mentioned this to the onco during our last chat and he referred me for a flexible sigmoidoscopy (less invasive version of the colonoscopy I believe) which is now scheduled in a couple of weeks time, just want to be sure its only a RT side effect and nothing more sinister (and hopefully get some kind of treatment for it ....). If it doesn't improve for you over the next few weeks it would certainly be worth you having a chat with your Onco about it (or your RT Team).

I have had a colonoscopy, a virtual colonoscopy (the easiest) and a sigmoidoscopy (the lower part of the intestines only) but this was before my prostate cancer and involved looking for polyps, which they found and removed.

I'd like to know how common my condition is (radiation proctitis, I believe) after 20 sessions of salvage radiotherapy and what are the chances of cure.

User
Posted 07 Jul 2023 at 13:43

Hi Chris

Just been reading all the post and replies about bleeding from behind post brachytherapy and radiotherapy approx 12 months ago.

 

The bleeding however didn't come along until February so approx 8 months post treatment. This did really frighten me I have had stool test which has ruled out bowel cancer. They did want me to have a flexible sigmoidoscopy which I haven't had as still feel vulnerable in this area.

I don't pass blood as such but still it in my stools but not everyday.

Just wanted to know will it get better of worse.

 

appreciate any help advice thanks and appreciate the post hope you are well

 

Regards Clive 

User
Posted 07 Jul 2023 at 17:11

Clive , a few minutes before my colonoscopy it was cancelled due to an oversight by the hospital staff. I insisted on having the virtual CT version instead of the Colonoscopy. I still had a probe up the back passage but only just inside,you still need the prep to clean the bowels out. One disadvantage is if they find things you may still need to have colonoscopy

They found nothing with my scan.

Thanks Chris 

 
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