Looking for tips on managing Radiation-induced proctitis

My husband developed radiation induced proctitis two years post-radiation therapy. Initially there was no visible bleeding but his hemoglobin dropped to 92 so they did a colonoscopy. The gastroenterologist used APC (argon plasma coagulation). Significant bleeding and explosive fecal incontinence sent us to emergency. We found out the APC burned the tissue in the rectum causing a rectal ulcer. Treatment was at home twice a day sucralfate enemas for about 9 weeks. Last Treatment was December 1st and the bleeding has not returned. Bowel movements are back to normal. The trick is to not let the rectum get irritated so my husband uses metamucil. My husband is also on blood thinners so risk of recurrence is higher.

Thank you. Surgeon has "not yet" recommended return trial of suralfate but that may be in the future. So the "not irritated" plan. I am/was still an avid bicycolist and exercise regularly. Does "not irritate" include such activities.

I think the surgeon was referring to irritating as straining and/or constipation. She said he needed to keep his stool the consistency of soft serve ice cream. But I read in a previous discussion that an avid bicyclist had to stop because it seemed to contribute to his bleeding. So I'm not sure about that.

If you search radiation induced proctitis you will find the previous discussion and there may be some helpful hints for you.

Radiation proctitis. Urinary and fecal Incontinence. Severe rectal bleeding. My story for over a year.
Tried all recommended procedures to stop the bleeding All were unsuccessful.
Finally went to Mayo (Rochester) for treatment using Formalin that stopped the bleeding once and for all.
Still have both Incontinence issues but no more bleeding.
Radiation is a nightmare that continues long after initial treatment at least in my case.
Hope you find a solution to your problem.

The first treatment didn't completely stop the bleeding, but it was dramatic. I've returned three times over the last five years. The procedure heals the areas treated and has documented effect of healing between some areas of treatment. Untreated areas can start to bleed as part of the long term effect of radiation. The bleeding doesn't resume in treated areas.
Hyperbaric treatment is also effective. It can take 45 to 90 sessions of sitting in the chamber for 2 hours. I stopped that treatment to avoid sitting in a closed space with 6 others during Covid.
There are other doctors mostly hospitalists-- one at Scripps, though you couldn't do better than "born happy" Buxbaum.
It was difficult to find out about this treatment. I was calling doctors named as authors on Pub Med reports.
best,
gently

Have appointment with surgeon to discuss formalin treatment coming up. Surgeon previously said he has not had good results with this but given outcome from argon colonoscpy this is where he wants to go, I think.

@lhs38, I moved your posts about radiation proctitis to this existing discussion

- Looking for tips on managing Radiation-induced proctitis
https://connect.mayoclinic.org/discussion/radiation-induced-proctitis/
I did this so you can see previous posts and connect with others members in the prostate cancer group who have experienced radiation-induced proctitis.

Also see this related discussion:
- Anyone been diagnosed with Radiation Proctitis?
https://connect.mayoclinic.org/discussion/radiation-proctitis/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539292/
The article has a paywall. I was so desperate. I paid 35$ for the article. And immediately called Rodney Eddi. He's a couple of hundred miles from me, but no longer had access to the halo 90. I lined up 19 possible doctors and began calling.
I want to say don't do formalin, but another poster has given better warning.
Let me instead say that the Halo 90 administers a dose that of precisely shallow depth and so doesn't damage the area below. Placement of the wand is precise and targets only the damaged surface area. It is restorative of normal functioning skin which grows back vascularized. Treated areas don't rebleed.
Bless your choice.

The Radiation Oncologist seem not to want to discuss any side effects from the radiation. I had 39 treatments and I am and have been sick since the beginning. Bloating, no appetite to speak of, stomach pain, stomach ache, and terrible amount of gas which nothing helps. I have a tremendous amount of mucus discharge and some bleeding. My Urologist is now on the same boat as I am and is saying there is no doubt you have radiation proctitis or Eneritis! I’m tired and tired of being sick

Scott