Bladder and Bowel Preparation for prostate radiation

I worried about the bowel part before my treatment began. I read that UK patients routinely take an enema but it was never mentioned to me. I'd eat light at night, wake, poop, and no issue.

It was the full bladder part that I struggled with at first. In the first couple of sessions I developed what I called 'the terrors' while inside the accelerator, so not being full enough and having to wait longer on the table was not an option.

My water intake was kind of casual in those first few day but when my friend (who drinks a lot of water) saw my distress she gave me a simple daily routine for hydration. After this, apart from the two days out of 28 when the hospital was off schedule, I had no issue. I started and finished my ounces at fixed times, drove to the center, had treatment and then usually, ran to the bathroom.

The upside of being in the radiation center is that every single person there understands your bathroom rush 🙂

28 sessions of x-ray EBRT for me. For prep, I was told they wanted my rectum empty of both fecal matter and gas, and they wanted my bladder "moderately full." I ate a diet that helped assure a bowel movement each morning. Wound up giving myself an enema three times when the BM didn't seem to completely empty me out. They wanted me to finish drinking 20 ounces of water 45 minutes before my treatment (and of course, don't pee). None of it was particularly bothersome. And the treatments themselves were simple - less than 10 minutes on the table, no muss, no fuss, no pain. No change of clothes - just lower my pants a few inches and pull up my shirt so they could see the markers on my hips and belly to get me lined up properly.

I am about to start PBT. I have gut issues (IBS) so am concerned about good bowel prep. At sim, I had to go right before the "treatment" - hard to hold in the water when doing that. So don't want to repeat that.

I currently take Miralax daily, but I wonder if folks use it or something similar a fixed time before each treatment, to time emptying the rectum?

So your IBS is the diarrhea type, not IBS C which causes bouts of constipation, correct?
If so, why are you taking Miralax? I’ve been taking it daily for the past 6 yrs for constipation issues following prostate surgery. Why are you taking it if bowel movements are frequent?
Phil

I have multiple bowel issues - with IBS a shorthand for it, so problem is both constipation and diarrhea. I just want to control *when* so I can have it empty for treatment. Miralax (recommended by GI) has been a great help, but not sufficient, or I'm using it wrong or at the wrong time. Also, I have only been using it for a few weeks.

The Miralax will definitely help the constipation. But because it is an osmotic laxative it could cause a watery stool. IBS is a certain entity, but unfortunately, even GI doctors use it as a catch all term for unexplained digestive issues - it’s not!
I suggest the FODMAP diet - look it up. It excludes many trigger foods - certain sugars and carbs that are fermentable and produce gas, which is a big no-no if radiation is involved.
I don’t have IBS and I basically followed this diet for the 6 weeks leading up to my 25 sessions. It’s not a guarantee, but by eliminating the gassy, fermentable components of your diet you will hopefully eliminate the “triggers” causing diarrhea.
The Miralax should keep you regular but if you find it’s not enough, I also used Healthy Fiber (amazon) - a guar gum based, non-fermentable fiber additive; drink PLENTY of water with it!
Stay away from psyllium - very irritating if you have IBS. Hope this helps
Phil

Tks. I'll take a look again at FODMAP - it's been a while since I did. I tried fiber in capsule form and it seemed to cause trouble.

Fortunately, gas is rarely an issue unless I eat beans - which I won't 🙂

I'll have to discuss this with my radiation oncologist.

The Healthy Fiber is not a tablet - most of those are psyllium. It’s a powder you mix with water.
The problem is that even in a non-IBS setting, the radiation diet is a tightrope between moving your bowels daily and doing it without regular fiber which can cause gas.
Beans are an obvious gas producer but many vegetables go through fermentation and produce smaller amounts of gas which could still get you kicked off the table.
Phil

Finished Proton Therapy in late February. Took, as recommended, Miralax every night after dinner. Never had to take an enema but I brought glycerine suppositories to the treatment center each day and used them several times for quick acting emptying of the bowel if that was otherwise an issue impeding that day's treatment. Also used Gas-X. Some of the guys in treatment used Milk of Magnesia instead of Miralax, saying it worked better for them.

Diet is very important, per my treatment center:

"Avoid gas-producing foods such as:
• beans, cabbage, cauliflower, kale and broccoli
• carbonated drinks (canned sodas, fizzy water or beer/champagne)
• chewing gum/mints.
• If there is significant gas despite these efforts, you may consider taking Simethicone (Gas-X) or Beano with every meal."

Essentially I went on a low-fiber diet and if I cheated on the weekends, I paid the price (the other guys apparently didn't).

@garylr May I know what machine was used in your treatment, that they allowed you to have enema three times? Maybe it depends on what machine is used. In my case, I was told no enema for me.