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One week of IMRT for recurrent PCa - issue with empty rectum
I started IMRT last week for a local recurrence (small nodule in prostatic fossa detected by DRE, PET PSMA and MRI scans; PSA is 0.11). Five treatment sessions so far and no side effects. The big challenge, which was really downplayed in the pre-RT instructions, is not having a full rectum (gas and solids). I’ve got the bladder filling down, and that is all good if the clinic stays on schedule (yesterday they were running 40 minutes behind). Today, the radiation therapist told me that my rectum had too much gas and that down the line, that would lead to diarrhea. I have a BM every morning like clockwork and then don’t eat before the treatment. She said to try for a BM again an hour before my appointment. I told her that I tried that last week, and the result was that my rectum was then too full of solids (no BM), and I didn’t receive a treatment that day. She then said I might need to alter my diet. I’m a para-vegan (no dairy, and no meat other than skinless chicken breast). I consume a whole grains/food diet and do not eat sugar nor ultra-processed foods. My diet is pretty much in accordance with all the dietary recommendations, and then some.
So, I’m a bit frustrated with situation. First, it would have been helpful to be informed of this issue before starting treatment so that I could have attempted some adjustments. Second, the dietician is recommending one thing and the radiation therapist something else. There is a lack of coordination on top of the lack of advanced information. I recall pressing a nurse about the BM issue and all she said was to have a daily BM before each session and I would be fine. Well, I have done that and apparently, the situation is not fine.
I have a consult with my RO tomorrow and will discuss this issue and get her take on it. In the meantime, I’d appreciate any feedback/shared experiences/solutions that worked. I’ll do my best to get this dialed in but there only seems to be so much I can do at this point. I might start be cutting beans out of my diet, or greatly reducing them.
Many thanks for sharing your thoughts and experiences.
M
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In the words of the radiology NP-C I spent some time with, "Beans bad, yogurt good." What amazes me is that I'm not stressed about the fact I have PCa, or ADT, or radiology treatments, but I'm highly stressed about a daily bowel movement. The importance and the absurdity of this does not escape me. I found this site helpful.
https://prostatecancernutrition.com/foods-to-avoid-during-prostate-radiation/
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3 ReactionsThanks! Very useful article. Looks like beans and broccoli will be out of my diet for several weeks. I can manage that—just wish I had better upfront info. So it goes.
I hear you. I really don’t think much about the PCa but the BM thing is a real stressor, and not that easy to control, unlike the bladder bit.
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1 Reaction@melvinw
You're welcome. I also find humor to be beneficial. Day 2 t-shirt...along with a belly sticker in case there's a trainee in the room...
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1 Reaction@melvinw Bowel prep was the single most stressful part of my treatment.
I followed a FODMAP diet, took the GasX religiously, even used enemas and suppositories on occasion and was still told I had more gas than they’d ever seen.
Of course, I never felt gassy…I really think swallowing air when you eat has a lot to do with it.
Chew and swallow with mouth closed and do not slurp liquids (coffee, soup). It did help!
Phil
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1 ReactionThanks Phil! More good information. I was just reading about the FODMAP diet. And I think you are onto something regarding swallowing air while eating (was reading about that too).
I will make dietary adjustments as needed, but I am also going to have a serious conversation with my RO today regarding the total lack of up front information about diet/nutrition during RT, especially in relation to having an empty rectum. It is far from a nontrivial issue.
I also came across this guide from the Veteran’s Administration regarding diet during RT for PCa. I will show this to both my RO and radiation therapist today. https://www.nutrition.va.gov/docs/Oncology/RadiationTherapyforProstateCancerNutritionMar2025.pdf
@melvinw Hey thanks for the link! Much more concise than the one I listed above.
3 down, 17 to go...😒
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1 Reaction@melvinw Sloan was very upfront about diet - so much so that I started my diet plan - including Healthy Fiber (Amazon) - during the 10 weeks of ADT before radiation.
I really wanted to know if I was going to be able empty my bowel being off all the high fiber foods I love. It was NOT easy, but I found the combo of things that worked for me.
Really a shame that you were not given a heads up weeks in advance.
Phil
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1 ReactionMany of us have carried small Fleet enema's in our pockets for just this occasion. My RO spoke against it after finding out I did it and had to use it once after getting thrown off the table. He asked if I used one the next week and I told I wouldn't tell him even if I did. Told him I was hell bent getting done with this torture.
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1 Reaction@melvinw
I don't know about you but, it's Friday and I'm grabbin a pizza. It'll work itself out by Monday. 😁
4 down, 16 to go...👍
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1 Reaction@heavyphil My RO seems to be of the mind of dealing with problems as they arise, rather than giving upfront information, as Sloan did for you (good on Sloan!). I spoke to her yesterday about the “gas in the rectum” issue, specifically saying that the only thing I was told was that I should try to have a bowel movement every day. No discussion of gas. I showed her the document from the VA too, that covered nutrition during RT in great detail. Her response was ‘we have something like that too, if you want it’. When I again emphasized that a heads up about gas in the rectum would have been helpful a couple weeks before initiating RT, her response was ‘I don’t like to overwhelm patients with information while they are coping with a cancer diagnosis’. On one hand, I sort of see her point, but I’m not that kind of patient and for me, withholding info just shows mistrust. Furthermore, how is a one sentence mention of “empty rectum means both empty of both stool and gas” so overwhelming? Well, I had may say, and I’m moving forward armed with better knowledge now, with much credit to you and this support group.
The good news is that yesterday. after a few tweaks to my high-fiber diet, the treatment went off without a hitch, and the radiation therapist gave me a double thumbs up. I’m sure it won’t be perfect every day, but at least I know now what I should have known at least two weeks ago and am getting my prep dialed in.
Btw, I’ve been taking a Senna-S tab every evening, starting over a month ago, and that seems to be doing the trick for staying regular. But I have the Healthy Fiber in my shopping cart if I need it. Thanks for the tip.