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One week of IMRT for recurrent PCa - issue with empty rectum

Posted by melvinw @melvinw, Oct 1 4:58pm

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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firespooks | @firespooks | Oct 5 7:08am

I had the same issue with my salvage radiation. Someone should have printed up , and gave me an instruction sheet on what to eat and what not to eat during my treatment regimen. The radiologists assume too much !

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mjp0512 | @mjp0512 | Oct 6 7:47am

Yeah...It's Monday. Another week of daily zapping. (Oh...and the pizza came out fine 😁)
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melvinw | @melvinw | Oct 6 8:24am

Yup, back to the grind. Being retired, weekends had lost any significance. Now, they are back with a vengeance.

May your bladder be full and your rectum just as empty!

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mjp0512 | @mjp0512 | Oct 6 8:40am
In reply to @melvinw "Yup, back to the grind. Being retired, weekends had lost any significance. Now, they are back..." + (show)
Profile picture for melvinw @melvinw

Yup, back to the grind. Being retired, weekends had lost any significance. Now, they are back with a vengeance.

May your bladder be full and your rectum just as empty!

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@melvinw

Just made me nozzle-nose my fill up the bladder water. 🤣🤣🤣

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melvinw | @melvinw | Oct 6 9:19am
In reply to @firespooks "I had the same issue with my salvage radiation. Someone should have printed up , and..." + (show)
Profile picture for firespooks @firespooks

I had the same issue with my salvage radiation. Someone should have printed up , and gave me an instruction sheet on what to eat and what not to eat during my treatment regimen. The radiologists assume too much !

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@firespooks Agreed, I don’t get this “not overwhelm you with info” approach. The whole bladder and rectum thing is pretty critical to successful RT and mitigating side effects and radiation damage beyond the target zone.

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chippydoo | @chippydoo | Oct 7 8:00pm

I carried a small Fleet enema which resolved the rectum issue. I carried one from day one of radiation and had to use one 2 times. MiraLAX and gasEx pills helped too. We have to take care of ourselves when doc's and tech's won't.

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chile3 | @chile3 | Oct 12 10:07pm
In reply to @melvinw "@heavyphil My RO seems to be of the mind of dealing with problems as they arise,..." + (show)
Profile picture for melvinw @melvinw

@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.

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@melvinw Melvin: Chile here. We exchanged info early on relative to post RP BCR probability associated with the VUA. Small world. I started RT last week. Look at my topic " Initial Conditions for Radiation Therapy" dated today Oct 12, 2025.
My last test PSA= 0.11 No kidding. Target volume for me is also the prostate fossa. No kidding Having trouble satisfying initial conditions. Sound familiar?
Talk Soon
Chile

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melvinw | @melvinw | Oct 13 7:45am

Twins from different mothers! I’ll hope over to your new thread to say more.

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mjp0512 | @mjp0512 | Oct 13 8:22am

And............another Monday. Only 2 more Mondays to go after today.
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jimbsmith | @jimbsmith | Oct 15 8:59am
In reply to @mjp0512 "In the words of the radiology NP-C I spent some time with, "Beans bad, yogurt good."..." + (show)
Profile picture for mjp0512 @mjp0512

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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@mjp0512 empty bowel is my only stress also

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