How Important Is Having A Full Bladder During Radiation Treatment?

“Full bladder” isn’t something that’s randomly done, nor is it something that’s to just be “…. encouraged by the techs.”

Coming out of the CT Simulation, you should’ve been informed exactly how many ounces of water to drink (and how many minutes) before each treatment.

(For me, that was just 18oz of water to drink just 30 minutes prior to each session. In the weeks leading up to my radiation treatments, I practiced every day. By the time of my first treatment, I had the routine down to a ritual. I never had problems holding that amount of water. It worked like clockwork every time and never caused an issue.)

It takes time for water you drink to make its way to your bladder - that time is different for each person (and you don’t really have to drink a lot), and should have been figured out at the time of your CT Simulation.

You should work this out with your radiation oncologist (or the nurse practitioner assigned to you), not with the tech guys.

Yes, it is absolutely necessary to have a full bladder during the procedure in order to both push the bladder and small bowel as possible away from the field of radiation and to keep other nearby organs and tissues in that area in the same location for each treatment. This needs to be done consistently and exactly the same way for each session.

@brianjarvis Thanks you very much for sharing this Brian. Unfortunately, it does not appear that my medical team is as dutiful to what you've shared.

More worrisome is that the tech who could visibly see the imaging of the situation emphatically explained that the bladder was not full, but this morning when I receive a call from radiation oncology and bring this up, I am told that "it was full enough" to do the treatment.

So it goes from the imaging tech being concerned about it to the point of being bothered by it, to "well, it was full enough to do the treatment."

In my medical history, I've been a patient in endocrinology, orthopedics, primary care of course, and ophthalmology. Have never felt unsure about doctors in these departments.

But in radiation oncology, I find myself needing to "sleep with one eye open" if I take a nap in a chair there.

@thanks4sharing Having been diagnosed with prostate cancer in April 2012, and treated in April 2021, I’ve been in the trenches now for nearly 14 years. Though I’m not formally educated to give advice, diagnose symptoms, interpret lab results, etc., I found that I had to become a “student of prostate cancer” if I was going to understand and self-advocate regarding my diagnostics and treatments.

After being told that I had prostate cancer - which in hindsight my urologist could’ve done a bit more eloquently - my first comments to him were, “I don’t know anything about prostate cancer so, I’ve got a zillion questions to ask before you cut anything out of me, or bombard me with radiation, or inject toxic chemicals into me……” From that point on, it was about self-advocacy and shared decision-making.

I look at this diagnosis like having to cram for a final exam or defend a dissertation. I go into every appointment, blood draw, exam, test, injection, scan, etc. with a thorough understanding of what’s going on, as well as questions to ask if anything remains unclear before I’m poked, prodded, stuck, or anything invasive done to me.

That’s what I liked about my last urologist, my radiation oncologist and my medical oncologist….they were all open to thorough discussions and answering questions, fully understanding that I would go home, research what we had discussed, and (possibly) come back with more questions.

That’s the relationship we all need to strive for with our medical teams.

@thanks4sharing Full bladder is absolutely essential and necessary fir successful radiation therapy.
@brianjarvis said it all perfectly: your simulation with a full bladder was the blueprint or template for all future treatments.
If the bladder is not as full for your treatments, radiation is gonna go where it shouldn’t and your side effects will be increased down the road.
I had a few moments where i almost pissed on the table as well - not because of me, but because they were running a half hour behind and it affected my timing of fluid intake. You gotta grit your teeth and hold it!
Please get clarification from your RO/tech about how much water to drink and how far in advance you need to do it.
I traveled an hour to my hospital so I had to down 18 oz about 20 mins into the drive.
Phil

I used a clamp every day for 38 sessions. No way could I empty bowels completely without it.

My prostate radiation in spring 2022 was especially tricky because I was still in a wheelchair, with only partial nerve recovery and muscle control below the middle spine.

I wasn't usually incontinent (I was grateful for that small blessing) and I managed somehow for most of the 20 sessions. On my way into one, though, my bladder got the better of my pelvic floor too quickly to wheel myself to an accessible washroom, and I had to message my spouse to bring the emergency change of clothes in from the car, where she was waiting in the parking lot.

Good times. 😕

If the people administering my radiation treatment were telling me to conform to their expectations as to how full my bladder had to be for success, and I could not do it, I would be expecting them to come up with an alternate plan, such as giving me a lesser amount to drink, which would result in a less full bladder after a prescribed time, so I could endure the treatment.

It almost sounds like they gave you so much to drink you could not endure the treatment without needing to empty your bladder, then they treated you anyway with whatever bladder contents you had. As if, who cares, trying to stay on schedule is more important to them than whatever consequences may result for you. If that is the case, if it was me, I would refuse further treatment by them.

Obviously, your mileage may vary.

I have to have confidence in the people treating me. If they screw up, its me who has to endure the permanent damage their bungling will cause for the rest of my life, not them.

As mentioned above by several others, the pre-treatment protocol needs to be followed, and again, (my opinion)whatever you did in the Planning scan should be copied exactly for all treatment sessions. For me, it was enema 1:15 before show up time, and empty bladder(accomplished during enema) drink 16 oz of water within 10 minutes 1:00 hour before show up time. I had treatment in morning, so I just didn’t eat until treatment was done. This minimized fecal mater and gas in the bowel. My opinion, not a good idea to be experimenting with liquid intake at this point in time, and I am in agreement with your assessment of the technicians and radiation team. You took 32 ounces of water? That is a lot, and my sympathies to you. I always brought a carry bag to the treatment center. Washcloth, towel, spare underwear, gallon bag to hold dirty stuff if needed. Your body is doing stuff it is not used to, so accidents happen, and if so, not anything to be embarrassed about.

For me, I asked the Planning team if they could tell with the CT scan if I had what they determined was a full bladder, and they said Yes. (I believe the Oncologist and radiation planner uses the CT data to aim the radiation?) So I did Exactly the same thing. No food, enema, 16 ounces water. Exactly the same every time. 5 sessions for me. Even under best of circumstances if you totally escape all urinary side effects you are in minority, as explained by the oncology nurse. I think the Quoted short term side effects for proton sbrt was bowel side effects hit 1-2% and urinary hits 10-20%. The urinary part got me pretty badly, starting end of second treatment. Peaked at about 1-2 weeks after. But I am now 9 weeks post treatment and things are nearly back to before treatment.

Bless you my friend, and best wishes during this difficult time.

Interestingly, I was not required to empty my bowels for my 20 rounds of radiation therapy to the prostate in 2022 (60 gy total), just to arrive with a full bladder. I still ate lightly before appointments, though.

They told me a "comfortably full bladder " was required. There's a contradiction. The human bladder holds between 10 and 17 ounces. My team wanted 16 oz of fluid consumed in 15 minutes completed 45 minutes prior to treatment. They also wanted a bowel movement or 2 before I showed up for my nine o'clock appointment for the first couple of weeks. After that they said things would be loose enough they weren't concerned. On one occasion they came close to refusing treatment because my bowel was not empty enough