Bladder and Bowel Preparation for prostate radiation

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 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 🙂

Ask your Doctor Nurses etc. about this. They might be able to offer some suggestions. There are some enemas that don't have laxatives/stimulants in them. You might also consider some anti cramping drugs like bentyl that slow down your intestines.

Healthy Fiber on Amazon; or Miralax. My RO discouraged enemas daily because of irritation to the rectum. Maybe with SBRT it’s limited but not for 25 or more sessions. Bowel prep is a challenge, no doubt about it!

Are there any documented problems with doing an enema or enemas not too long after fiducial markers and a spacer is placed? Thank you.

I had exactly what you are experiencing but no required enema. The OAR did its job, thank goodness. Best of luck to you.

Perhaps there is a difference in protocol depending on the number of treatments, methodology (proton vs traditional radiation aka photon radiation) and the location of your treatment. (For example: I believe there is some difference btw Mayo MN and Mayo AZ; both do proton beam treatment.)
I have detailed my experience here: https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/?pg=4#comment-708134
Briefly, I had five Proton Beam treatments (over two weeks) in Feb 2020 at the Mayo Clinic in Rochester MN. I had the SpaceOar spacer and fiducial (carbon?) marker placement about a week before treatment.
I had an enema before each treatment at an area in Mayo focused on that. I didn't find it embarrassing, nor did I have to insert the enema prep myself (a friend at home getting 25 traditional xray treatments had to handle his own enema each day - it wasn't always easy or 'fun'). I don't remember any requirement to drink a large quantity of water. There was no insertion of anything into my rectum (for treatment).

Not all facilities are equal or take the same approach for the same type of therapy. Loma Linda is one of the oldest hospitals providing proton beam treatment. I think the method of delivery may have changed but I believe they still use a 25 treatment protocol. It may also be worth saying that not all facilities charge the same amount for (nearly) identical therapies. Its my casual impression that Mayo MN may charge very low amounts for Proton Beam Therapy - maybe due in part to donors with deep pockets.

I will be having the traditional external beam radiation therapy. I, too, had the SpaceOAR implant as well as the fiducial markers. It sounds like you did not have to empty the bowels each day w/emema, and your water intake was half of my recommended volume. I wonder why the difference? My friend also had Proton therapy at the Phoenic Mayo and experienced no pain during each of his 28 treatments. He has been cancer -free for ten years. I am hoping for a positive outcome even with these differences.
Thanks for your input.

Addendum: Have read about or talked to close to men who have had proton therapy and not once has anyone indicated an enema as part of prep.

Have completed 19 of 29 proton treatments and had Space OAR. Only preparation each day is filling bladder with water one hour before treatment. Most of the time I am in the range and maybe 4 times have had to drink more and wait 10- 20 minutes before treatment and a few times have had to drain some off. Slightly uncomfortable not being able to pee when you choose to but easily tolerated. I try to have a bowel movement before I go so as not to have excess gas ( eat prunes in the morning)that has to be released by the nurse. So far, I am batting 1,000.
Preparation is actually easily done.