Initial Conditions for Daily Radiation Sessions

it is about timing- I would recommend a late morning time- by then, you should ahve had time to dump and fil everything...start with some good strong coffee and a can of prune juice ! then plenty of water...but not so much you cant get thru the session..

believe those sessions last about 30 min each ?

Some great info here...good luck.
https://connect.mayoclinic.org/discussion/one-week-of-imrt-for-recurrent-pca-issue-with-empty-rectum/

And on a side note: your bladder must be huge. I'm only drinking 27oz (which is 3oz more than instructed) 1 hour prior to schedule to get a full bladder. 64 oz I'd never make the drive to the cancer center. 😮

I’m 2.5 weeks into my salvage IMRT, and as you know, our journeys are similar. The bladder filling is the easy part—mostly a hydraulics problem that can be controlled for consistent results. The empty rectum thing is a bit more complex. I seem to have it worked out now, although the first week was rough. I’m sure I will have days where it isn’t quite optimal, but so it goes.

Some things to share from my ongoing experience:

- get feedback from the radiation team. How’d things look today? Connect what you feel going on down below to what they see. The biofeedback really helped me get dialed in.

- my appointments initially were at 1:00pm. That was causing problems for me. I would eat breakfast around 7:00am, have a BM shortly thereafter, then fast until after the treatment. By noon or so, my guts would start rumbling and things were moving. Gulping down 28 oz of water just before my appointment (as required for the full bladder) just stimulated more lower GI activity. I was able to switch to 11:30am and that made a huge difference for me.

- I’m keeping a detailed journal, noting any changes in sensations, bodily habits, side effects, etc.

- I switched my diet up a bit. My normal diet is para-vegan with a lot of whole grains and beans (I still eat chicken but don’t eat dairy). I cut out the beans, have oatmeal with fruit and walnuts for breakfast then don’t eat again until after treatment. It is working. I also upped by yogurt (nondairy) consumption. Come Friday afternoon and Saturday, I “treat” myself to eating as I please. Sunday is a return to the regiment.

- I posted this in a couple other threads, but the attached guidelines from the VA on nutrition during RT for PCa have been really useful for me.

Last comment (for now) that is a bit humorous. Last week I started feeling some physical fatigue and brain fog. The brain fog seemed odd for radiation to the pelvic region and I couldn’t find any literature to support a connection. On Friday it dawned on me that I had stopped drinking coffee a few days before starting RT. So, I brewed up a cup of joe and said hello to an old friend. By the time I was finished with the cup, the fog was lifting and the fatigue dissipating. Go figure. So, one cup of coffee every morning is back into my daily routine and my energy levels and brain functioning are normal again. Seems to have no notable effect on my excretory functioning. If I start experiencing bladder irritation, I’ll re-evaluate.

The empty rectum challenge seems to be fairly universal. Lots of good advice here and different solutions. It just takes some messing around to get it right.

An ancient Irish blessing for RT for PCa (that I totally made up): May your bladder be full, and your rectum be just as empty.

Cheers,
M

There’s always the enema route…My RO discouraged them but at times it was either enema or NO treatment due to feces/gas.
Do what you have to do to get thru the sessions but I wouldn’t advise a daily enema since they can irritate the rectum. Best,
Phil

Are you sure about the “64-80ozs H2O?” I think the maximum bladder size is 1/2 that volume.

For me, that was just 18oz of water to drink just 30 minutes prior to each fraction. I emptied my bladder 45 minutes prior to treatment time, started the 40 minute drive to the radiation center, 10 minutes into the drive drank 18oz of water, arrived at the treatment center 30 minutes later, and had the treatments. Worked every time; never had a problem.

As for the other issue —> The rectum being “empty” didn’t mean it had to be clean like it is for a transrectal biopsy. What my radiation oncologist told me was what they really mean is nothing in the lower intestine, material or gas, that might move during the radiation treatment and cause the prostate to move. So, no gassy foods that might cause issues; so at the same time as emptying the bladder 45 minutes prior to treatment (as I mentioned above), I would also empty bowels. Worked every time; never had a problem.

The full bladder/empty bowel routine was easy to manage. 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.

You just have to find a process that works for you.

@heavyphil that's exactly what I used when I recently underwent 5 SBRT sessions. Even if I had somewhat of a BM I would use a enema before leaving home for my session. It worked well for me.

It's very helpful if they schedule at the same time every day. My first 2 weeks, my schedule was all over the place, 10AM to 3PM, even on alternating days. Tough to get a bowel routine going. Glad that's behind me...😂🤣

It took me two days to figure out how to have empty bowels and full bladder for 5 weeks of daily IMRT treatments. Laxative did nothing for me but a full cup of coffee about 1.5 hours prior to my scheduled sessions and drinking a full 33 oz Smart Water on the one hour drive to the facility did the trick.

I was fortunate to have never been sent out of the treatment room to empty my bowels or drink more fluids. In fact, some days they said my bladder was 110% full...not sure how that worked? Many other men were often sent out to drink more water before the RO team could administer their treatments.

Consider the coffee + water program...

I did a Fleet enema every morning. It's really not bad. Put it in and done in a 1/2 hour, nothing like a colonoscopy prep. It's just a lower bowel treatment, not like a laxative. There were times in the waiting room where people weren't clean and needed to get cleansed before the procedure. Fleet is available at most pharmacies.