Connect
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
Like
Helpful
HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
Connect
@mjp0512 Exactly! 6 down, 32 to go for me...
Bowel prep was a huge stressor for me, also. It was complicated by the fact that I have PI-IBS and Celiac.
My solution was to eat low-residue, very low FODMAP diet. I only ate one meal a day, after the treatment. I also used a glycerin suppository. I was able to do all 28 sessions without failing, although one time they kicked me off the table, and I was able to clear my rectum (without losing water - a tricky painful thin) and then get treated.
I lost a lot of weight, but I felt fine through all of it (other than the mental stress) - got up every early morning for about a 1 mile dog walk.
Good luck!
-
Like -
Helpful -
Hug
3 Reactions@melvinw Your RO’s answers sound dubious - especially the one about overwhelming you with too much information. Really? I think you caught her in one of those situations where she knew she didn’t have a proper answer for you but only an apology. I think an apology would’ve been much better than BS…
Instead, she made herself look like the all-knowing, all seeing person in control of your poor little destiny….well at least you confronted her and now maybe she’ll be more forthcoming in the future.
Glad your next treatments went better, but just exercise a bit of caution with those Senna tabs. I got kicked off the table for having too much gas at one session and I told them I took Smooth Move herbal tea, which contained Senna. Both the RO and his PA both shouted NOOO!!! in unison. They explained that Senna root causes a lot of gas and that’s how it did its magic. But if it worked for you, keep doing it until you’re told otherwise…Best,
Phil
-
Like -
Helpful -
Hug
1 ReactionThanks for sharing. I'm 23 months out from surgery and still, thankfully < .1, my first thought after reading your post was "Oh man, I thought I was done with the dreaded DRE forever after my prostatectomy". I hope your treatment goes well and thanks for sharing so others can learn.
-
Like -
Helpful -
Hug
1 Reaction@rotate Wow, that most have been challenging, to say the least. Glad you got through it.
All is going better for me after making a couple dietary tweaks. And I have a really good relationship with the radiation therapist. We are both straight up and honest with each other, and seem to work well together well. I am very thankful that. She is watching out for me, and I am grateful for that!
Many thanks for sharing your experience.
M
-
Like -
Helpful -
Hug
2 Reactions@heavyphil Yeah, I was less than impressed with her response to the issue. She has good medical creds, and I believe she knows what she is doing as regards prescribing the radiation. But she isn’t so great at answering questions that catch her a little off guard. No one is perfect, and we get on fine otherwise. And my radiation therapist is really dialed in to helping me get things right, so in some ways, that is more important to me. I’m getting good care when I’m on the table. Gratitude for that.
So far the Senna is keeping me regular with bowel movements. Adjusting my diet a bit seems to be working for controlling the gas. Also, I moved to an 11:30a time from a 1:00p time, and that works much better with how things go with my GI tract.
Cheers,
M
-
Like -
Helpful -
Hug
1 Reaction@keywest19 I’ve had so many DREs that the dread just went away after a while. Hope you stay undetectable!
-
Like -
Helpful -
Hug
2 Reactions@melvinw It was a nightmare. The best time of day was when I was on the radiation bench and the x-rays showed all was okay.
Good luck to you. It sounds like you have it under control.
BTW, I didn't have a single radiation therapist at Mayo's Phoenix proton center, but they were all very nice and very helpful. But this problem was one I had to figure out mostly myself, with a little help from the GI folks.
And I didn't mention... in the middle of all this, I caught C. diff - a nasty gut infection, and that added more steps to my regiment (taking vancomycin several times a day). It was amusing to go to radiation and see the techs donning rubber smocks and gloves, due to the contagious nature of C. diff. But they did it all in good spirits.
-
Like -
Helpful -
Hug
2 ReactionsI had the same issue... Once immediately before my first IMRT session. The oncology dietitian recommended the FODMAP diet. It did the trick and I never had a problem during my 28 IMRT sessions. FODMAP is quite challenging but it worked. Good luck.
I completed 28 radiation therapy in August 2025 - the no gas in bowels was not in the brochure. I got thru it taking 4gas pills a day n occasional enema. I had 90bowel movements in that time n twice I was told gas was present n couldn't be treated. It was even suggested I take a daily enema - that I couldn't do.