SBRT and perianal abscesses

Curious as to whether you used a rectal spacer with your SBRT?

@brianjarvis

No spacers, just empty bowel, full bladder, and 39 times struggling not to pee on the machine (mostly successful). No one ever mentioned spacers to me in 2015.

@briang1958 - Oh sorry you were asking about SBRT. No spacers there either, no mention. My SBRT Treatments were on the left and right iliac nodes. 1 zap each.

@briang1958 I can understand why rectal spacers weren’t mentioned to you.
> SpaceOAR Hydrogel was FDA-approved in 2015;
> The enhanced version of SpaceOAR Hydrogel (called SpaceOAR Vue) was FDA-approved in 2019.
> Barrigel was FDA-approved in 2022.
> BioProtect was FDA-approved in 2023.

So, they’re all fairly recent developments.

However, in 2015 when you were having radiation treatments, endorectal balloons were commonly used to minimize rectal injury during radiation treatments.

During my 28 proton radiation treatments I only had to drink 18 oz of water 30 minutes prior to treatment. 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 and never came close to having an incident.

@brianjarvis

Like everyone says - everyone has differences. I had 39 EBRTs to the prostate bed in 2015. No practice on my urine holding ability. When they took my prostate, they found a lesion on the bladder neck, so much posterior urethral reconstruction was required. Holding my pee was and is still very difficult (makes me miss the good old BPH days).

@briang1958, how is the healing going? Were you given any information about how to prevent future perianal absesses?

@colleenyoung Hi Colleen
Still no official diagnosis or cause determined. Except that is most likely due to bowel damage (radiation? not sure).
This latest surgery is still healing, and I still have a drainage tube after nearly 3 weeks. One Doc mentioned "stuck poop" as a possibility.
Treatment plan: eat better, move more, lose weight, control my type 2 diabetes.

@briang1958 That sounds truly awful and painful - feel for you!! What do these surgeries involve - incision/drainage?
Seems to me that healing would be impossible in the presence of so much fecal bacteria day in and out.
Has anyone mentioned povidone iodine suppositories for daily use? They use them sometimes in transrectal prostate biopsies; inserted one hour before, it prevents 99.5% of infections…please ask!!
Phil

@heavyphil - Yeah pretty much go to sleep and some lucky OR person gets to (well, I'm sure you get it). Last Feb I had a 3cm with external access so no real cutting, this one was 1.7cm deeper so invasion was necessary.

Thanks for the povidone iodine suggestion, I'll check it out.

And BTW, Dr. Google told me it is a possible future side effect of salvage full cavity radiation which I had 10 or so years ago. None of my current Docs have stated any correlation between by bowel issues and radiation. I am just starting with a new Oncologist a little closer to home, perhaps he has some input.