One of the more common side effects of primary prostate cancer treatment with any form of x-ray or ionizing radiation is known as radiation proctitis and the related radiation colitis.

Radiation proctitis is inflammation and damage to surrounding organs and tissue caused by stray radiation. Radiation proctitis most commonly occurs after treatment for many different cancers including prostate, cervical and colon cancers so the damage involves the lower intestine, sigmoid colon and the rectum.

Depending upon when the radiation proctitis begins it is referred to as either acute or chronic.

Acute radiation proctitis is characterized by symptoms occur in the first few weeks after therapy. These symptoms include diarrhea and the urgent need to defecate, often with pain while defecating. In most cases acute radiation proctitis resolves without treatment after several months, but symptoms may improve with butyrate enemas. This acute phase is due to direct damage of the lining of the colon.

Chronic radiation proctitis is characterized by symptoms that may begin as early as several months after the completion of the treatment, but sometimes not until several years after the completion of the therapy. The symptoms of chronic radiation proctitis include diarrhea, rectal bleeding, painful defecation, and intestinal blockage.

The intestinal blockage results from the narrowing of the rectum which blocks the flow of feces. Connections (fistulae) may also develop between the colon and other parts of the body such as the skin or urinary system. Chronic radiation proctitis occurs in part because of damage to the blood vessels which supply the colon. The colon is therefore deprived of oxygen and necessary nutrients.

Symptoms such as diarrhea and painful defecation may be treated with oral opioids and stool softeners, respectively. Complications such as obstruction and fistulae may require surgery. Possible ways to lessen the effects of radiation proctitis include sucralfate, hyperbaric oxygen therapy, corticosteroids, metronidazole, argon plasma coagulation, and radiofrequency ablation.

I have one friend who very successfully used Hyperbaric Oxygen Therapy (HBOT) caused by external beam radiation of his prostate more than sixteen years earlier (chronic radiation proctitis). He did offer one cautionary note when he described his experience. He said, “caution: I do not recommend the coffin-style HBOT. It should be in a fully operational, walk-in pressure chamber with attending physician standing by, and a qualified diver-tech accompanying the patient(s) in an extensive, four or more weeks treatment, five dives each week, approximately five hours per dive…costly in time and charges but worth it to me to regain control of my rectal sphincter.”

Have you had an experience treating your radiation proctitis which you would be willing to share? If so, please leave a comment describing your experience, why you decided to elect the treatment modality you elected and what were the results.

Joel T. Nowak, M.A., M.S.W.