You might think that after battling cancer and completing a difficult treatment like radiation therapy, you feel a great sense of relief, right? But sometimes, after these treatments, a new problem can arise. That is, an inflammation or irritation of your rectum, the lower part of the digestive tract. Doctors call this 'Radiation Proctitis'. Today, we will talk about this simply, in a way that you can understand.
What is Radiation Proctitis?
Simply put, radiation proctitis is an inflammation of your rectum after radiation therapy for cancer in your pelvic area, which is the area below your stomach. "Procto-" means "anus." "-itis" means "inflammation." This inflammation can cause a variety of discomforts, especially changes in toilet habits.
There are several types of cancer that can cause this condition, especially when treated with radiation for cancers in the pelvic area:
- Cervical cancer
- Prostate cancer
- Rectal cancer
- Urinary bladder cancer
- Uterine cancer
- Anal cancer
When does radiation proctitis occur?
It can vary from person to person. There are two main types of radiation proctitis, depending on the time they appear:
1. Acute radiation proctitis: This is a type that appears suddenly. It can occur either during radiation therapy or a few days after treatment ends.
2. Chronic radiation proctitis: This type takes a while to appear. It can appear three months after radiation treatment, or even two years or even longer.
Importantly, about 20% of people who receive radiation therapy to the pelvic area are at risk of developing this condition called chronic radiation proctitis.
What are the symptoms of Radiation Proctitis?
This also varies depending on whether you have acute or chronic type.
Symptoms of acute radiation proctitis:
These are usually a little less, which means they're not that bad.
- Diarrhea, sometimes with blood.
- Nausea and vomiting.
- Stomach ache, feeling like you're going to throw up.
- A sudden, unbearable need to go to the toilet (rectal or fecal urgency).
- Feeling the need to go to the toilet frequently, but not being able to pass stool when you do (tenesmus).
- A little bit of bleeding from the anus.
- Mucous-like fluid coming out of the anus (mucoid discharge).
Symptoms of chronic radiation proctitis:
These symptoms are often the same as those in the acute phase. However, they can last longer and be more severe than the acute phase. In addition, the following may occur:
- Narrowing of your rectum (rectal stricture).
- The occurrence of ulcers in the rectum.
- A fistula is the formation of a new opening or passage between two body parts that are not normally connected. Think of it like a connection between the anus and the vagina.
What causes Radiation Proctitis?
The main reason is that it occurs as a side effect of radiation therapy to your pelvic area. Before you start treatment, your doctor will talk to you about the benefits and possible risks of radiation therapy to help you make an informed decision.
What are the specific causes of late radiation proctitis?
Late radiation proctitis usually occurs when radiation therapy causes the following things to happen to the rectum or surrounding tissues:
- The accumulation of scar-like tissue (fibrosis).
- Widening of blood vessels (telangiectasia).
- Narrowing of small blood vessels (arterioles).
Who is at higher risk of developing radiation proctitis?
You may be at higher risk of developing this condition if:
- If your rectum receives a radiation dose of more than 45 Gray (Gy). (Gy is a unit of measurement for radiation).
- If you have `(HIV/AIDS)` status.
- If you have inflammatory bowel disease (IBD)
How is Radiation Proctitis diagnosed?
A doctor will review your medical history, ask about your symptoms, and perform a physical exam. They may also recommend several tests to rule out other gastrointestinal diseases that have similar symptoms. These tests may include:
- Blood tests: A blood sample is taken to check for infection.
- Stool tests: A sample of your stool is checked for blood or bacteria.
- Proctoscopy: In this, the doctor carefully inserts a straight, hollow tube (which has a camera and light at one end - called a proctoscope) into your rectum and examines your rectum and anus.
- Flexible sigmoidoscopy: In this, the doctor carefully inserts a long, flexible tube (also equipped with a camera and light - this is called an endoscope) and examines the lower part of your colon.
Don't be afraid of these tests. Doctors do them to help them figure out exactly what's wrong with you.
What are the initial treatments for radiation proctitis?
It depends on the severity of your radiation proctitis. Mild cases may resolve without treatment. However, there are things you can do to reduce discomfort:
- Drinking a liquid containing water, sugar (glucose), and electrolytes (such as sodium, chloride, potassium, and bicarbonate). This is called ``rehydration therapy.'' This can help restore the amount of water lost from the body.
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Analgesics
- Stool softeners.
- Medicines that reduce body spasms (Antispasmodics).
For more severe cases of radiation proctitis, your doctor may recommend treatments such as:
- Using an enema containing a medicine called ``(Sucralfate)``.
- Applying a low concentration of formaldehyde (formalin) to the affected areas.
- Using a rectal suppository containing a type of corticosteroid called a glucocorticoid.
- A treatment called ``Argon plasma coagulation.`` In this, something called argon plasma is used to burn the bleeding areas.
- A treatment called `(Hyperbaric oxygen therapy)`. In this, oxygen is administered in a high-pressure chamber.
- Surgery to change the way stool is passed out (`(ileostomy)` or `(colostomy)`).
- Surgical removal of the affected parts.
How quickly will I feel better after treatment?
It depends on several factors:
- How much radiation treatment you needed.
- The severity of your symptoms.
- Your body's response to treatment.
Your doctor will give you a better idea about this.
What can I expect if I have radiation proctitis?
This also depends on the severity of your symptoms and whether you have acute or chronic form. Your symptoms may be mild or severe. You may have symptoms only during treatment and then go away. Or, your symptoms may go away and then come back, or they may last for a long time.
Your doctor will explain to you exactly what to expect, depending on your situation. Don't worry, they will help you.
Is Radiation Proctitis completely curable?
It varies from person to person. For some people, symptoms of radiation proctitis go away after radiation treatment is finished. However, chronic radiation proctitis can be a long-term condition, meaning you may have ongoing symptoms. Talk to your doctor about this. They will explain how they plan to diagnose radiation proctitis and how to monitor and treat it to reduce the risk of long-term symptoms.
Can Radiation Proctitis be prevented?
Doctors are trying to minimize or prevent radiation proctitis by using modern radiation therapy techniques. For example, they use methods such as ``image-guided radiation therapy`` and ``intensity-modulated radiation therapy``. These methods minimize radiation exposure to your rectal tissue and other surrounding tissues while killing cancer cells.
They may also try things like these to minimize radiation exposure to healthy tissue:
- You will be placed supine during your radiation treatment.
- It provides protection by injecting a substance called ``collagen'' between your rectum and prostate gland.
- A water-filled balloon (endorectal balloon) is carefully inserted into your rectum to help hold the prostate in place.
What is the best diet for radiation proctitis?
Your doctor may recommend changes to your diet to reduce gastrointestinal symptoms that can further damage inflamed tissues. They may recommend things like:
- Reducing dairy products (milk, cheese, butter, yogurt).
- Limiting foods high in saturated fats (eggs, fatty meats - beef, fatty parts of pork, skinless poultry - and oils - coconut oil, palm oil).
- Eating more fiber-rich foods (fruits, vegetables, beans, lentils, nuts, etc.) Things we can eat in Sri Lanka like kohila, mukunuwenna, and banana are very good.
When should I see a doctor?
If you have symptoms of radiation proctitis, be sure to see a doctor. Also, if you are diagnosed with radiation proctitis and your symptoms do not improve after treatment, let your doctor know.
What questions should I ask the doctor?
You can ask your doctor questions like these:
- What are my chances of developing radiation proctitis?
- Do I have acute radiation proctitis or chronic radiation proctitis?
- Why does chronic radiation proctitis take so long to appear?
- Is my condition mild or severe?
- What treatment do you recommend?
- Will treatment cure my symptoms, or will they come back?
What is the new name for Radiation Proctitis?
Another name for radiation proctitis is radiation proctopathy .
Another name for chronic radiation proctitis is radiation-associated vascular ectasias (RAVE) .
What vitamins are good for radiation proctitis?
Some studies have found that vitamin C and vitamin E may help reduce symptoms of radiation proctitis, such as diarrhea, rectal bleeding, and rectal urgency. However, it is best to talk to your doctor about this.
Finally, take-home message:
Going through cancer treatment can be stressful. It can be even more challenging when you have problems with your toileting habits. Radiation proctitis can occur during your treatment, or months or even years later.
Therefore, if you notice any changes or discomfort in your toilet habits, it is very important to tell your medical team about it. They can diagnose whether the cause is radiation proctitis and recommend the most effective treatment for you. Remember, you are not alone, and there are doctors who can help with these things.
` Radiation Proctitis, Radiation Therapy, Rectal Inflammation, Cancer Side Effects, Pelvic Radiation, Acute Proctitis, Chronic Proctitis
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