IMRT Low Fiber Diets and Normal Bowel Movements

swl1956

This coming Tuesday I'm beginning 8 weeks of IMRT radiation treatments. They want me to start eating a low fiber diet to minimize gas in the bowels. Evidently gas can cause the prostate and other organs to move around a bit which could affect the accuracy of the beam radiation. Also they want me to empty my bowels and have a full bladder daily before receiving treatment. I currently eat a high fiber diet which has kept me regular for years, but just recently I had to go on a temporary low fiber diet for a few days prior to a radiation planning visit where they did CT and MRI imaging then tattooed 4 small dots in the groin area for alignment purposes which will be used during treatment. Anyhow, just those few days of low fiber really messed with my bowel movements. I was not regular and was constipated. Ended up aggravating a hemorrhoid. I'm worried about how to prepare and address these issues. Has anyone any advice on how they dealt with maintaining regularity and a healthy anus during these weeks of radiation treatments while eating a low fiber diet?

Clevelandguy

Hi,

I would not doubt you bathroom habits will be screwed up getting use to the low fiber. I would think the hemorrhoids are a result of straining. Ask your doctor if you allowed to take a gentle laxative. Your local pharmacist might be able to recommend something.

Dave 3+4

Marlon

Post surgery, I was advised to take over-the-counter stool softener. Even started in the hospital. Softener is not a laxative, but eases straining.

centralPA

Exercise

Nothing gets my GI tract in fighting form like going out jogging. Hiking and walking too. Exercises that directly involve the core like squats and situps. Going for a walk with a backpack with some weight in it. Great for your mental health too!

Turn this journey into something with at least an element of positive in it. Give yourself a gift of time spent moving. Put on some headphones and walk to a happy place.

swl1956

https://csn.cancer.org/discussion/comment/1721226#Comment_1721226

Yeah! Or maybe crap my drawers and piss myself whilst I'm three miles from a toilet. Lols!

I do routinely walk about 3 miles everyday the weather permits. It has and is helping me immensely. Can't say I'm in a happy place though. Just got my PSA results after a few weeks on Orgovyx. Has reduced it from 9 down to 1. I know it's only part of the battle, but at least it's putting a temporary hurting on the bandit. I'd be less happy if it were still rising.

VascodaGama

Hi,

Along the weeks of my IMRT I continued eating my breakfast of 100% bran + plain yogurt without any trouble for the treatment. Surely I am not asking you to do the same but I felt very well.

Josephg

I did not materially change my diet during my IMRT therapy. There were times that my stools were a bit soft, but never anything to be concerned about. Prior to IMRT, I was given a bottle of a specific size, and I was told to drink the entire container of water 1 hour before each and every IMRT session. I was also told to empty my bowels as much as possible before each IMRT session.

I was fortunate to have the first scheduled appointment at the radiation facility each day, so I was able to proceed onto work at the end of each IMRT session.

swl1956

Spoke with Radiation technician yesterday at the Fox Chase facility where I will be getting my imrt treatments. She claims it's very important to have a empty rectum. I explained that my regularity has become sporadic due to attempting to eat a recommended low fiber / residue diet and currently would be impossible for me to achieve routinely (for 40 treatments) She told me it's more important to be able to empty the rectum prior to radiation. So if that means going back to my usual diet so be it. I think I'll just stay away from the foods that cause me gas. Perhaps a gasX pill may be in order? I will be receiving cone beam imrt. They did not implant fiducial markers, but tattooed my abdomen in 4 locations for alignment purposes. They do a daily CT scan as well. I've been reading that a newer technology of MRI guided radiotherapy has advantages over the one I will be receiving, but due to scarcity of these machines and distance to get to one it is was it is. I feel at bit nervous about not getting the latest and greatest technology. I must admit it's causing me some paranoia.

Oldernow

My two cents worth -

I had my 28 radiation sessions at a Cleveland Clinic associated hospital in May to June of 2023. I was told to have an empty rectum and a FULL bladder for each treatment. This was accomplished by developing a routine. They gave me a measured container to insure I was drinking a consistent volume of water before each treatment. Also took GasX to insure the rectum was empty of air as well as stool.

I had the tattoos for alignment and a pre-treatment CT scan at each visit. I could feel the table move after the CT scans to tweak my position for the radiation treatment. I was told that I was doing a great job with the full bladder/empty rectum routine based on the daily CT scan.

The radiation (along with Lupron ADT) rendered my PSA undetectable (<.03). Thankfully, it has remained undetectable going on two years.

The downside - within a few months of finishing the radiation, I developed radiation proctitis. Apparently even though I did a "great job" with the daily prep, my rectum was damaged by the radiation. None of my doctors (urologist, radiation oncologist) ever mentioned SpaceOAR. Knowing what I know now I would have insisted on them using that spacer gel to protect my rectum. I now have to contend with occasional blood and mucous in my stool and must take daily big doses of Metamucil to bulk the stool to avoid further irritating the damaged rectum.

I will get my next PSA in April 2025. Hoping it is still <.03…

While the proctitis is a pain in the butt (pun intended), the real ongoing issue relates to the ADT (Lupron) treatment. The desired effect of the ADT is to block testosterone production to starve the prostate cancer cells that thrive on it. It is very effective but has drastic and long lasting side effects. Even 19 months after my last injection my testosterone remains extremely low. I have been in and out of physical therapy due to loss of muscle tone leading to serious knee issues. I have an upcoming appointment with an orthopedic Surgeon to see what I can do about my super painful knees.

Sorry to ramble - that was definitely more than two cents worth..

I think we have all found on this site that it is therapeutic to vent from time to time.

Best of luck on your journey -

Oldernow (and a bit wiser)

Marlon

Why are enemas pre-treatment not part of the protocol? I would have assumed that it was only the very lower part of the rectum that would be exposed.

swl1956

https://csn.cancer.org/discussion/comment/1721307#Comment_1721307

Thank you for your rambling Oldernow, Much appreciated

I'm sorry you have to deal with the proctitis. I've read where there are treatments for it. Have you tried any? Sounds like you didn't have any urinary issues? I'm scared about both of these. My radiation oncologist says that 40 IMRT sessions which I have chosen will have a lower incidence of side effects than the now more common 25 sessions. Can't say I'm looking forward to two months of treatments though. She recommended not having the Spaceoar installed due to the ablated area in my prostate from the Electroporation Focal Therapy I had. She also noted that it would delay treatment by several weeks and sometimes there are complications with the Spaceoar installations. I've been on Orgovyx (relugolix) for several weeks now which hasn't given me any trouble yet other than a few night time hot flashes. It has lowered my PSA from 9 down to 1 in only a couple months. Orgovyx is supposed to be better for testosterone recovery after stopping it than Lupron. I think Orgovyx is relatively new. They probably didn't offer it to you? I will also be starting on Zytiga (abiraterone) with prednisone. I imagine the ADT side effects may increase? I find it very frustrating knowing that there are newer linear accelerators that use MRI imaging guidance that very much reduce the potential side effects. Just none are convenient enough for me to get back and forth to. I'm glad your PSA is undetectable. 😀

swl1956

https://csn.cancer.org/discussion/comment/1721308#Comment_1721308

Beats me, but I'm glad they're not!

Oldernow

https://csn.cancer.org/discussion/comment/1721316#Comment_1721316

Thanks for your kind words.

We're all different in the way we react to these treatments. Glad you were able to get Orgovyx. It was mentioned back in 2023 but my urologist and the radiation oncologist seemed to think the tried and true Lupron would be the way to go. They also didn't think my Medicare would cover it completely, if at all. It's true that you should recover your testosterone quickly after you stop the Orgovyx. At my age (78) I'm told I may never fully recover the testosterone level I had before Lupron. They even said I may need testosterone replacement therapy to get some normalcy back.

The adventure continues…