Radiation Proctitis

What is radiation proctitis?

Radiation proctitis is inflammation that occurs in your rectum after radiation therapy to treat cancer in your pelvic area. This may include:

• Cervical cancer
• Prostate cancer
• Rectal cancer
• Urinary bladder cancer
• Uterine cancer
• Anal cancer

“Procto-” means “rectum” and “-itis” means “inflammation.” The inflammation can cause many symptoms, including discomfort and changes to your bathroom habits.

When does radiation proctitis occur?

It depends. There are two different types of radiation proctitis, and they develop at different times. They include:

• Acute radiation proctitis. This type develops suddenly. It may develop during radiation therapy or shortly after completing it.
• Chronic radiation proctitis. This type takes longer to develop. It can occur three months or even two or more years after radiation therapy.

Chronic radiation proctitis affects up to 20% of people who go through radiation therapy in their pelvic regions.

What are the symptoms of radiation proctitis?

It depends on the type of radiation proctitis you have.

Acute radiation proctitis symptoms are generally milder. They may include:

• Diarrhea, which may be bloody
• Nausea and vomiting
• Abdominal cramping
• A strong, sudden need to poop (rectal or fecal urgency)
• Frequent urge to poop but you can’t go (tenesmus)
• Mild rectal bleeding
• Mucus-like discharge from your anus (mucoid discharge)

Chronic radiation proctitis symptoms are often the same as acute radiation proctitis symptoms. But they may last longer and be more severe than acute radiation proctitis symptoms. They may also include:

• Narrowing of your rectum (rectal stricture)
• Sores (ulcers) in your rectum
• An opening or tunnel that develops between two body parts that don’t usually connect (fistula)

What causes radiation proctitis?

Radiation proctitis may develop as a complication of radiation therapy in your pelvic area. Before you start treatment, a healthcare provider will review the benefits of radiation therapy and weigh them against the potential risks so you can make an informed decision.

What causes late radiation proctitis?

Late radiation proctitis usually develops because radiation therapy causes:

• Scar-like tissue to build up in your rectum or the surrounding tissues (fibrosis)
• Wide blood vessels (telangiectasia)
• Narrow arterioles

Who does radiation proctitis affect?

You may be at a greater risk of developing radiation proctitis if you:

• Receive a dose of radiation to your rectum greater than 45 gray (Gy)
• Have HIV/AIDS
• Have inflammatory bowel disease

How is radiation proctitis diagnosed?

A healthcare provider will review your medical history, ask questions about your symptoms and perform a physical exam. They’ll also recommend testing to make sure it isn’t a gastrointestinal disease that has similar symptoms. These tests may include:

• Blood tests. A provider takes a blood sample to look for signs of infection.
• Stool tests. A provider examines a sample of your poop for the presence of blood or bacteria.
• Proctoscopy. A provider gently inserts a straight, hollow tube with a camera and light at the end (proctoscope) to examine your rectum and anus (butthole).
• Flexible sigmoidoscopy. A healthcare provider gently inserts a long, flexible tube with a camera and light at the end (endoscope) to examine the lower part of your large intestine (colon).

What is the first-line treatment for radiation proctitis?

It depends on the severity of your radiation proctitis. Mild radiation proctitis may heal on its own without treatment. But you can help alleviate discomfort with:

• Drinking a formula of water, sugar (glucose) and electrolytes (sodium, chloride, potassium and bicarbonate) to rehydrate your body (rehydration therapy)
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Analgesics (painkillers)
• Stool softeners.
• Antispasmodics

For more severe radiation proctitis, a healthcare provider may recommend:

• Enema with sucralfate
• Applying a low concentration of formaldehyde (formalin) to your affected areas
• Inserting a type of corticosteroid (glucocorticoid) into your rectum (rectal suppository)
• Argon plasma coagulation
• Hyperbaric oxygen therapy
• Surgically changing the way poop exits your body (ileostomy or colostomy)
• Surgically removing the affected areas

How soon after treatment will I feel better?

It depends on several factors, including:

• How much radiation therapy you need
• The severity of your symptoms
• Your body’s response to treatment

A healthcare provider will give you a better idea of what to expect.

Can radiation proctitis be prevented?

Healthcare providers try to minimize or prevent radiation proctitis by using modern radiation therapy techniques, such as image-guided radiation therapy and intensity-modulated radiation therapy. These techniques destroy cancer cells while minimizing radiation exposure to your rectal tissue and other tissues in the surrounding area.

They may also try to minimize radiation exposure to healthy tissue by:

• Placing you face-up (supine) during your radiation therapy treatments
• Injecting collagen between your rectum and prostate to provide protection
• Gently inserting a water-filled balloon (endorectal balloon) into your rectum to keep your prostate in place

What can I expect if I have radiation proctitis?

It depends on the severity of your symptoms and whether you have acute or chronic radiation proctitis. Your symptoms may be mild or severe. You may only have them during treatment, or they may go away and come back or last a long time.

A healthcare provider will give you a better idea of your outlook and what exactly you should expect according to your unique situation.

Does radiation proctitis ever go away?

It depends. For some people, radiation proctitis symptoms go away after completing radiation therapy. But chronic radiation proctitis may be a long-term condition that causes persistent symptoms. Talk to a healthcare provider. They’ll explain how they plan on detecting radiation proctitis and what they’ll do to monitor and treat it to reduce your risk of long-term symptoms.

What is the best diet for radiation proctitis?

A healthcare provider may recommend changes to your eating patterns to reduce any gastrointestinal symptoms that can further irritate inflamed tissue. They may recommend:

• Cutting back on dairy products, including milk, cheese, butter and yogurt
• Restricting foods high in saturated fats, including eggs, high-fat meats (fatty cuts of beef and pork and poultry with skin) and oils (coconut oil, palm oil and palm kernel oil)
• Eating more high-fiber foods, including fruit, vegetables, beans, lentils, seeds and nuts

When should I see a healthcare provider?

Call a healthcare provider if you have symptoms of radiation proctitis. You should also reach out to a provider if they diagnose you with radiation proctitis and your symptoms don’t go away after treatment.

What questions should I ask a healthcare provider?

Questions you may want to ask your provider include:

• What are the chances that I develop radiation proctitis?
• Do I have acute radiation proctitis or chronic radiation proctitis?
• Why does chronic radiation proctitis take so long to develop?
• Is my case 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?

Vitamin C and vitamin E may help reduce radiation proctitis symptoms such as diarrhea, rectal bleeding and rectal urgency.