Bowel and bladder problems

Treatments for prostate cancer such as surgery, external radiotherapy and brachytherapy may cause damage or inflammation to organs near the prostate such as the bowels and the bladder.

Men we interviewed described episodes of bleeding from the back passage, diarrhoea, constipation and damage to the bowel after radiotherapy.

Explains how he developed problems with the back passage after radiotherapy.

Age at interview 70

Gender Male

Age at diagnosis 66

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There were 20 sessions of that [radiotherapy] and it was halfway through that I discovered that I was having problems with the back passage which I mentioned to them and they well you know you were sort of told that this could happen. And that gradually got worse, even when the treatment finished that got worse and that’s still there and I am told that it will never heal up. What it is it’s damage, I think it’s called proctitis, it’s damage to the back passage caused by the radiation treatment, it’s radiation to healthy cells. The tissue doesn’t heal up properly and the result is you have to keep your bowels as regular as you possibly can because if you don’t you’ll just aggravate it, you’ll make it worse. And also the frequency is increased, instead of possibly just going once or even twice a day you know at the extreme you might have to go three times a day, but the plus sign is you do go as soon as you wake up.

Is it sore as well?

It’s not now, it was for the first, it can be painful you know immediately after you’ve had an evacuation but it’s nothing like as sore and as painful as what it used to be and I very rarely use any treatment now. Now the treatment, I tried all the treatments that there are for back passage problems and the best one I was found was Proctofoam.

Is that like a sort of cream?

It is actually a foam and it’s inserted into the back passage via a crude kind of hypodermic, like a syringe.

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Describes how radiotherapy severely affected his bowels.

Age at interview 69

Gender Male

Age at diagnosis 67

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Well the, I had the radiotherapy from February to March, that was not unpleasant but the consequences of it were unpleasant, I think the regularity of my bowels opening 8 hours after I’d eaten you know were like clockwork. You know you could, exactly 8 hours after I’d finished a meal I was going to the toilet and I could expect to be, I had to be near the toilet to do that. So the trick was as I drove, went for the treatment by myself, nobody else went with me, I would try and delay the times I would eat so that it would fit in so I wasn’t caught unawares.

So does the radiotherapy affect your bowels?

Oh yes, oh yes.

Could you explain more about that?

Well very severe diarrhoea, very severe and it would be, again that was explained to me I was going to get a problem here and that my rectum would probably be injured as a consequence of the radiotherapy. That was all explained to me before, you don’t know what it means until you get it and then you realise what they mean. But we were all prepared for it so that was, we coped with that and the consequence of that lasted about 3 weeks after the treatment and then it’s gradually got better since.

Are there any other side effects as a result of the radiotherapy?

Not really, not really no. It was just, just that and it has injured my rectum and currently I’m doing this course, a week ago last Friday I was told that the tumour was gone and that I explained the symptoms to the specialist, he said ‘Well the best thing it will get better with time. Now once I’d heard that I said ‘Right well take a course of hyperbaric oxygen to see if that repairs it quicker, makes it you know affects a quicker repair.

What’s hyperbaric oxygen?

It’s breathing pure oxygen under pressure for about an hour, that enriches the blood and it’s used widely for mending limbs or repairing injuries or sporting injuries in particular, ulcers, it cures gangrene so if anything that I can do to improve my well being I’ll do it.

When you said it’s damaged, is it just sore or raw?

Well the frequency bowel opening, as soon as theres some faeces gets into the rectum it has to… it has to come, go to the loo basically. That’s right.

So the muscles lack tone?

That’s right yes, get that back so that at least I’m just opening my bowels once a day instead of 2 and 3 times.

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Comments on the symptoms he developed after external beam radiation.

Age at interview 65

Gender Male

Age at diagnosis 63

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At this stage I’m beginning to develop one or two symptoms and the main symptom is that the back passage is bleeding which I understand is quite a normal thing, and passing motions becomes very sore and quite unpleasant and I would imagine perhaps like someone has got very bad piles and the bleeding associated with the piles was very much the experience that I was having. It was important at that stage to keep myself particularly loose because otherwise it was excruciating if I didnt eat lots of fruit, roughage things like that, to make sure that I could pass motions easily. That was one aspect of it.

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Describes the problem with irregular bowel movements after radiotherapy.

Age at interview 77

Gender Male

Age at diagnosis 76

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The only thing is after I finished then we my bowels become irregular.

Your bowels became irregular?

Irregular and like you see very hard pieces, very hard, it was a problem to pass them so I asked my GP here and he gave me medicine. There I told them they said nothing to worry, this happens. And I never realised because I never looked, then after this had finished, after 4 weeks my wife, one day I was changing my clothes, she looked at my abdomen she said ‘It’s all black what is this?’ and I had never realised it, I looked and I said ‘Oh what is this?’ and then I asked the doctor, he said it is because of the radiotherapy.

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Radiotherapy sometimes results in pain and inflammation of the bladder, and a burning sensation during urination, the need to urinate more often, a sudden urge to urinate and difficulty urinating. Some men may also experience leaking urine but this is not common with radiotherapy. Brachytherapy may cause temporary urinary problems from swelling of the prostate after the insertion of the hollow needles when the seed implant is performed. Brachytherapy may also cause temporary bowel problems.

Comments on the discomfort in urinating after having radiotherapy.

Age at interview 70

Gender Male

Age at diagnosis 66

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Were there any other side effects of the operation or the radiotherapy, apart from the back passage soreness?

Apart from the, burning sensation and obviously when you’re urinating that can be painful and that still, that still exists today and that I’m told is due to due to the radiation treatment in the prostate area. It’s all very tender and you know it’s all been upset and it resents it kind of thing. But following that 7 months later after the operation I had to go back in again to have a, there was a stricture in the urethra?

Urethra yes.

There was a stricture there that had to be sorted out, a further bladder incision. I don’t know what that was all about but that, I had to have that done.

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Describes his temporary problems with passing water after Brachytherapy.

Age at interview 59

Gender Male

Age at diagnosis 59

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After the Brachytherapy, although at no time did I suffer any embarrassment I felt that the opportunity to be embarrassed was there. So this, you know I phoned the doctor up because it was extremely uncomfortable and very painful and I’ve since seen the doctor and this is one of the side-effects that certain people experience. I experienced this pain in the bladder and trouble passing water and passing water far too often to get involved in doing anything else and this obviously leads to a lack of confidence and you don’t feel like leaving home. But this has improved dramatically over the last week and it’s nearly, I wouldn’t say it’s nearly back to normal that’s probably right but it’s on it’s way and this is one of the symptoms that you may get. And the doctors aren’t worried so far be it for me to be worried because I don’t have their experience and I’m sure they’re right. And my confidence is gradually returning and I can go out of the house.

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Prostate cancer surgery can cause urinary problems if muscles or nerves are damaged. Problems include; leaking urine and difficulty urinating. One man, who had had a prostatectomy, described some urinary problems after the operation. Another man had bowel problems after he had a radical prostatectomy (bowel problems are rare after radical prostatectomy).

Describes the urinary problems after having a prostatectomy.

Age at interview 63

Gender Male

Age at diagnosis 56

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Since the operations theres been problems with what terminology used to me as scaring of the urethral tube and I’ve had three sort of mini small operations then shall I say to remove that scar tissue an experience again all of its own. Early days during that had its limitations with passing urine, and the fact of a limited flow but from each time of taking this local operation which meant a small, again instrument being passed down through your penis into the area where the operation and the joining up had taken place in the tube was just a matter of clearing that out and scraping it out and taking some small items away from there that were blocking it and since then that sort of thing has been, not created any problems at all.

Was that another general anaesthetic?

No they were done by local anaesthetics…

Epidural?

No just local freezing.

I still get some irritation there, you still get some urgency and you still do feel uncomfortable from time to times in passing water but my experience since then has been quite good. The other effect though, the other thing that I do suffer with at the moment is that I’ve got a hernia which seems to be related to the one of the drain areas and I suppose if I have any problems at all in total re the prostatectomy it’s more related to that than what it is to the bladder, the penis or passing of any water.

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He developed bowel problems after he had his prostatectomy.

Age at interview 49

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And what was recovery like?

Well, I mean what I call doctors, one collects every complication going. I had bled during the surgery and after the surgery I was totally incontinent, but only urinary incontinent. But my bowels had been altered but not, I’m glad to say to give rise to incontinence. But I developed the symptoms and signs of a mega-colon, which was trying, particularly if the pelvic floor isn’t as strong as it was so you have the combination a mega-colon and poor pelvic floor. So that was a bit of a problem. And one has, of course, a very sore bottom when you wake up from the prostate [operation].

Do you mind explaining to other people what a mega-colon is?

A mega-colon is when one’s colon is dilated, when you have a mega-colon, so it becomes almost like a reservoir so instead of being a muscular tube which is going to propel the faeces along, it becomes a collecting tank for faeces. Is that a good description do you think?

In practical matters it becomes ‘?

Practical matters instead of saying well I want to go to the loo, I must go to the loo, one’s bowel seems almost never to be properly emptied. But it can become very over-full and so even without being constipated in terms of having hard faeces or that type of problem, one does have a great faecal mass which has to be expelled from time to time. And there’s not much muscle power to do the expulsion because the propulsive, the peristaltic power of the colon has rather diminished.

And the side effects, the bowel problem, how long did that go on for?

Still have it. And so that’s 6 years.

So that’s a permanent’?

Yes, I was just left with that. And then one was, of course, impotent.

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National Institute for Health and Care Excellence (NICE) guidelines 2014 (CG175) recommends that men ‘with troublesome urinary symptoms after treatment have access to specialist continence services for assessment, diagnosis and conservative treatment. This may include coping strategies, along with pelvic floor muscle re-education, bladder retraining and pharmacotherapy.’ And in some extreme cases men with intractable stress incontinence should be referred to a specialist surgeon to discuss the possibility of an artificial urinary sphincter.

High Intensity focused ultrasound (HIFU) is thought to reduce bowel and bladder side effects. However bowel and bladder side effects may still occur. It is still a new treatment and more data is needed to assess its effectiveness in reducing side effects.

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