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How can prostate cancer treatment affect bowel function?
Problems and changes in your bowel function can occur from a range of prostate cancer treatments.
Follow the links below to see an overview of the side effects that you may experience with or after each specific treatment.
- Surgery side effects
- Radiation therapy side effects
- Hormone therapy side effects
- Chemotherapy side effects
- Focal therapy side effects
- Theranostic side effects
Side effects can happen because your prostate gland sits just in front of your bowel and rectum, so these areas can be affected by treatment. Radiation therapy may cause the most side-effects. It can sometimes inflame the lining of your bowel and rectum causing irritation, leading to diarrhoea, bleeding from your rectum through your anus (bottom), gas and pain.
With all treatments, your bowel problems can sometimes improve quickly, but sometimes they don’t go away so you may need further support from your healthcare team. You can also reach out to a PCFA nurse if you need advice or more information on treatment side effects.
This section of your toolkit explains the symptoms that can affect your bowel function during or after treatment and how you can manage them.
What bowel-related side effects can you experience after prostate cancer therapy?
The bowel-related symptoms that you may experience after prostate cancer treatment include:
- Changes in faecal consistency, frequency and urgency
- Rectal bleeding, pain and proctitis (inflammation of the rectum)
- Bowel incontinence
- Diarrhoea and constipation
- Flatulence (gas or wind), bloating, mucus in your faeces
- Fistulas (a hole that forms between your urethra and rectum)
Changes in faecal consistency, frequency and urgency
During the second half of radiation therapy treatment, you might feel the need to go to the toilet to open your bowels more frequently or more urgently, though you may not pass much. Occasionally, you may be prescribed suppositories to reduce the irritation in your bowels.
Diarrhoea is less common. You may pass some mucus or have excess wind and/or discomfort when you go to the toilet.
Rectal bleeding, pain and proctitis
Occasionally, radiation therapy can damage the lining of your rectum causing inflammation and bleeding– this is called radiation proctitis. Other symptoms of proctitis are feeling like you need to open your bowels, pain, gas, bloating and passing mucus.
Proctitis usually goes away by itself, but sometimes the symptoms continue. It can also occur months or years after radiation therapy.
Focal therapy may also cause rectal (bottom) pain.
Surgery may cause bleeding from your bowel (although this is rare). Always tell your doctor if you notice blood in your faeces, as it may have a different cause that needs to be investigated, and not be related to your prostate cancer treatment. Your doctor may ask for further investigations to rule out other problems, such as bowel cancer.
How is bleeding from your bowels managed?
Contact your doctor, a member of your healthcare team or go to a hospital emergency department if you experience bleeding from your rectum (bottom)
Your doctor may recommend a colonoscopy to see if the bleeding is from radiation scar tissue or something else. If you have proctitis, you may be given medicine to treat it. Bleeding may also be treated by laser treatment or surgery.
If the bleeding doesn’t respond to treatment, your doctor may recommend a special therapy called hyperbaric oxygen therapy, which involves breathing oxygen inside a pressure chamber for 1 to 2 hours. This helps the tissues in your bowel to heal and get stronger.
Bowel incontinence
Bowel incontinence (or faecal incontinence) is an involuntary leaking of faeces (poo). The amount of leakage may vary from a drop to total loss of your bowel control. Although it’s rare, it can happen after radiation therapy.
The main issue with bowel incontinence is that it’s rarely discussed or reported, so it’s not highlighted as a major concern. Seeking advice and assistance from your healthcare team can help you overcome distress or concerns related to bowel incontinence. You can also talk to a PCFA nurse.
How do you manage bowel incontinence?
A health professional, such as a dietitian, continence nurse or physiotherapist can look at everything that might be affecting your bowel, including your diet and fluid intake, exercise, how mobile you are and the medicines you are taking. Making changes to your lifestyle can often help to control bowel incontinence.
To find out more about managing bowel incontinence after treatment follow the link to Pre-& Rehabilitation.
You can also find out about healthy eating and exercise through the following links:
Constipation and diarrhoea
It’s not expected that you will have bowel problems after surgery, but sometimes you can have constipation straight after your procedure. Constipation causes hard and painful bowel movements. This can be a problem after surgery, as pushing or bearing down to expel a hard poo can cause bleeding in your urine, affect wound healing and weaken the pelvic floor muscles that you need to control your bowel movements and urination. Talk to health care team if you have constipation following surgery as you may need some medication to help manage this.
Diarrhoea (frequent and watery bowel movements) can sometimes occur after or during radiation therapy or hormone therapy. Constipation and diarrhoea can also happen while on chemotherapy or theranostics.
How is constipation and diarrhoea managed after treatment?
Drinking plenty of water, eating a healthy diet and regular exercise can help with bowel problems. You can ask your doctor for a referral to a dietitian to talk about managing diarrhoea or constipation if you need support with your diet. But always tell your doctor if you are making any changes to your diet.
For tips on getting healthy and helping manage constipation and diarrhoea follow the links to:
If you are experience diarrhoea, keep the area around your anus (bottom) clean to prevent skin irritation. After each bowel movement, wash your bottom with warm water and gently pat dry. You may need to apply a barrier cream to protect the area.
There are also medicines you can take to control constipation and diarrhoea. Ask your doctor or member of your healthcare team about what to expect and when to report diarrhoea or constipation. Write down how many bowel movements you have in a day and make sure you tell them if you have any blood in your faeces (poo).
Fistulas
A fistula is a hole between your urethra and rectum and is a very rare side effect of surgery and/or radiation therapy for prostate cancer.
Sometimes pain, smelly urine and infections of the bladder and urethra can be early signs of a fistula, although there may be other causes of these symptoms.
Contact your doctor or a member of your healthcare team if your urine is strong smelling or you have a temperature after your treatment, as these could be signs of an infection. Discharge from your penis or diarrhoea after treatment may also be signs of a fistula. If you develop a fistula, you may need to have an operation to repair the hole.
Managing side effects and looking after yourself
There are many things you can do to improve and help you manage bowel side effects after prostate cancer treatment. Remember, you can always ask your GP, a PCFA nurse or a member of your healthcare team for advice.
Many diet and lifestyle factors also help with bowel-related side effects, such as healthy food choices and exercise. You can also find out more through the following links:
For general tips on recovering after treatment follow the link to Recovery & Rehabilitation. For specific rehabilitation therapies before and after treatment follow the link to Pre- & Rehabilitation.
Key Points
- Your prostate gland sits in front of your bowel and rectum so prostate cancer treatments can cause problems or changes in your bowel function
- A range of prostate cancer treatments can cause bowel symptoms.
- Radiation therapy may cause most side-effects as it can irritate the bowel lining
- Symptoms can include changes in faecal frequency, consistency and urgency, bowel incontinence, diarrhoea and constipation, flatulence and rectal pain or bleeding
- Symptoms can often be managed with the support of your healthcare team, medications, dietary and lifestyle changes and physical activity
- Contact your doctor, a member of your healthcare team or go to a hospital emergency department if you experience any bleeding from your bowels
