Although much more unusual than urinary incontinence or sexual difficulties after prostate cancer treatment, bowel problems do occur among survivors. One study conducted in The Netherlands found that bowel leakage occurred once a week or more in 14 per cent of prostate cancer patients treated with radiotherapy and in 5 to 8 percent of patients treated with other methods; in a normative, age-matched population without prostate cancer, the rate was 2 per cent.

The severity and duration of these bowel problems, which are more commonly caused by external beam radiation than by brachytherapy or by other forms of internal radiation therapy, can vary significantly. (See an abstract of the 2009 study from The Netherlands on “Bowel, urinary, and sexual problems among long-term prostate cancer survivors.”)  Often, these difficulties go away over time, usually within a few weeks after therapy ends. Sometimes and for some men, however, bowel difficulties are more long lasting, or they occur many months after treatment has ended.

What are the symptoms of bowel problems?
Men may experience anything from intestinal irritation (which is sometimes called radiation enteritis) to bowel leakage. Here is a list of possible symptoms:

• Diarrhoea or very loose and runny stools (frequent and watery bowel movements)
• Cramping
• Gas
• Burning and pain or tenderness
• A strong urge to have a bowel movement right away
• Bowel leakage
• Loss of control of bowel movements
• A mucus discharge that is thick and stringy
• Bleeding with bowel movements or blood in the stools

Bowel leakage and faecal incontinence (lack of control over the muscles that operate the rectum) are particularly embarrassing for men, especially if they are unaware of when these episodes are occurring. A loss of “bowel cues” sometimes means that men who experience bowel leakage cannot tell that seepage is happening and just discover smears of faecal matter in their undergarments.

How are these problems caused by prostate cancer treatment?
 Although surgery can cause bowel problems, these difficulties are more usually the result of external beam radiation therapy. Healthy cells in the intestines and the rectum can be damaged by the radiation therapy that kills cancer cells. And these damaged cells may not function properly as a consequence. Because the intestines help the body to take in food, water, and other nutrients, and the rectum, the anal canal, the anus, and the sphincter eliminate waste matter in the form of a bowel movement, damaging the cells of the bowel can cause the symptoms described previously.

What can be done?
Treatment options for long-term bowel dysfunction are few, but there are many ways to cope with the various symptoms. Anti-diarrhoea medications, both over the counter and prescription, can be used to help with loose stools. And other medicines can ease soreness or skin problems around the rectum. Laser therapy can sometimes be used to stop rectal bleeding.

Diet, biofeedback, and other self-help or monitoring techniques can help you live a full life in spite of the continuation of some of the more embarrassing bowel problems. Here is a digest of common advice, but be sure to discuss your specific symptoms and medical situation with professionals.

• Keep a record of your bowel movements, problems, and diet for a week or two. Include time of bowel movement, stool consistency, whether there is any blood or mucus in the stools, and number and time of involuntary stools, as well as whether any leakage occurred.  Record symptoms such as gas, cramping, pain, or skin irritation. Also keep a journal of what you eat and drink.
• On the basis of this record and in consultation with your medical team, develop a regular bowel movement scheduling program and a diet that helps you maintain this program. Things to consider include
  • establishing a consistent and appropriate time for bowel movements, e.g., after breakfast;
  • using assistive methods to develop the habit of having a bowel movement at this time each day; and
  • emptying your bowel and bladder before any planned periods of activity, including sexual activity.
• Dietary habits that help include
  • eating well-cooked mild vegetables and potatoes, fruits such as bananas canned peaches and pears, boiled eggs and mild cheese, and baked or broiled fish and lean meats;
  • avoiding spicy foods, sodas, high-fibre foods, nuts and seeds, fried and greasy foods, and milk products, if you are sensitive to them;
  • drinking lots of fluids to avoid the dehydration that can occur with diarrhoea;
  • limiting caffeine and alcohol;
  • eating 5 to 6 small meals a day;
  • chewing foods well and eating slowly; and
  • avoiding very hot or cold foods.
• Wear appropriate protection. There are varying absorbencies and designs of pads and pants, so choose the one that is right for your condition and level of activity. Here are a few, listed from the ones offering the most to the least protection:
  • All-in-one products or adult diapers are useful for both urinary and faecal incontinence.
  • Pull-up products are less bulky than adult diapers and offer slightly less security and protection; however, if you are physically active, they may be the best option.
  • Large pads worn with stretch support pants offer good protection and are also suitable for both urinary and faecal incontinence.
  • Small shaped pads, worn either with stretch support pants or close-fitting underwear protect against faecal smearing and light to moderate urinary incontinence.
  • At the bottom end of the absorbency and security scale are rectangular insert pads worn with close-fitting underwear. Washable products, such as Y-shaped or pouch pants, also offer protection at this more limited level.
• Develop a good hygiene and skin-care routine. Men with bowel problems often experience skin irritation around the anus. So make sure you clean and dry yourself gently and thoroughly after each bowel movement, avoiding any product that could irritate the skin. (Some men use protective cream and mild, unscented baby wipes.) Seek medical advice if your skin becomes broken.
• Wear loose clothing that does not rub the area and that aids with ventilation.
• Learn ways to decrease and manage stress, and develop comfort strategies, for example, a warm bath to soothe a sore bottom or a heating pad for cramps.
• Talk to your partner honestly and calmly about your bowel problems and intimacy. Ask for your partner’s thoughts, feelings, and strategies, and listen carefully. Then consider doing the following:
  • Make a plan together about what to do in the event of an accident during sex, e.g., ignore and continue, clean up together, move to the shower then clean up alone, or whatever works for you both.
  • Think about beginning to explore intimacy after prostate cancer treatment in the bath or shower.
  • Protect the bedding with special towels and small sheets that can be easily replaced or bundled away, as well as with rubber, washable mattress covers, and keep a supply of sheets and towels on hand close to the bed.
  • Explore positions or forms of intimacy that put the least amount of pressure on the bowel and that give you the physical and emotional comfort you need.

For more information:

The Canadian Continence Foundation
The National Association for Continence (US)