Bleeding from the back passage (rectum) after radiotherapy is common, but it is usually mild and often doesn’t need treatment. Bleeding sometimes improves gradually and can stop on its own after a few years.
Bleeding may not always be caused by the radiotherapy. It can be caused by piles (haemorrhoids) or straining on the toilet. But even if you think you know the cause, always tell your cancer doctor or nurse specialist if you have any bleeding from the back passage. It is important to find out the cause and to rule out serious problems. Your doctor will do an examination of your back passage and may refer you to have a test to look at the inside of your rectum (an endoscopy).
If there is only a small amount of blood and you are finding it manageable, you probably won’t need any treatment. You will be given advice about your bowel habits to help minimise the bleeding and avoid constipation. If you are taking blood-thinning drugs, your dose may be reduced and monitored.
If you have heavy bleeding that is interfering with your day-to-day life or if you become anaemic (have a lack of red blood cells), you are likely to need treatment. Your doctor or specialist nurse will explain more about your treatment options and give you more detailed information.
The most commonly used treatment for bleeding from the back passage is a drug called sucralfate (Antepsin Suspension®). It is given as an enema. This is when a fluid (usually medicine) is gently infused into your back passage through a short tube. Sucralfate works by coating the lining of the rectum. This reduces inflammation and encourages healing. It is important to avoid getting constipated when you are being treated with sucralfate.
A drug called formalin is also helpful for some people. It works by sealing the bleeding blood vessels. Your doctor can give it to you using an endoscope, which is passed into the bowel. You can have this done under a general anaesthetic.
If the bleeding is higher up in the large bowel (colon), or if enemas don’t reduce the bleeding, other treatments may be helpful:
- Argon plasma coagulation directs heat at areas that are bleeding. The heat seals the blood vessels and destroys damaged tissue. It’s given during a colonoscopy (where a doctor passes a thin, flexible tube with a light into your back passage). Doctors don’t yet know how successfully this treats heavy bleeding. There is also a risk that it can cause complications, such as serious tissue damage. Your doctor will discuss this with you.
- Hyperbaric oxygen therapy works by increasing the amount of oxygen that gets to tissue that’s been damaged by pelvic radiotherapy. This can encourage new blood vessels to grow and may help the tissue heal. Treatment takes up to eight weeks. This treatment isn’t widely available, so you may need to travel some distance for it.