Radiation enteropathy; Radiation-induced small bowel injury; Post-radiation enteritis
Causes, incidence, and risk factors
Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells.
Along with the cancer cells, radiation therapy may also damage cells that make up the lining of the intestines.
Anyone who receives radiation therapy to the belly or pelvic area is at risk. This may include people with cervical, pancreatic, prostate, uterine, or colon and rectal cancer.
Symptoms may be different depending on what part of the intestines received the radiation.
Changes in bowel movements may include:
- Bleeding or mucus from the rectum
- Diarrhea or watery stools
- Feeling the need to have a bowel movement most or all of the time
- Pain in the rectal area, especially during bowel movements
Other symptoms can include:
- Loss of appetite
- Nausea and vomiting
- Stomach cramping or pain
Most of the time, these symptoms get better within 2 - 3 weeks after radiation treatment ends. This is called acute radiation enteritis.
When symptoms become long-term (chronic), other problems may include:
- Bloody diarrhea
- Greasy or fatty stools
- Weight loss
Signs and tests
The health care provider will do a physical exam and ask you questions about your medical history.
Tests are not needed very often, but may include:
Starting a low-fiber diet on the first day of radiation treatment can be helpful.
Avoiding the following foods may help with symptoms:
- Alcohol and tobacco
- Almost all milk products
- Coffee, tea, chocolate, and soda drinks with caffeine
- Foods containing whole bran
- Fresh and dried fruits
- Fried, greasy, or fatty foods
- Nuts and seeds
- Popcorn, potato chips, and pretzels
- Raw vegetables
- Rich pastries and baked goods
- Some fruit juices
- Strong spices
Foods and drinks that are better choices include:
- Apple or grape juice
- Applesauce, peeled apples, and bananas
- Eggs, buttermilk, and yogurt
- Fish, poultry, and meat that has been broiled or roasted
- Mild, cooked vegetables such as asparagus tips, green or black beans, carrots, spinach, and squash
- Potatoes that have been baked, boiled, or mashed
- Processed cheeses, such as American cheese
- Smooth peanut butter
- White bread, macaroni, or noodles
Other ways to control the symptoms of radiation enteritis include:
- Eat foods at room temperature
- Eat small meals more often
Your doctor may suggest or prescribe certain medications:
- Drugs that help decrease diarrhea, such as loperamide
- Pain medications
- Steroid foam that coats the lining of the rectum
- Special enzymes to replace enzymes from the pancreas
Drink plenty of fluids (up to 12 8-ounce glasses) every day when you have diarrhea. Some people need fluids given through a vein (intravenous fluids).
Your health care provider may choose to stop or reduce the dosage of radiation for a short period of time.
There often are no good treatments for chronic radiation enteritis. Your doctor may discuss surgery to either remove or go around (bypass) a section of damaged intestine.
When the abdomen receives radiation, there is always some nausea, vomiting, and diarrhea. In most cases, the symptoms get better 2 - 3 weeks after treatment ends.
However, when this condition develops, symptoms may last for a long period of time. Long-term (chronic) enteritis is rarely curable.
Calling your health care provider
Call your health care provider if you are undergoing radiation therapy or have had radiation in the past and are experiencing a lot of diarrhea or stomach pain and cramping.
Newer treatment methods are used, when possible, to avoid or decrease the chance of radiation enteritis. These methods include:
- Adjusting how much radiation is given during any one treatment session, so that lower amounts are delivered more evenly or higher amounts are delivered to specific areas
- Having a full bladder during treatments
- Placing special clips surgically around the area needing radiation. This helps the radiation doctor focus on the treatment area.
Czito BG, Willett CG. Radiation injury. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier;2010: chap 39.
Gastrointestinal Complications (PDQ). Radiation Enteritis. Last modified October 8, 2009.
Reviewed By: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.