Colon Maladies

Radiation enteritis is a condition in which the lining of the bowel becomes swollen and inflamed during or after radiation therapy to the abdomen, pelvis, or rectum. The large and small bowels are very sensitive to radiation. The larger the dose of radiation, the greater the damage to normal bowel tissue. Most tumors in the abdomen and pelvis need large doses, and almost all patients receiving radiation to the abdomen, pelvis, or rectum will show signs of acute enteritis. (potentially causing frequent bms after partial colon removal)
Acute symptoms are those that appear during the first course of radiation therapy and up to 8 weeks later. Chronic radiation enteritis may appear months to years after radiation therapy is completed. Only 5% to 15% of persons treated with radiation to the abdomen will develop chronic problems.
Acute enteritis symptoms usually resolve 2 to 3 weeks after the completion of treatment.

Medical management of acute enteritis
Medical treatment includes treating diarrhea, dehydration, malabsorption, and abdominal or rectal discomfort. Symptoms usually resolve with medications, dietary changes, and rest.

Medications may include the following:
Kaopectate, Lomotil , Donnatal, Imodium and in addition to these medications, opioids may offer relief from abdominal pain.

Nutrition and acute enteritis
Damage to the intestinal walls from radiation therapy results in a reduction or loss of enzymes, one of the most important of these being lactase. Lactase is essential in the digestion of milk and milk products. Although there is no evidence that a lactose-restricted diet will prevent radiation enteritis, a diet that is lactose free, may prove beneficial.

Foods to avoid
Milk and milk products. Exceptions are buttermilk and yogurt, which are often tolerated because lactose is altered by the presence of lactobacillus. Processed cheese may also be tolerated because the lactose is removed from the whey when it is separated from the cheese curd. Milkshake supplements such as Ensure are lactose free and may be used.
Whole-bran bread and cereal.
Nuts, seeds, and coconuts.
Fried, greasy, or fatty foods.
Fresh and dried fruit and some fruit juices such as prune juice.
Raw vegetables.
Rich pastries.
Popcorn, potato chips, and pretzels.
Strong spices and herbs.
Chocolate, coffee, tea, and soft drinks with caffeine.
Alcohol and tobacco.

Foods Recommended
Fish, poultry, and meat that is cooked, broiled, or roasted.
Bananas, applesauce, peeled apples, and apple and grape juices.
White bread and toast.
Macaroni and noodles.
Baked, boiled, or mashed potatoes.
Cooked vegetables that are mild, such as asparagus tips, green and waxed beans, carrots, spinach, and squash.
Mild processed cheese, eggs, smooth peanut butter, buttermilk, and yogurt.

Helpful Tips
eat food at room temperature
Drink 3,000 cc of fluid per day. Carbonated beverages should be allowed to lose carbonation before being ingested.
Add nutmeg to food, which will help decrease mobility of GI tract.
Start a low-residue diet on day 1 of radiation therapy treatment.

Chronic Radiation Enteritis
Only 5% to 15% of the patients who receive abdominal or pelvic irradiation will develop chronic radiation enteritis. Signs and symptoms include colicky abdominal pain, bloody diarrhea, tenesmus, steatorrhea, weight loss, and nausea and vomiting.

Treatment of chronic radiation enteritis  (potential causes of frequent bms after partial colon removal)
Medical management of the patient’s symptoms as above, with surgical management only indicated for severe damage. Fewer than 2% of the 5% to 15% of patients who received abdominal or pelvic radiation will require surgical intervention.
The timing and choice of surgical techniques remains somewhat controversial. A lower operative mortality and incidence of anatomic dehiscence have been reported with intestinal bypass than with resection. Those who favor resection point out that the removal of diseased bowel decreases the mortality rate for resection and is comparable to the bypass procedure. All agree that simple lysis of adhesions is inadequate and that fistulas require bypass.

Surgery should be undertaken only after careful assessment of the patient’s clinical condition and extent of radiation damage because wound healing is often delayed, necessitating prolonged parenteral feeding after surgery. Even after apparently successful operations, symptoms may persist in a significant proportion