Medically reviewed by Dr. Jonathan Mitchem, Department of Surgery, Division of Surgical Oncology University of Missouri School of MedicineMedically reviewed by Dr. Jonathan Mitchem, Department of Surgery, Division of Surgical Oncology University of Missouri School of Medicine
Low anterior resection syndrome is a collection of symptoms or issues patients have after undergoing an anastomosis of the colon low in the rectum. This is a type of surgery involving the resection or removal of part of, or the entire, rectum (last 6-8 inches of the large intestine with an anastomosis or “hook up” of the colon low in the rectum). Anastomosis means that the two remaining ends of the large intestine and the rectum are sewn or stapled back together.
With a surgery like this, side effects are not surprising. One of those effects is referred to as LARS, or low anterior resection syndrome.
The symptoms of LARS are different for everyone, but could include:
- Frequency or urgency of stools, largely due to the fact you have less space to store stool after removing part of the rectum
- Clustering of stools (many bowel movements during a few hours)
- Fecal incontinence (lack of control over bowel movements)
- Constipation for more than a few days, followed by multiple bowel movements a few days later
- Increased gas
- Abdominal pain
- Small risk of urinary and/or sexual function due to nerve damage
“My surgeon explained the possibility of LARS symptoms as a quality of life issue after ileostomy reversal. I had no idea how difficult it would be during the first two years and it took some time to accept that even though it would improve some, it was a permanent issue.” Kelly, stage III survivor
Many survivors report these symptoms can interfere with daily living and reduce quality of life. While many patients experience these side effects diminish with time, some experts believe that if LARS symptoms exist at one year post-surgery (or stoma closure), they are likely to continue to exist 10 years later.
“One thing to keep in mind is that it may take several months for [bowel movements] to settle out after either stoma reversal or primary surgery. As an example, some patients with rectal cancer had surgery with diversion and then underwent 4-6 months of chemo, then waited another 2 months for reversal, and they haven’t “pooped” in months. It may take time to get used to using their bottom again.” – Dr. Jonathan Mitchem, Department of Surgery, Division of Surgical Oncology University of Missouri School of Medicine
There are ways to manage LARS; however, this can be challenging as management is extremely individualized – what works for one person may not work for another. Here’s a list of some ways people manage:
- Kegel exercises to help to strengthen muscles. (To do this, tighten your muscles like you are trying to hold back a bowel movement. Hold this position for 5 to 10 seconds. Release and rest. Repeat.)
- Dietary changes to help with urgency and incontinence (Eating small, frequent meals and staying away from gas-causing foods like cabbage, beans and fried foods).
- Use of medications and over-the-counter drugs to help with incontinence (imodium for clustering, Metamucil® as a fiber supplement, for example).
- Counseling – For some, talking about the challenges that result from LARS can really help ease stress and shift the focus to other things in life.
- Stool training and biofeedback. These are non-surgical therapies that can retrain your muscles to manage bowel dysfunction like fecal incontinence and constipation. Essentially, you learn through reinforcement how to train the muscles in your bowel to normalize function. To learn more, register for the Physical Therapy Webinar on November 14, 2017, as biofeedback will be addressed.
- Carrying a survival pack because you never know when you might need one! You may consider including flushable wipes, clean underwear, plastic bag, hand sanitizer, etc.
According to Dr. Jonathan Mitchem who works in the Department of Surgery, Division of Surgical Oncology at the University of Missouri School of Medicine:
“The first step in low anterior resection syndrome (as in most things) is to start simple. Fiber bulks up stool and generally makes it easier to empty out and is a great place to start. Loperamide can be helpful for those with looser bowel movements and/or diarrhea to help with control. Also, keeping track of the diet can be informative and lead to some avoidable foods that exacerbate LARS. Probiotics may also be helpful and work in some patients. After these things, next would be to try pelvic floor physical therapy. This will help the pelvic floor muscles strengthen and get in sync, it can be very helpful in the right patients. Rectal irrigation (enemas) prior to going out is a strategy to try and clean everything out of the rectum to avoid accidents. As always, I would suggest that patients discuss this with their surgeon. He or she may have other tips that have helped their patients in the past and shepherd them through the process.”
After your low anterior resection surgery, it is extremely important to talk to your doctors about any symptoms you experience, and to keep them updated even as you move into recurrence monitoring.
Your doctors can work with you to find ways to manage symptoms of LARS. These could include the suggestions listed above, and even forms of safe integrative medicine like acupuncture. While there is no proven “cure” for this cluster of side effects, don’t give up!
For more information:
- Sturiale A., Martellucci J., Valeri A. Long term functional results after laparoscopic low anterior resection for rectal cancer. Colorectal Disease (2015), Poster Abstracts. 17: 38–101. doi: 10.1111/codi.13053
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