Home Blog What is Low Anterior Resection Syndrome (LARS)? What is Low Anterior Resection Syndrome (LARS)? October 18, 2017 • By Sharyn Worrall Resources and Research Blog Share this:Click to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window) Share on Facebook Share on LinkedIn Share on Twitter Copy this URL Share via Email Medically reviewed by Dr. Jonathan Mitchem, Department of Surgery, Division of Surgical Oncology University of Missouri School of Medicine What causes Low Anterior Resection Syndrome (LARS)? One type of treatment that can be effective for curing colorectal cancer is low anterior resection surgery. This involves removing portions of the colon containing cancer cells and connecting the remaining parts of the colon, leaving only healthy cells. Rectal cancer patients may undergo resection of part, or the entire, rectum (the last 6-8 inches of the large intestine), which can lead to a collection of symptoms known as Low Anterior Resection Syndrome (LARS). Low anterior resection syndrome can occur after resection surgery to the lower part of the colon. After the resection or removal, of the part of the rectum containing cancer cells, your surgeon will perform an anastomosis, or “hook up,” of the colon. Anastomosis means that the two remaining ends of the large intestine and the rectum are sewn or stapled back together, resulting in a shorter colon, which leads to the symptoms that make up LARS. What is Low Anterior Resection Syndrome? With such a major surgery, side effects are not surprising. LARS refers to several related symptoms that patients may experience post-surgery. 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 rectumClustering 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 laterIncreased gasAbdominal painSmall 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. How do you manage LARS? There are ways to manage LARS, but finding the right regimen 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.)Use of medications and over-the-counter drugs to help with incontinence (Imodium for clustering, Metamucil® as a fiber supplement, for example).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 about biofeedback, watch our webinar on using physical therapy to manage colorectal cancer symptoms. .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.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. Dietary changes to consider Dietary changes can help prevent urgency and incontinence. Here are some to consider: Eat small, frequent meals (skipping meals can cause increased gas)Drink plenty of fluids slowlyEat foods help slow and firm up stool including, white rice, pasta, bread, pretzels, tapioca, marshmallows, peanut butter, bananas, potatoes, and yogurtAvoid foods that cause gas, including, carbonated beverages, beer, dairy products, nuts, and certain vegetables (such as cabbage, spinach, cucumbers, broccoli, cauliflower, onions, beans, and corn) 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 to managing LARS is to start simple. Start with dietary changes, like eating more fiber, and incorporate medications to manage incontinence. Following these lifestyle changes, Dr. Mitchem recommends trying to incorporate other management strategies, such as probiotics, pelvic floor physical therapy, and rectal irrigation. 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: https://www.mskcc.org/cancer-care/patient-education/about-your-low-anterior-resection-surgerySturiale 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 Fight CRC blogs are one of the many free resources for patients that we offer! Our Resource Library is full of medically-reviewed, trustworthy materials for you to read, download or request in print! Visit the library now! 35 thoughts on “What is Low Anterior Resection Syndrome (LARS)?” Hi, I have stage 3 cancer of the rectum, with a LAR op due in 2 weeks after having the 8 week break after radio/chemo pre surgery treatment. I asked my surgeon what will happen to my BM after my stoma reversal surgery, he said you will go back to a completely normal life, there may be some differences, your brain just has to readjust. But what I am reading here tells me a very different story, LARS, never mentioned in any talks with the specialists, nurses, or in any cancer council booklets. I am already terrified by the notion that I have cancer in the first place, I am a fit, healthy 47 year old. Exercise, eat well, always active, never smoked, don’t drink, no family history of bowel cancer! The pre surgery radio/chemo, surgery, stoma, then 4 months of intravenous chemo are a great shock! Now I am worried about more long term issues as stated here. Ewa, You will do great and bounce back! Not everyone has LARS as a result. The good news is that there is help/solutions for any side-effects. Nobody has to live with uncontrollable bowels, even if they have LARS. For those with LARS, t’s just a matter of finding the underlying cause (e.g. infection, bacteria overgrowth, tailored diet, strategies for emptying/having BM’s, etc.). You have so much going for you with your prior good health…You will do great in surgery and have positive outcomes and a speedy recovery! Hi Ewa – thanks for sharing your story! Make sure to talk to your doctor about LARS. They may even recommend a physical therapist to help pre and post surgery. Thanks Kas, Sharyn, for your positive words. I am doing everything possible to be fighting fit for the op. My Bowel cancer nurse, when asked, did say that gastro stop would be necessary, at least initially after reversal of the stoma, whenever I wished to leave the house for any length of time. In ten days out after my ileostomy reversal after my rectum removal surgery in July. You’ll do fine. Trust your doctor and look to online communities for support. And give it time… Recovery from this phase is tough but very doable. Load up on barrier cream, soft wipes and Metamucil for the first couple weeks. It’s all manageable but don’t expect to be normal for a while. You will improve. I am 10 months out from my resection surgery. They told me the bowel issues would hopefully get better after chemo was complete. That has been almost 4 months ago and it has not gotten better. It has gotten worse. I have multiple BM’S just about everyday. There is no rhyme or reason to them. I can’t go anywhere or do anything unless I take something to clogged me up then I pay for it later. The pain towards the end 9f the cycle of BM’S is so bad I have to take pain meds. These cycles can come anytime of the day or night. I had a follow up CT and that came out good. I have another colonoscopy this week. I’m so thankful that I’m clean so far but this bathroom issue is horrendous. It feels like you can’t make people understand when you tell them you can’t go somewhere or do something g when you’re having a bad day. Now I’m breaking out in hives from something. I used to be such a control freak and now I can’t seem to control anything. All of this really messes with your head. Karen, Find a good GI doctor who can test you for SIBO (it’s a breath test) which is a bacteria overgrowth in your gut that hinders proper digestion which can be the source of multiple BMs per day. You may have to weed through a few doctors as I found that most GI doctors only cared about CT scans & colonscopies fearing cancer had returned and ignored my concern about my gut problems and uncontrollable BMs. I had to really push to find a dr. who would focus on helping find the source of the problem behind the uncontrollable BMs so I could resume life. Most want to say it’s because of LARS (damage from the surgery & treatment) and not offer any real solution. Also, do a stool test from Genova Diagnostics which offers an in-depth evaluation on what’s really going on in your gut (e.g. it tests for gut infections that a typical GI dr. doesn’t test). It’s worth the money out of pocket! Check Genova’s website for lists of doctors near you that offer the test. Often times a gut infection (treatable thru an antibiotic like Metronidazole/Flagyl) leads to SIBO and both can be treated which will tremendously help reduce/eliminate having multiple BM’s (uncontrolled) a day. The diet for SIBO will also help reduce the pain & bloating. Note: it’s misleading when you are having multiple BM’s a day to think you may be constipated but chances are, you are constipated caused by SIBO-C so once you get that emptied (thru antibiotic if there’s an infection, diet plan for SIBO-C and an enema if need be) you will start to have a more normal life within ~ 2 weeks and have only a few BM’s per day, controlled. Below are a few things that have helped me after stage 3 colorectal treatment which included chemo, radiation, complete resection of entire rectum, ileostomy bag for 6 months, ileostomy reversal. For almost 3 years after ileostomy reversal, I had fecal incontinence 20-30 times per day (plus flatulence incontinence so I had to resign from my job). I used anti-diarrhea meds which made things worse. Later found out I had an infection in my gut plus vaginal infection. I also had symptoms similar to SIBO-C (Sibo-Constipation). Treatment: 1. Antibiotic for infections: Flagyl; the infection(s) were causing what I thought was diarrhea; in reality I was so constipated that diarrhea formed around the impacted stool; –Enemas can help kick off initial clean out: https://www.walmart.com/ip/Enema-Bucket-Set-w-Castile-Soap-Gentle-L-Care-1500-mL-1-Each/497039918 2. SIBO-C: went on strict diet and STOPPED taking probiotics; I found this diet online which has been a lifesaver: https://www.siboinfo.com/uploads/5/4/8/4/5484269/low_fermentation_diet.pdf 3. Oregano Oil: 3 capsules / day (to reduce the overgrowth of bacteria which cause severe, uncontrollable flatulence). Reducing the bacteria also has aided in having “formed” sufficient BM’s (1-3x/day). I like Natural Factors Oil of Oregano softgels 80% carvacrol; reduce quantity if causes diarrhea 4. In morning, strong cup of french roast coffee, Peet’s ground is best if you can find it in your grocery store (add in 2 Tbsp butter + 1 tsp coconut oil; fat = helps constipation) plus 2 peppermint oil capsules. Goal is to have a large bowel movement in the a.m. to avoid further BM’s during the day + it reduces flatulence. Mike Parkes, there is a LowerAnterior Resection Syndrome Facebook page. It would be great if you would become a member and share that info of things too have tried with others, if you already have not. There is a Facebook page called Living with Low Anterior Resection Syndrome. Answer the questions which asks if you have LARS and you will be admitted to this closed Facebook group. It is a wealth of information and support. It is so helpful to know I am not alone in dealing with LARS I take immodium, and then I might be stopped up for a day or two; then I will go for at least an hour and continues for hours, I am 7 months after reversal. Any hints would be great Below are a few things that have helped me after stage 3 colorectal treatment which included chemo, radiation, complete resection of rectum, ileostomy bag for 6 months, ileostomy reversal. For almost 3 years, I had fecal incontinence 20-30 times per day (plus flatulence incontinence so I had to resign from my job). I used anti-diarrhea meds which made things worse. Later found out I had an infection in my gut plus vaginal infection. I also had symptoms similar to SIBO-C (Sibo-Constipation). Treatment: 1. Antibiotic for infections: Flagyl; the infection(s) were causing what I thought was diarrhea; in reality I was so constipated that diarrhea formed around the impacted stool 2. SIBO-C: went on strict diet and STOPPED taking probiotics; I found this diet online which has been a lifesaver: https://www.siboinfo.com/uploads/5/4/8/4/5484269/low_fermentation_diet.pdf 3. Oregano Oil: 3 capsules / day (to reduce the overgrowth of bacteria which cause severe, uncontrollable flatulence). Reducing the bacteria also has aided in having “formed” sufficient BM’s (1-3x/day). I like Natural Factors Oil of Oregano softgels 80% carvacrol 4. In morning, strong cup of french roast coffee, Peet’s ground is best if you can find it in your grocery store (add in 2 Tbsp butter + 1 tsp coconut oil; fat = helps constipation) plus 2 peppermint oil capsules. Goal is to have a large bowel movement in the a.m. to avoid further BM’s during the day + it reduces flatulence. This is an excellent thread. I am now 7 months post reversal and my mobility and overall QoL is much restricted by LARS in the ways variously described here. I am exploring LARRIS – Rectal Irrigation for Lars via a Peristeen system researched by Dr Grace McCutchan in Cardiff UK but I am also thinking about surgery to install a permanent colostomy: thoughts appreciated. I live in Vancouver, Canada and am 78yrs. Pleased to be alive. I’m 4 years out from my reconnection and have daily issues.Having my rectum and most of my colon removed doesn’t give my stool enough time to dry out and compact so the majority of the time it is more of a liquid state. Metamucil helps thicken the stool and Lomotil/Imodium help slow down the process so the stool has more time to firm up. Also irrigation with a Fleet bottle helps rinse fragments out of the colon and cleans any fluids away from the anus which causes the burning and discomfort. Use luke warm tap water and lubricate the tip for insertion.It may take 2-3 times before you notice the discharge becoming cleaner. I’ve noticed in the past 6 months things getting better but it’s a slow and arduous process. Be patient….take your Metamucil everyday… and get some exercise! Remember..your alive..and this is your new “norm”. You are right on! I have been 1 1/2 yrs out and have issues. Couldn’t explain it any better than you have. Time is everything. Lisa Spot on. I never knew there is a name for it. LARS! I have had it for ten years. I try not to let it control my life. Just be patient with yourself. Mike Parkes, very interested in what you are doing. I am 16 months post reversal. Though things are better, I am not where I want to be. There is a LARS Facebook page, too, for people like us to,share things we have done that could be helpful to others. I’m 6 years out and I HAVE to have; what we call an emergency bag in every vehicle. There isn’t any warning. I carry in each emergency bag wipes, recticare, diaper, sweats, and over the counter liquid anti diarrhea medicine. I carry a prescription bottle of lomotil with me everywhere I go. If I know we’ll be out for most of the day I will take prescription anti diarrhea medicine. I’ll do it if going to see a movie as well. Nothing sucks more than having to go to the bathroom during it. I can end up on toilet for 2 hours anytime I have a bowel movement due to actively having bowel movements. Hi Becky, having an ’emergency bag’ sounds like a great tip. Thanks for sharing! I am a 34 year old female and am 2 years post ileostomy take down. I had nothing but problems after my reconnection. I couldn’t urinate on my own and had a cath the first 6 weeks post surgery, followed by two weeks of self catheterizarion, before I regained that ability. Once I was cleared to have sex again, we realized the issues weren’t just limited to going to the bathroom, but also to intercourse (pain and dryness). I’ve seen countless specialists, went to pelvic floor physical therapy, tried hormone therapies, etc., and nothing has helped. I’ve done plenty of research on everything colorectal cancer related and this is the first I’ve ever heard about LARS. Would love to chat with any other ladies who may be experiencing the same issues as I am. This is my first time reading all of this. I am 7 months post ileostomy reversal. My surgeons office mentioned this condition when I described my symptoms but really didn’t go into it. I feel better that I’m not alone but I truly was hoping this was temporary now I’m not so sure. Four and a half years after my LAR I still have LARS. Grateful to be alive, but it’s a “new” life and definitely not easy. Oddly enough, I moved to Mexico and thought that my LARS would get worse, but it’s gotten MUCH better. Different food? Less stressful environment? Who knows but I’m hoping it continues to improve. I was offered the low anterior resection or APR surgery with a permanent colostomy for my Stage IV rectal cancer. I chose the APR surgery for two reasons: 1) to help prevent a local recurrence, and 2) to have a known outcome with a known quality of life rather than risk being incontinent or experiencing LARS. That was almost 3 years ago.I don’t regret my decision, and I am NED. For me, it was the right decision. Thanks for sharing, Jane. It’s great to hear you were such an active participant in treatment decision making – it’s SO important. I have this but i didnt know it was common with that type of surgery. So glad to know iam not alone! I am 13 months from my LAR surgery. I suffer daily with LARS. In addition my bladder stopped working after the surgery. I have been dealing with not being able to void on my own. I feel like I am at my ropes end. Mentally this is so hard. I want to he normal again. I want to be able to go for a drive or get on an airplane without constant fear. I want to not have to leave a conversation or finish a 30 minute TV show without having to go to the bathroom. I want my life back. My LARS was complicated by BAM (bile acid malabsorption/diarrhea ) and SIBO (small intestine bacteria overgrowth). BAM d/t gall bladder removal during initial LAR surgery & ablation/resection of liver mets. Diarrhea now pretty well controlled by Prevalite (there are others) & diet. SIBO from ileostomy & reversal. Treated with antibiotic. I went for over a year being told it was LARS, then a smart gastro put it all together. So ask about these possibilities. Life is not normal but profoundly improved. Wow, thank you for sharing your story, Linda! I just hit five years out last week. Unfortunately, I deal with the symptoms of LARS every single day. I still haven’t given up hope that something will come along to help manage the symptoms. Excellent! I am struggling in Vancouver Canada with LARS four months post reversal. My goal is to travel back to England each year for a couple of months. Keep up this great research and communication. David Thanks David, safe travels! Adriana..Hang in there…. I like the look of this forum. Mike New Zealand Yes….. I had an ultra low LAR with reconnection May 2016. Pretty well lost most of my rectum. Also had real anastomosis stricture issues and have been surgically stretched twice. Now I’m dilating at home. I can empathise with the above and I’m still working on it. Interestingly my surgeon and follow up crew have never used the term. Would like to hook up with anyone in a similar situation. Having done a few techniques to ease the situation I would like to share my knowledge I have the same thing. Only my dialation is done in my doctor’s office every week to 10 days depending on how my symptoms dictate. I also gave diverticulitis and calitis..so diet is a huge struggle. Please share whatever you can. Thanks Thank you for the information and the tips . I haven’t given up hope after two years of getting closer a step at the time to a new normality Comments are closed.