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Low anterior resection syndrome2025-03-17T19:09:50+00:00

Low Anterior Resection
Syndrome (LARS)

One type of treatment that can be effective for curing colorectal cancer is low anterior
resection surgery, but this surgery may also cause uncomfortable side effects like low anterior resection syndrome.

Low Anterior Resection
Syndrome (LARS)

One type of treatment that can be effective for curing colorectal cancer is low anterior resection surgery, but this surgery may also cause uncomfortable side effects like low anterior resection syndrome.

What causes LARS?

Low anterior resection surgery involves removing portions of the colon containing cancer cells and connecting the remaining parts of the colon, leaving only healthy cells and tissue. Rectal cancer patients may undergo resection or removal of part or of 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).

What causes LARS?

Low anterior resection surgery involves removing portions of the colon containing cancer cells and connecting the remaining parts of the colon, leaving only healthy cells and tissue. Rectal cancer patients may undergo resection or removal of part or of 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).

About 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.

About 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.

Symptoms

LARS refers to several related symptoms that patients may experience post-surgery. The symptoms 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
  • Risk of urinary and/or sexual dysfunction due to nerve damage

Many survivors report symptoms of lower anterior resection syndrome can interfere with daily living and reduce their quality of life. While some patients report that these side effects improve over time, some experts believe that if symptoms exist at one-year post-surgery (or stoma closure), they are likely to continue to exist 10 years later.

Symptoms

LARS refers to several related symptoms that patients may experience post-surgery. The symptoms 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
  • Risk of urinary and/or sexual dysfunction due to nerve damage

Many survivors report symptoms of lower anterior resection syndrome can interfere with daily living and reduce their quality of life. While some patients report that these side effects improve over time, some experts believe that if symptoms exist at one-year post-surgery (or stoma closure), they are likely to continue to exist 10 years later.

Listen to our pelvic floor health webinar for tips on managing LARS.

Listen to our pelvic floor health webinar for tips on managing LARS.

Managing 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 exercises2024-12-18T02:37:13+00:00

Kegels may help strengthen the muscles of the pelvic floor. 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. Before you begin a kegel routine, please consult with a pelvic floor specialist.

Irrigation2024-12-18T02:39:06+00:00

Many patients with LARS claim that irrigation to clean out the colon greatly decreases the daily distress and LARS symptoms. Irrigation must be done carefully and under the advisement of a doctor. There are irrigation products by Coloplast that can be used, and some patients also buy supplies via Amazon.

Medicines and Probiotics2024-12-18T02:39:58+00:00

There are medications and over-the-counter drugs that can help with incontinence (Imodium for clustering, Metamucil® as a fiber supplement, for example). Also: some patients find that taking a probiotic pill, or having daily servings of yogurt, kombucha, Keifer, or other probiotic-rich foods and drinks help. Be sure to talk with your physician before beginning a new medication regimen.

Stool training and biofeedback2025-02-11T20:54:53+00:00

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. Seek pelvic floor physical therapy to address your symptoms of LARS.

Survival pack2024-12-18T02:41:27+00:00

You need to be prepared if you have LARS. Consider carrying a survival pack that includes soft/flushable wipes, clean underwear, plastic bags, hand sanitizer, Imodium, and butt paste.

Counseling2024-12-18T02:42:14+00:00

For some, talking about the challenges that result from LARS can really help ease stress and shift the focus to other things in life. Reducing stress may also reduce LARS symptoms.

Managing 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 exercises2024-12-18T02:37:13+00:00

Kegels may help strengthen the muscles of the pelvic floor. 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. Before you begin a kegel routine, please consult with a pelvic floor specialist.

Irrigation2024-12-18T02:39:06+00:00

Many patients with LARS claim that irrigation to clean out the colon greatly decreases the daily distress and LARS symptoms. Irrigation must be done carefully and under the advisement of a doctor. There are irrigation products by Coloplast that can be used, and some patients also buy supplies via Amazon.

Medicines and Probiotics2024-12-18T02:39:58+00:00

There are medications and over-the-counter drugs that can help with incontinence (Imodium for clustering, Metamucil® as a fiber supplement, for example). Also: some patients find that taking a probiotic pill, or having daily servings of yogurt, kombucha, Keifer, or other probiotic-rich foods and drinks help. Be sure to talk with your physician before beginning a new medication regimen.

Stool training and biofeedback2025-02-11T20:54:53+00:00

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. Seek pelvic floor physical therapy to address your symptoms of LARS.

Survival pack2024-12-18T02:41:27+00:00

You need to be prepared if you have LARS. Consider carrying a survival pack that includes soft/flushable wipes, clean underwear, plastic bags, hand sanitizer, Imodium, and butt paste.

Counseling2024-12-18T02:42:14+00:00

For some, talking about the challenges that result from LARS can really help ease stress and shift the focus to other things in life. Reducing stress may also reduce LARS symptoms.

What to Eat

Making changes to your diet may help prevent urgency and incontinence. Here are some to consider:

  • Eat small, frequent meals (skipping meals can cause increased gas)

  • Drink plenty of fluids slowly

  • Eat foods that help slow and firm up stool including:, white rice, pasta, bread, pretzels, tapioca, marshmallows, peanut butter, bananas, potatoes, and yogurt

  • Avoid 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) 

What to Eat

Making changes to your diet may help prevent urgency and incontinence. Here are some to consider:

  • Eat small, frequent meals (skipping meals can cause increased gas)

  • Drink plenty of fluids slowly

  • Eat foods that help slow and firm up stool including:, white rice, pasta, bread, pretzels, tapioca, marshmallows, peanut butter, bananas, potatoes, and yogurt

  • Avoid 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) 

Living with LARS

One of the best resources for patients living with LARS is the Facebook group Living with Low Anterior Resection Syndrome. In this group, patients tell-all about side effects, products that help LARS symptoms, routines like irrigation, and more.

Living with LARS

One of the best resources for patients living with LARS is the Facebook group Living with Low Anterior Resection Syndrome. In this group, patients tell-all about side effects, products that help LARS symptoms, routines like irrigation, and more.

Medical Review

Jonathan Mitchem, MD

Cleveland Clinic

Last reviewed: January 31, 2022

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