Following surgery for colon or rectal cancer, many patients experience significant changes in bowel function – more frequent urges, urgency, or even involuntary leakage. This is known as low anterior resection syndrome (LARS), a common but often overlooked side effect affecting up to 90% of individuals after colorectal procedures.
Understanding LARS is crucial because these symptoms are treatable, and quality of life can improve dramatically with the right approach. Many patients are simply not informed about this potential outcome, leaving them feeling confused or embarrassed when it occurs.
What Causes LARS?
The rectum functions as a storage reservoir for stool. When part or all of the rectum is removed during surgery, the remaining bowel lacks the same capacity, leading to more frequent and unpredictable bowel movements. Doctors sometimes underestimate the prevalence of LARS, contributing to delayed diagnosis and treatment.
As Dr. Marylise Boutros of the Cleveland Clinic Florida notes, “Nine out of 10 patients I see in my LARS clinic were not told about LARS by their clinician.” This lack of awareness underscores the importance of proactive patient education.
Recognizing the Symptoms
LARS presents with a range of symptoms, including:
- Increased frequency or urgency of bowel movements
- The sensation of needing to go even when the bowel is empty
- Involuntary leakage of gas or stool
- Changes in stool consistency (diarrhea or constipation)
- Abdominal pain
Patients often hesitate to discuss these issues with healthcare providers due to embarrassment. Dr. Jeongyoon Moon of the University of Texas MD Anderson Cancer Center emphasizes, “People don’t necessarily bring it up on their own because there’s a certain stigma associated with bowel movements.” However, open communication is vital for effective management.
Effective Treatments and Strategies
While LARS has no single cure, symptoms often subside within six months to two years post-surgery. In the meantime, several treatments can significantly improve quality of life.
Lifestyle Adjustments
Dietary modification is the first line of defense. Common triggers include spicy foods, caffeine, and alcohol, but individual responses vary. Keeping a food and symptom diary helps pinpoint personal triggers.
Physical activity also plays a role. Dr. Boutros explains, “When you walk and exercise, you increase abdominal pressure and so it can increase the symptoms.” Timing meals strategically – eating dinner earlier, for example – can also help if symptoms worsen at specific times of day.
Medications and Supplements
Various medications can address specific LARS symptoms:
- Fiber supplements (psyllium husk) to regulate bowel movements
- Antidiarrheals (loperamide, ramosetron) to reduce urgency and incontinence
- Laxatives to relieve constipation and prevent overflow diarrhea
- Ondansetron (Zofran) to slow down bowel motility
- Perianal skincare to soothe irritated skin
Pelvic Floor Therapy
Surgery can weaken pelvic floor muscles, leading to incontinence or difficulty with bowel movements. Pelvic floor physical therapy, including muscle training and biofeedback, can restore control without significant side effects.
Advanced Interventions
For severe cases:
- Enemas and transanal irrigation provide short-term relief by emptying the bowel. Transanal irrigation involves self-administering water into the rectum to induce controlled bowel movements.
- Sacral nerve stimulation uses an implanted device to regulate bowel function.
- Colostomy (creating an opening in the abdomen for stool collection) is reserved for cases where other treatments fail.
The Importance of Support
LARS profoundly impacts daily life, from work and travel to social interactions. Many patients struggle emotionally with the condition. Peer support is invaluable; connecting with others who understand can reduce isolation and empower individuals to take control of their health.
Online communities and doctor-recommended support groups provide a safe space to share experiences and learn practical strategies.
Ultimately, LARS is a manageable condition. With proactive medical attention, lifestyle adjustments, and peer support, patients can regain control over their bowel function and improve their quality of life.
