Ann Coloproctol.  2019 Aug;35(4):160-166. 10.3393/ac.2019.08.10.

Postoperative Bowel Function After Anal Sphincter-Preserving Rectal Cancer Surgery: Risks Factors, Diagnostic Modalities, and Management

  • 1Section of Colon and Rectal Surgery, Department of Surgery, Southern Philippines Medical Center, Davao City, The Philippines.
  • 2Department of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
  • 3Section of Colorectal Surgery, Department of Surgery, Rizal Medical Center, Pasig City, The Philippines.
  • 4Department of Surgery, Clinica Antipolo Hospital and Wellness Center, Antipolo City, The Philippines.
  • 5Department of Surgery, Saidabad Clinic, Dhaka, Bangladesh.


Low anterior resection syndrome (LARS) refers to a disturbance of bowel function that commonly manifests within 1 month after rectal cancer surgery. A low level of anastomosis and chemoradiotherapy have been consistently found to be risk factors for developing LARS. Thorough history taking and physical examination with adjunctive procedures are essential when evaluating patients with LARS. Anorectal manometry, fecoflowmetry, and validated questionnaires are important tools for assessing the quality of life of patients with LARS. Conservative management (medical, physiotherapy, transanal irrigation), invasive procedures (neuromodulation), and multimodal therapy are the mainstay of treatment for patients with LARS. A stoma could be considered when other treatment modalities have failed. An initial meticulous surgical procedure for rectal cancer, creation of a neorectal reservoir during anastomosis, and proper exercise of the anal sphincter muscle (Kegel's maneuver) are essential to combat LARS. Pretreatment counseling is a crucial step for patients who have risk factors for developing LARS.


Rectal neoplasm; Surgical procedures; Bowel function; Diagnosis; Therapy

MeSH Terms

Anal Canal
Physical Examination
Quality of Life
Rectal Neoplasms*
Risk Factors
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