Lower anterior rectum syndrome (LARS)

Low Anterior Resection Syndrome

Defective defecation function, also known as low anterior resection syndrome (LARS), is a common problem after surgical treatment of rectal cancer that has a detrimental effect on quality of life

• LARS is a significant problem found in about one third of rectal cancer patients after colorectal anastomosis. Symptoms of concern include pain on defecation and decreased ability to hold. Risk of having major LARS increases with adjuvant treatment and lower anastomotic level

Management of low anterior resection syndrome

NICE suggest (2):

Give information on low anterior resection syndrome (LARS) to people who will potentially have sphincter-preserving surgery. Advise them to seek help from primary care if they think they have symptoms of LARS, such as:

• increased frequency of stool
• urgency with or without incontinence of stool
• feeling of incomplete emptying
• fragmentation of stool (passing small amounts little and often)
• difficulty in differentiating between gas and stool

Assess people with symptoms of LARS using a validated patient-administered questionnaire (for example, the LARS score)

Offer people with bowel dysfunction treatment for associated symptoms in primary care (such as dietary management, laxatives, anti-bulking agents, anti-diarrhoeal agents, or anti-spasmodic agents). Seek advice from secondary care if the treatment is not successful

Reference:

• Ekkarat P et al. Factors determining low anterior resection syndrome after rectal cancer resection: A study in Thai patients.Asian J Surg. 2016 Oct;39(4):225-31
• NICE (January 2020). Colorectal cancer.