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Low anterior resection syndrome (LARS)

An ESCP Guide for Patients

View our short printable guide

What is LARS?

Low anterior resection syndrome (LARS) is a common condition that can occur after surgery to remove part or all of the rectum - usually for rectal cancer.

This surgery, known as a low anterior resection, reconnects the remaining large bowel (colon) to the anus. Since the rectum helps store and control bowel movements, its removal can lead to various changes in how your bowel functions.

Symptoms of LARS

LARS comprises a collection of different symptoms and everyone's experience is different. You may experience some or all of the following:

  • Sudden or urgent need to use the toilet
  • Frequent bowel movements
  • Loose or watery stools
  • Bowel leakage or incontinence
  • Incomplete emptying of the bowel
  • Soiling or staining of underwear
  • Unpredictable bowel habits

How LARS can affect your life

These symptoms can have a big impact on daily activities and emotional well-being, seriously affecting quality of life, including:

  • Anxiety about reaching a toilet in time
  • Disruption of social life, travel, and work
  • Embarrassment or fear of accidents
  • Changes in intimacy and relationships
  • Fatigue from frequent bathroom trips

Treatment options for LARS

There’s no one-size-fits-all solution - treatment depends on your specific symptoms and lifestyle. The main goal is to improve quality of life, not necessarily to return bowel habits to 'normal'. Your care team will guide you through options like:

Postoperative care tips

Typically, LARS symptoms stabilise after 6-12 months. With the help of some tips during the first months after surgery, the quality of life can already improve. An overview of measures that can help during the early postoperative period:

  • Follow your doctor's instructions, as they know your situation best
  • Stay hydrated
  • Medication management
  • Practice pelvic floor exercises
  • Use a scheduled bathroom routine
  • Wear protective pads if needed

Lifestyle and dietary changes

  • Hydration: drink plenty of water to keep stools regular
  • Fibre intake: eating the right amount of fibre can help regulate stools. Do not overdo it, as too much too quickly might cause bloating.
  • Avoid trigger foods: fatty foods, caffeine, and spicy foods may worsen symptoms
  • Toilet routine: try going to the toilet at the same time each day to train your bowels
  • Pelvic floor exercises: strengthening the muscles around the anus can improve bowel control

Medication

Medication can help regulate stool frequency and consistency, making bowel movements more predictable and easier to manage.

  • Anti-diarrheal drugs (e.g. loperamide): can slow down bowel movements and reduce urgency
  • Bulking agents (e.g. psyllium): help make stools firmer and easier to control
  • Laxatives: can help if constipation is a problem

Pelvic floor therapy and biofeedback

  • Pelvic floor exercises (like Kegels) strengthen bowel muscles
  • Biofeedback therapy helps patients learn to control bowel muscles using real-time feedback together with a therapist

Transanal irrigation (TAI)

  • This technique flushes out the bowel using water, reducing the need for frequent toilet trips. Also see this video on YouTube>
  • It requires some training but can improve bowel control, reduce urgency and improve continence

Sacral nerve stimulation (SNS)

  • A small device is implanted under the skin to send electrical signals to the nerves controlling the bowel and sphincter
  • It can help improve continence and reduce urgency or limit the number of bowel movements

Stoma surgery (if needed)

  • In severe cases, a stoma may be created. This is an opening in the abdomen that allows stool to pass into a bag, bypassing the backend altogether.
  • This option is usually considered as a last resort when other treatments do not provide sufficient relief.

Long-term management of LARS

LARS often improves over time. Regular follow-ups and self-care can help you regain control. Focus on:

  • Maintaining a suitable diet
  • Continuing pelvic floor exercises
  • Using medication when needed
  • Staying in contact with your colorectal care team

The LARS Score helps you assess your symptoms. It is a short questionnaire consisting of 5 questions. The number of points you can score for each question is shown in bold next to the answer options. It can also help to see whether a certain treatment objectively improves symptoms.

When to see a doctor

If bowel problems are affecting your quality of life, consult a colorectal surgeon. They specialise in managing LARS and can provide tailored solutions.

Living with LARS can be challenging, but with the right support, many people live full, active lives. Don’t hesitate to seek help - you’re not alone.

If you have any questions, speak with your doctor or colorectal surgeon for personalised advice.

Disclaimer

The information provided here is general and hopes to correctly inform the patient to the extent possible. However, this document cannot discuss all aspects of a specific condition or procedure, or of the individual patient.

The decision on which procedure will give you the best result is made by your doctor or colorectal surgeon during consultation and based on shared and informed decision-making with the patient.