Continence and defecation management after low anterior rectal resection

Disorders of bowel evacuation and incontinence are the major components of the low anterior resection syndrome (LARS), which occurs in up to 70% of cases after sphincter-preserving rectal resection. The LARS can be treated with pelvic floor rehabilitation, dietary and medicinal stool regulation and by the use of evacuation aids in the form of suppositories and enemas. Furthermore, anal irrigation has been proven to be a highly effective tool for the treatment of severe LARS. If anal irrigation is unsuccessful or cannot be performed, neuromodulatory methods can be used. Percutaneous tibial nerve stimulation (PTNS) as well as sacral nerve stimulation (SNS) have been shown to be effective for LARS in randomized studies. If all these procedures do not result in a satisfactory quality of life, antegrade irrigation via a percutaneous cecostomy or a Malone stoma can be discussed. Alternatively, a definitive stoma must be discussed with the patient.