Living with LARS: Managing Life After Bowel Surgery

Life after bowel cancer surgery can come with unexpected challenges, and for many Australians, one of the most impactful of these is LARS or Low Anterior Resection Syndrome. While it’s rarely discussed outside of cancer circles, LARS affects a large number of people following surgery for rectal cancer, particularly when the rectum is partially or fully removed. If you’re experiencing urgent, frequent, or unpredictable bowel movements after your surgery, you’re not alone and most importantly, there are ways to manage it.

This blog offers an in-depth look at LARS, how it might affect your quality of life, and what can be done to ease its symptoms. Whether you’re newly diagnosed, preparing for surgery, or already adjusting to your new normal, understanding LARS can make a meaningful difference in your post-treatment journey.

What Is Low Anterior Resection Syndrome (LARS)?

LARS is a group of bowel symptoms that can occur after rectal cancer surgery, especially when a low anterior resection is performed. This surgery removes part or all of the rectum and reconnects the remaining bowel to the anus. While it’s often a successful approach in terms of cancer outcomes, it can significantly alter bowel function.

Common symptoms of LARS include:

• Urgency (a sudden, intense need to empty the bowels)
• Increased frequency of bowel movements
• Incontinence or leakage
• Fragmentation (passing small amounts of stool multiple times)
• Difficulty fully emptying the bowel
• Bowel clustering (multiple trips to the toilet in a short period)

The severity of LARS can vary. Some people experience mild symptoms (like I do), while others may find their daily activities heavily affected. The LARS score, a simple questionnaire developed to measure the impact of these symptoms, can help assess how severely someone is affected.

Why Does LARS Happen?

LARS is caused by changes to how the bowel functions after surgery. When the rectum is removed or altered, it disrupts the normal storage capacity and coordination needed for smooth bowel movements. Additional factors can worsen symptoms, including:

• Removal of the rectum or part of it
• Radiation therapy to the pelvis
• Nerve damage during surgery
• Changes in the shape of the bowel or scarring

Over time, some people find that their symptoms improve as the bowel adapts. For others, LARS may be a long-term or permanent condition requiring ongoing management.

Who Is Most at Risk?

Australians undergoing low anterior resection for rectal cancer, especially those with early-onset bowel cancer, are at a higher risk for LARS. This is due to the younger demographic often being offered sphincter-preserving surgery, which increases the likelihood of developing these symptoms postoperatively.

You may be at higher risk if:

• Your tumour was located low in the rectum
• You received neoadjuvant radiation or chemoradiation
• Your surgery involved a total mesorectal excision (TME)
• You had a temporary ileostomy followed by reversal
• You are younger and more physically active (which can increase awareness and impact of symptoms)

Diagnosis and the LARS Score

If you’re experiencing bowel symptoms after rectal surgery, your healthcare team may use the LARS score to assess the severity. This tool is quick, evidence-based, and helps guide management decisions.

The LARS score categorises symptoms as:

• No LARS
• Minor LARS
• Major LARS

Knowing your score helps with treatment planning, whether it’s dietary adjustments, pelvic floor therapy, or medical interventions.

LARS Score Questionnaire

Please answer the following questions based on your typical bowel habits. Select the response that most closely matches your current experience.

1. 1. Do you ever have bowel movements more than once within one hour?
      ☐ Never (0 points)
      ☐ Less than once per week (4 points)
      ☐ At least once per week (7 points)

1. 1. Do you have an uncontrollable urge to have a bowel movement?
      ☐ Never (0 points)
      ☐ Less than once per week (11 points)
      ☐ At least once per week (16 points)

1. 1. Do you have accidental leakage of stool?
      ☐ Never (0 points)
      ☐ Less than once per week (7 points)
      ☐ At least once per week (14 points)

1. 1. Do you use the toilet again within 1 hour of a bowel movement because you did not completely empty your bowel?
      ☐ Never (0 points)
      ☐ Less than once per week (9 points)
      ☐ At least once per week (11 points)

1. Do you have any gas (wind) leakage?
   ☐ Never (0 points)
   ☐ Less than once per week (2 points)
   ☐ At least once per week (4 points)

🔢 Scoring: Add up your total points from all five questions.

• 0–20 points = No LARS
• 21–29 points = Minor LARS
• 30–42 points = Major LARS

This score can be used during discussions with your surgeon, gastroenterologist, stoma nurse, or pelvic floor physiotherapist to guide treatment and support planning.

Managing LARS: Strategies That Help

The good news? There are many ways to manage LARS, both medically and holistically. It may take time and trial-and-error, but with the right tools and support, most people find ways to regain control and quality of life.

1. Dietary Adjustments

• Keep a food and symptom diary to identify triggers
• Eat small, regular meals to avoid overloading your bowel
• Limit caffeine, alcohol, and high-fat foods which may worsen urgency
• Reduce high-fibre foods if experiencing diarrhoea or clustering
• Increase soluble fibre (e.g., oats, psyllium husk) to help bulk stools
• Stay well hydrated but consider spacing fluids apart from meals

2. Bowel Training

• Try to establish regular toilet times, especially after meals
• Use gentle laxatives or stool bulking agents if needed, under medical guidance
• Avoid straining and consider using a footstool to mimic a natural squatting position

3. Pelvic Floor Physiotherapy

• Pelvic floor exercises can improve bowel control and reduce urgency
• Seek a referral to a pelvic floor physiotherapist with experience in bowel dysfunction
• Biofeedback therapy may also help retrain bowel coordination

4. Medications

• Anti-diarrhoeal medications such as loperamide can be effective when used correctly
• Bulking agents like Metamucil or Normacol may improve stool consistency
• Antispasmodics can reduce urgency and cramping

5. Transanal Irrigation

• A method of flushing out the bowel using warm water to prevent accidents
• Requires training from a stoma nurse or specialist clinic
• Often used when other measures don’t provide adequate relief

6. Supportive Devices and Lifestyle Changes

• Incontinence pads or anal plugs can offer reassurance and reduce anxiety
• Plan outings with toilet locations in mind using the National Public Toilet Map
• Carry a “Just Can’t Wait” card for easier access to public bathrooms

Emotional Impact and Coping with Stigma

LARS doesn’t just affect the body, it can take a toll on mental health, confidence, and relationships. Fear of accidents, embarrassment, or feeling like your body is unpredictable can lead to isolation or anxiety.

Helpful coping strategies include:

• Joining a bowel cancer support group, either online or in person
• Speaking with a psychologist experienced in chronic illness
• Communicating openly with trusted friends and family
• Reframing self-image through kindness and patience with your body

Bowel Cancer Australia offers peer-to-peer support through their Bowel Cancer Peer Support Network, connecting people who understand what you’re going through.

Practical Tips for Daily Life

• Work: Discuss flexible hours or work-from-home options during flare-ups
• Travel: Pack spare underwear, wipes, and a change of clothes in your bag
• Sleep: Avoid eating too close to bedtime and have easy access to the toilet
• Exercise: Gentle movement such as walking or yoga can aid digestion
• Sex and Intimacy: Speak to a sexual health counsellor or pelvic floor therapist if symptoms are affecting intimacy

When to Seek Help

You shouldn’t have to suffer in silence. If LARS is affecting your quality of life, talk to your colorectal surgeon, GP, or a cancer nurse. Many people delay seeking help due to embarrassment, but there are professionals who specialise in post-surgical bowel care.

Ask for referrals to:

• A colorectal physiotherapist
• A continence nurse
• A dietitian familiar with bowel resection diets
• Bowel Cancer Australia’s nurses via the Helpline (call 1800 555 494)

Hope for the Future

Research into LARS is ongoing, and new treatments continue to emerge. Some Australian centres are exploring surgical techniques to reconstruct internal reservoirs (pouches) that mimic rectal function, while others are testing neuromodulation devices and enhanced pelvic rehab protocols.

You’re not alone and the medical community is increasingly aware of how LARS impacts recovery and wellbeing. The more we talk about it, the better care we can all receive.

Resources for Australians Living with LARS

• Bowel Cancer Australia – for support services, LARS information, and helpline
• Continence Foundation of Australia – for incontinence advice and support
• Pelvic Floor First – physiotherapy resources and exercise tips
• Carer Gateway – support for those assisting someone with post-cancer bowel issues
• National Public Toilet Map – essential for travel and outings

Final Thoughts

Living with LARS can be a challenging part of life after bowel cancer, but it’s one that can be managed with knowledge, support, and proactive care. It may take some time to find what works for you, but you don’t have to figure it all out on your own. Empower yourself with information, reach out to the right professionals, and don’t be afraid to speak up about your symptoms. There is life, full, meaningful, and joyful after surgery.