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Randomized Controlled Trial
. 2022 Nov 1;276(5):761-768.
doi: 10.1097/SLA.0000000000005632. Epub 2022 Jul 27.

The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial

Anne Asnong  1 , André D'Hoore  2 , Marijke Van Kampen  1 , Albert Wolthuis  2 , Yves Van Molhem  3 , Bart Van Geluwe  4 , Nele Devoogdt  1   5 , An De Groef  1   6   7 , Ipek Guler Caamano Fajardo  8 , Inge Geraerts  1
Affiliations
Randomized Controlled Trial

The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial

Anne Asnong et al. Ann Surg. .

Abstract

Background and objective: Total mesorectal excision (TME) for rectal cancer (RC) often results in significant bowel symptoms, commonly known as low anterior resection syndrome (LARS). Although pelvic floor muscle training (PFMT) is recommended in noncancer populations for treating bowel symptoms, this has been scarcely investigated in RC patients. The objective was to investigate PFMT effectiveness on LARS in patients after TME for RC.

Methods: A multicenter, single-blind prospective randomized controlled trial comparing PFMT (intervention; n=50) versus no PFMT (control; n=54) 1 month following TME/stoma closure was performed. The primary endpoint was the proportion of participants with an improvement in the LARS category at 4 months. Secondary outcomes were: continuous LARS scores, ColoRectal Functioning Outcome scores, Numeric Rating Scale scores, stool diary items, and Short Form 12 scores; all assessed at 1, 4, 6, and 12 months.

Results: The proportion of participants with an improvement in LARS category was statistically higher after PFMT compared with controls at 4 months (38.3% vs 19.6%; P =0.0415) and 6 months (47.8% vs 21.3%; P =0.0091), but no longer at 12 months (40.0% vs 34.9%; P =0.3897). Following secondary outcomes were significantly lower at 4 months: LARS scores (continuous, P =0.0496), ColoRectal Functioning Outcome scores ( P =0.0369) and frequency of bowel movements ( P =0.0277), solid stool leakage (day, P =0.0241; night, P =0.0496) and the number of clusters ( P =0.0369), derived from the stool diary. No significant differences were found for the Numeric Rating Scale/quality of life scores.

Conclusions: PFMT for bowel symptoms after TME resulted in lower proportions and faster recovery of bowel symptoms up to 6 months after surgery/stoma closure, justifying PFMT as an early, first-line treatment option for bowel symptoms after RC.

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Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Trial recruitment. *Due to psychosocial circumstances, distance to the hospital or group preference.
FIGURE 2
FIGURE 2
Representation of the LARS categories for the experimental and control group at each timepoint. *P-values correspond to the results of the exact proportion test of the proportion differences, based on the 1 month timepoint.
FIGURE 3
FIGURE 3
Representation of the trajectories of the LARS and COREFO scores over time.
See this image and copyright information in PMC

References

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