Pelvic Floor Muscle Training effectively controls bowel symptoms after Total mesorectal excision for rectal cancer
Researchers from Belgium suggested in their study that pelvic floor muscle training can be used as an early, first-line treatment option for bowel symptoms as it helped in lower proportions and faster recovery post-surgery/stoma closure. The study results were published in the journal Annals of Surgery.
Low anterior resection syndrome (LARS) is a common and frequently and significantly encountered bowel symptom in Total mesorectal excision (TME) for rectal cancer (RC) patients. Even though pelvic floor muscle training (PFMT) is recommended in noncancer populations for treating bowel symptoms, this was not thoroughly investigated in RC patients. Hence researchers from Belgium conducted a study to investigate PFMT effectiveness on LARS in patients after TME for RC.
A multicenter, single-blind prospective randomized controlled trial was carried out by comparing PFMT intervention versus no PFMT for 1 month after TME/stoma closure. There were 50 patients in the intervention group and 54 patients in the control group. 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:
There was a statistically significant proportion of participants with an improvement in the LARS category after PFMT compared with controls at 4 months (P=0.0415) and 6 months (P=0.0091), but no longer at 12 months (P=0.3897).
| Duration | Intervention | Control |
| 4 months | 38.3% | 19.6% |
| 6 months | 47.8% | 21.3% |
| 12 months | 40.0% | 34.9% |
There was a significantly lower score for the following secondary outcomes at 4 months:
LARS scores | (continuous, P=0.0496) |
ColoRectal Functioning Outcome scores | (P=0.0369) |
frequency of bowel movements | (P=0.0277), |
solid stool leakage | (day, P=0.0241; night, P=0.0496) |
the number of clusters as derived from the stool diary. | (P=0.0369) |
No significant differences were found for the Numeric Rating Scale/quality of life scores.
Thus, pelvic floor muscle training should be offered as a first-line option for the improvement of bowel symptoms in all patients with bowel symptoms, due to the lack of side effects as it resulted in faster recovery of bowel symptoms up to 6 months after surgery/stoma closure.
Further reading: Asnong A, D'Hoore A, Van Kampen M, et al. The Role of Pelvic Floor Muscle Training on Low Anterior Resection Syndrome: A Multicenter Randomized Controlled Trial. Ann Surg. 2022;276(5):761-768. doi:10.1097/SLA.0000000000005632
