Medical Oncologist
CION Cancer Clinics
Low anterior resection syndrome (LARS) | CION Cancer Clinics
Low anterior resection syndrome, or LARS, is the group of bowel problems that follow removal of the rectum: going very often, having to rush, several motions in a cluster, and sometimes leakage. It usually starts after the temporary stoma is closed, is worst in the first weeks, and improves for most people over the following months. It is expected, and there is a ladder of treatments that help. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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The short answer
What is low anterior resection syndrome?
Low anterior resection syndrome, usually shortened to LARS, is the group of bowel problems that follow removal of the rectum: going very often, having to rush, passing several small motions in a cluster, and sometimes not making it in time. It is common, it is expected, and it is not a sign that the operation went wrong.
Why it has a name of its own
For years people were told their bowel would settle and were left to manage alone. Giving the pattern a name means it is now asked about at follow-up, measured with a short questionnaire, and treated in steps. If your surgeon has not mentioned it, raise it yourself.
When it starts and how long it lasts
It starts when stool begins passing through the new join, which for most people means after the temporary stoma is reversed. The first weeks are usually the worst. Most people improve over the following months, and the pattern often keeps settling for a year or more. Some people have a milder version for good.
What this page cannot tell you
It cannot tell you how bad yours will be or how long it will last. That depends on how low the join is, whether you had radiotherapy, the state of the muscle ring at the anus, and your age. Your surgical team can give you a better estimate than any website.
What it looks like
The five patterns people describe
Most people have two or three of these, not all five. Naming yours helps the team choose what to try first.
Frequency
Going many times a day, often with small amounts each time. The bowel above the join no longer has a store to hold stool in, so it passes what arrives.
Urgency
Very little warning between the first feeling and needing to go. This is the symptom that keeps people at home, and it usually improves the most with time and treatment.
Clustering
Several motions close together, often after a meal, with a feeling of not being finished. Then nothing for hours. Families often mistake it for loose motions.
Leakage
Escape of wind, liquid or stool, particularly at night. A pad and a barrier cream manage it while it improves. It is nothing the team has not heard many times.
Feeling unfinished
Sitting a long time, straining, and still feeling something is left. Straining makes it worse. The feeling comes from the join and the nerves, not from stool that is actually there.
Not sure whether this applies to you?
Ask an oncologistThe reason
Why does removing the rectum do this?
The rectum is a stretchy store that holds stool until a convenient moment and tells the brain how full it is. When most of it is removed, the bowel joined in its place is narrower, less stretchy and has not learnt the job. The muscle ring at the anus has to work harder with less warning.
What makes it worse
The lower the join, the more symptoms to expect. Radiotherapy to the pelvis before surgery stiffens the tissue and the muscle ring, so people who had it tend to have more trouble. A leak at the join during healing, and age, both add to it. None of these are things you did wrong.
Why it improves
The new segment of bowel slowly stretches and learns to store. The nerves partly recover. And you learn your own pattern, which foods and times of day trigger it, and how to plan around it.
Who this does not apply to
If your whole rectum and anus were removed and you have a permanent colostomy, LARS does not apply, because there is no join. If your stoma has not yet been reversed, you will not have these symptoms yet, but this is the page to read before the reversal.
In order
What helps, from the simplest step upwards
Food and routine
Regular meal times, smaller portions, and foods that firm the stool such as rice, banana and toast. Less very spicy or oily food, caffeine and fizzy drinks. A fibre supplement such as isabgol, if your team suggests it.
Medicines that slow the bowel
Loperamide is the usual first choice. Your team sets the amount and the timing. Stopping it without asking is a common reason symptoms return.
Pelvic floor exercises
Training the muscle ring and the muscles around it to hold on for longer. A physiotherapist teaches the exercises, and some centres use a screen that shows whether you are squeezing the right muscle.
Washing the bowel out
Transanal irrigation means gently running water into the bowel through a small tube at a set time each day, so it empties fully and stays quiet for many hours. It sounds daunting; many people who try it wish they had started sooner.
When symptoms stay severe
Some centres offer stimulation of the nerves that control the bowel, or discuss a stoma. Ask your centre what it offers and who it suits.
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On your notes
Words you will meet, in plain language
- LARS score
- A short questionnaire that puts a number on how much the symptoms affect you. It is used to track change, not to judge you.
- Neorectum
- The piece of bowel joined in place of the rectum. Over time it stretches and takes over some of the storing job.
- Anastomosis
- The join between the bowel and what remains of the rectum or anus. The lower it sits, the more symptoms to expect.
- Sphincter
- The muscle ring at the anus that holds stool in. Its strength before surgery shapes function after it.
- Transanal irrigation
- Washing the bowel out through the back passage with water at a set time each day, using a small kit.
Commonly believed
Four things families tell us, and what is actually true
"Going so often means the cancer is back."
Frequency and urgency after rectal surgery are the bowel adjusting to the loss of the rectum, and they are expected. Follow-up scans and blood tests are how the team watches for the cancer. Bowel pattern on its own is not a sign either way.
"He should eat less so he goes less."
Skipping meals makes the pattern less predictable and weakens someone who is recovering. Smaller, regular meals of firming food give the bowel a rhythm, and that rhythm reduces the trips.
"Loperamide is for loose motions, not for this."
It slows the bowel and gives the new segment time to hold stool, which is exactly the problem in LARS. Taken as your team prescribes, it is one of the most useful tools there is.
"Nothing can be done, we just have to live with it."
There is a ladder of treatments, from food and medicines to exercises, irrigation and nerve stimulation. Most people get real improvement somewhere on that ladder. Living with it in silence is the one option that does not help.
Did you know
The rectum tells the brain whether what has arrived is wind, liquid or solid. After it is removed that sense is dulled, which is why people with LARS describe not trusting a passing of wind. It partly returns with time.
Questions we are asked
Common questions about LARS
How long does LARS last?
The first weeks after the stoma is closed are usually the worst, and most people improve steadily over the following months. The pattern often keeps settling for a year or more. Some people have a milder version that stays. Nobody can tell you in advance which group you will be in.
Will I be able to go back to work?
Most people do. What helps is knowing where the toilets are, eating the main meal after work rather than before, and carrying a small kit with wipes, a pad and spare underwear. A letter from the team about toilet access can help with an employer.
Is it safe to take loperamide every day?
When your team has prescribed it for LARS, many people take it daily for a long time. The amount and the timing are set by the team, not by the packet. Tell them if you become constipated or bloated, because the plan may need adjusting.
Why is it worse after I eat?
Eating triggers the bowel to move all the way down, and without a rectum to hold the result you feel it straight away. This is the clustering pattern. Smaller meals and avoiding very hot or fatty food both reduce it. Ask your team how to time any prescribed medicine around meals.
What is transanal irrigation really like?
You sit on the toilet, place a small soft tube in the back passage and run in warm water from a bag or pump. The bowel empties, and then it is usually quiet for the rest of the day. A nurse teaches it over a few sessions. It takes time each morning and gives back the rest of the day.
Will radiotherapy have made mine worse?
People who had radiotherapy to the pelvis before surgery do tend to have more trouble, because it stiffens the remaining rectum and the muscle ring. It does not mean the radiotherapy was wrong; it was given to lower the chance of the cancer returning. It does mean starting the steps above early.
Can I ask for the stoma back?
Yes. A small number of people with severe LARS decide that a well-managed stoma gives them a better life, and surgeons respect that choice. It is a decision to take after the simpler treatments have been tried properly, with your team and family, and never in the first difficult weeks.
Who should I talk to about this?
Your surgical oncologist at follow-up, and the stoma or colorectal nurse, who deals with these questions every day. Bring a written note of how many times you go, when the urgency is worst and what you have already tried. Call the helpline if you want to talk it through before the appointment.
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Dr. C. Raghavendra Reddy
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Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Dr. Vajja Sandeep Kumar
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Sources
- Macmillan Cancer Support — Bowel cancer
- Cancer Research UK — Surgery for rectal cancer
- American Cancer Society — Surgery for rectal cancer
- NICE — Colorectal cancer (NG151)
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Managing Frequency, Urgency and Clustering After Rectal SurgeryPractical day-to-day tactics for the worst symptomsBowel Retraining After Rectal SurgeryExercises and routines that help the new bowel learnDoes Bowel Function Improve With Time?What changes over months and yearsIleostomy Reversal: Timing and What to ExpectThe operation after which LARS usually beginsRadiation Before Rectal Surgery: How It Changes ThingsWhy pelvic radiotherapy affects bowel function afterwards
Talk to us
Struggling with your bowel after surgery?
Call the helpline and tell us what the pattern is like and what you have tried. A surgical oncologist or colorectal nurse will talk you through the next step.