Effectiveness of transanal irrigation in low anterior resection syndrome

Low anterior resection syndrome (LARS) is a frequent issue leading to bowel dysfunction after anterior resection surgery. NICE guidelines state that there is limited research around the management of LARS. Transanal irrigation (TAI) is a suggested treatment by guidelines; however, there is limited research surrounding the effectiveness of this treatment.

The aim of this prospective study was to evaluate the effectiveness of TAI in reducing LARS score post anterior resection surgery.

Patients who were referred to the pelvic floor nurse specialist team between 2019 and 2023 with bowel dysfunction post anterior resection surgery were evaluated. Bowel dysfunction was assessed using the LARS scoring system during the first assessment and on discharge. These patients were offered TAI and trained to perform TAI. Patients with missing LARS scores and those who were not using TAI were excluded from the study.

Of the total 37 patients who were referred and using TAI, 16 were excluded. In total, 21 patients were included (12 male, 9 female). At baseline, 33% of patients were recorded to have minor LARS, and 66% with major LARS. At discharge, there was a significant improvement in LARS score (80% of patients reported no LARS, 10% minor LARS and 10% major LARS). Overall, the LARS score at discharge was significantly lower among patients who underwent irrigation (mean 34.57 vs. 12.48, p = 0.0000000038).

Our study shows the importance of TAI in the management of bowel dysfunction post anterior resection for rectal cancer, with more than two-third of patients' symptom improvement.