Significant bowel problems, often called low anterior resection syndrome (LARS), are prevalent after a total mesorectal excision (TME) for rectal cancer (RC). While pelvic floor muscle training (PFMT) has been shown to be effective in alleviating gastrointestinal symptoms in non-cancer populations, its use in RC patients is understudied. The purpose of this study was to examine the efficacy of PFMT on LARS in patients who had had TME for RC. About 1 month after TME/stoma closure, participants were randomly assigned to either PFMT (intervention; n=50) or no PFMT (control; n=54) in a multicenter, single-blind, prospective randomized controlled experiment. The major outcome measure was the percentage of participants who moved up a LARS category by 4 months. Secondary outcomes measured at 1, 4, 6, and 12 months included continuous scores on the LARS, the ColoRectal Functioning Outcome, the Numeric Rating Scale, the stool diary items, and the Short Form 12. At 4 months (38.3% vs 19.6%; P=0.0415) and 6 months (47.8% vs 21.3%; P=0.0091), PFMT significantly increased the proportion of patients with an improvement in LARS category compared with controls, although this effect was no longer significant at 12 months (40.0% vs 34.9%; P=0.3897). At 4 months, there was a statistically significant improvement in the secondary outcomes of LARS scores (continuous, P=0.0496), ColoRectal Functioning Outcome scores (P=0.0369), bowel movement frequency (P=0.0277), solid stool leakage (day, P=0.0241; night, P=0.0496), and the number of clusters (P=0.0369), all derived from the stool diary. The quality of life scores on the Numeric Rating Scale did not show any statistically significant variations. Lower rates and quicker resolution of bowel symptoms up to 6 months after surgery/stoma closure following PFMT for bowel symptoms after TME support using PFMT as an early, first-line therapeutic option for bowel complaints after RC.
