Structured pelvic floor physiotherapy rehabilitation for low anterior resection syndrome in colorectal cancer: An Australian feasibility study.

Abstract

Low Anterior Resection Syndrome (LARS) is a common and debilitating outcome of sphincter-preserving surgery for colorectal cancer, severely affecting quality of life. While pelvic floor rehabilitation (PFR) is recommended as a conservative treatment, access to structured care is limited. This study assessed the feasibility and acceptability of a structured, physiotherapist-led PFR programme in an Australian outpatient setting, and explored the within-person changes in bowel function and quality of life. A non-randomised, single-arm prospective study was conducted at Concord Repatriation General Hospital (Sydney, Australia) from September 2020 to April 2024. Colorectal cancer survivors with LARS (score > 20) and bowel continuity restored > 6 months previously were enrolled. The 10-week PFR programme included education, pelvic floor muscle training, rectal balloon biofeedback, and home exercises, with adaptations for telehealth due to COVID-19. Primary outcome was programme adherence. Secondary outcomes included bowel, bladder, and sexual function, quality of life, and anorectal physiology; measured at baseline, post-intervention (3 months) and follow-up (9 months). Fourteen participants (median age sixty-three; seven female) completed the programme (one dropout with non-clinical reason), with 100% attendance and high home exercise adherence (median completion 100%). Bowel function improved significantly (median LARS score reduction -13.0; p = 0.004), with 71.4% achieving meaningful change post-intervention and 63.6% at follow-up. Quality of life significantly improved on validated measures. Anorectal physiology showed increased anal pressures, sensory thresholds, and better defaecatory coordination. No adverse events were reported. A structured, physiotherapist-led PFR programme is feasible and acceptable for colorectal cancer survivors with LARS. While improvements in bowel function and quality of life were observed over time, these findings should be interpreted as exploratory. The hypothesis-generating findings support further evaluation of PFR in a controlled trial to evaluate effectiveness and inform integration into multidisciplinary survivorship care.