Pelvic Floor Re-training After Rectal Surgery

What is Pelvic Floor Re-training?

Pelvic floor re-training, often referred to as pelvic floor physical therapy, is a specialized program designed to improve the function of the pelvic floor muscles after rectal surgery. Procedures like low anterior resection can lead to a constellation of symptoms known as Low Anterior Resection Syndrome (LARS), which includes fecal incontinence, urgency, and frequent or incomplete bowel movements. This re-training program aims to improve bowel control, reduce symptoms, and enhance quality of life by strengthening the sphincter muscles, improving sensory awareness, and re-coordinating the muscles involved in defecation and continence.

Key Components:

• Kegel Exercises: To strengthen the external anal sphincter and puborectalis muscles.
• Biofeedback: A technique that uses sensors and visual feedback to help patients learn to isolate, strengthen, and coordinate their pelvic floor muscles.
• Bowel Retraining: Establishing a regular toileting schedule and dietary habits to promote more predictable bowel function.

Who are Good Candidates for Pelvic Floor Re-training?

This therapy is ideal for motivated patients who are experiencing significant bowel dysfunction and a reduced quality of life after sphincter-preserving rectal surgery. Good candidates include those with:

• Low Anterior Resection Syndrome (LARS): Particularly those with symptoms of fecal incontinence, urgency, and clustering of bowel movements.
• Fecal Incontinence: After other anorectal procedures that may have affected sphincter function.
• Obstructed Defecation: Difficulty evacuating stool due to poor coordination of the pelvic floor muscles after surgery.

The therapy is most effective when initiated after the acute postoperative recovery period, typically 6-12 weeks after surgery.