Low anterior resection syndrome is a collection of symptoms or issues patients have after undergoing a resection or removal of part of or the entire rectum (last 6-8 inches of the large intestine with an anastomosis or “hook up” of the colon low in the rectum). These symptoms may include the following: frequency/urgency of stools, clustering of stools (numerous bowel movements over a few hours), stool incontinence, no stool for a day or two or more and then numerous bowel movements another day, and/or increased gas.
Not all patients experience every symptom. Each patient is unique. Some patients may notice that their symptoms resolve over time while others may continue to have symptoms. The purpose of this handout is to offer suggestions that may be helpful in coping with these issues/symptoms.
1. Muscle strengthening exercises combined with dietary changes may help with urgency and stool incontinence.
2. For clustering of bowel movements try:
- Imodium AD
- You may start by taking one 2 mg tablet prior to each meal, increasing to two tablets 4 times a day. You may take up to 16 mg of Imodium daily.
- Imodium should be taken before loose bowel movements, ideally 30 minutes before meals and at bedtime.
- A probiotic such as FloraQ, Align or VSL #3 (available online) may be helpful.
- Citrucel or Metamucil, one dose in a glass of water or juice at bedtime
3. Chew foods thoroughly.
4. Try small, frequent meals (5-6 per day). Skipping meals may worsen watery stools and cause increased gas.
5. Add new foods one at a time to determine the effect it has on your bowel movements.
6. Drink plenty of fluids. Sip fluids slowly and drink either between meals or at the end of a meal.
7. Avoid caffeine and/or alcohol. This can worsen stool output.
8. Eat foods high in soluble fiber and use fiber supplements.
- Psyllium based products improve stool consistency by absorbing water but not reducing the volume. This may help slow and thicken the stool.
9. Milk and milk products contain lactose and can worsen diarrhea for some people. Try lactose free milk or enzyme tablets if the milk affects you.
10. Imodium AD is an anti-diarrheal medication that is available over the counter that is well-tolerated and may improve anal sphincter pressure. This helps thicken stool as well as helps with stool incontinence.
11. Carry a “survival pack” consisting of wet wipes, protective ointments (example: Calmoseptine or other “diaper-type” barrier ointments), and Imodium AD.
Foods that can cause gas:
Foods that make stools firmer:
White boiled rice
White bread (not high fiber)
Milk Arrowroot biscuits
Foods that may cause softer and more frequent stools:
Vegetables: red capsicum, cabbage, onions, spinach, dried and fresh beans, peas, corn, Brussels sprouts, and broccoli.
Fruit: Fresh, canned or dried fruit. Grapes, apricots, peaches, plums, and prunes.
Spices: Chili, curry, and garlic.
Caffeine: Coffee, tea, cola, and chocolate.
Alcohol: beer and red wine.
Glucose free foods containing Sorbitol or Mannitol: Sugar free chewing gum, some mints, sweeteners, and snack bars.
Bran, other high fiber cereals and breads as well as some fiber supplements.
Milk and other dairy products.
Nuts and popcorn.
Prune, orange and grape juice