Pelvic Floor Prehabilitation for Prevention of Low Anterior Resection Syndrome: Insights From a Randomized Trial ( CARRET Study)

OBJECTIVES: To assess the effectiveness of presurgical and postsurgical pelvic floor physiotherapy on the bowel symptoms and anorectal function of patients with rectal cancer undergoing LAR. METHODS: Randomized controlled trial. The sample included 14 patients undergoing LAR, with 3 months after ileostomy reversal follow-up. INTERVENTION: Pelvic floor physiotherapy (pelvic floor exercises, biofeedback, balloon training, and health education); one session before LAR, four sessions before ostomy reversal, and five to eight sessions after reversal. OUTCOMES: Bowel function assessed with the International Consultation on Incontinence Questionnaire Bowel Module and LARS score, and high-resolution anorectal manometry. RESULTS: Only 25% of the intended sample was recruited, limiting the ability to assess the intervention's effectiveness. Data revealed no difference between groups on bowel symptoms (bowel pattern, bowel control, and quality of life) and anorectal function (pressures and sensitivity); p > 0.05. Bowel function domains worsened at final assessment, compared to baseline. The mean resting pressure was the most reduced both before LAR (44.3 [SD = 12.0] mmHg) and post LAR (27.2 [SD = 10.7] mmHg). Women were more likely to adhere to the intervention. Despite several implementation barriers, the intervention proved feasible, with higher adherence before tumor resection and lower adherence before ileostomy reversal. CONCLUSIONS: Due to the limited sample size, definitive conclusions regarding the effectiveness of pelvic floor prehabilitation for LAR cannot be drawn. The challenges in implementing pelvic floor prehabilitation studies, as illustrated in this research, should be carefully considered. TRIAL REGISTRATION: ACTRN12620000040965.