I have a TME in my near future and I'm pretty paranoid about LARS. I know it'll be what it'll be and I'll just have to deal w/ whatever is to come. However, I want know what I can do pre/post-op to help prevent, or at least lessen, any future issues.
I was reading up on LARS on "Up to Date" (a sort of clearing house that gathers and summarizes all of the latest/greatest medical info for doctors) and I came across this one sort of throw-away paragraph:
"Additionally, patients who receive a protective stoma as a part of their low anterior resection may be at increased risk of developing LARS. In a follow-up study 12 years after a randomized trial, patients who underwent low anterior resection with a protective stoma reported increased incontinence for flatus and liquid stools and worse overall LARS score compared with patients who underwent low anterior resection without a protective stoma. Thus, patients who have a protective stoma that is not expected to close within one to two months should also receive daily or two- to three-times-per-week enemas or anterograde colonic irrigation via the stoma."
So basically an enema a day keeps the LARS away. Sounds unpleasant but if that's what it takes... For whatever reason the two studies that this paragraph references are about daily enemas for patients w/ LARS after reversal when this clearly says you should have them prior to reversal. So, I don't know where this pre-reversal enema recommendation came from. I would assume the enemas help keep the nerves stimulated and the muscles in shape. Plus, it's probably better to learn how to use your new plumbing w/ a controlled volume of water rather than an uncontrolled volume of poo.
I've asked my two prospective surgeons, at Johns Hopkins and at Memorial Sloan Kettering, about this enema thing and both expressed total ignorance of it and instantly dismissed the idea. Sadly this reinforced my impression that surgeons have little knowledge of, or interest in, LARS
So, to the group, has anyone heard of, or participated in, doing daily enemas prior to Ilo reversal? Is there a good central source for LARS prevention? Any advice on what I should be doing pre-surgery (besides enjoying food while I still can)?
DX at 45yo 6/9/16, 2.4cm tumor, 9cm from Anal Verge, 6/27/16
Clinical staging IIIC, CEA 3.1 7/1/16
30x Chemorad 8/5/16 - 9/16/16
CT/MRI/Scope => CCR 11/1/16... Rolling the dice on Watch & Wait
Snake Eyes: Tiny regrowth at scar 11/1/17
LAR 1/17/18: Path = 3mm tumor, 0/12 nodes Med Onc doesn't recommend chemo.