Pelvic Floor Physical Therapy Prehabilitation (PrePFPT) for the prevention of low anterior resection syndrome

Low Anterior Resection Syndrome (LARS) is a syndrome of lifestyle-limiting defecatory dysfunction diagnosed after the treatment of rectal cancer that can afflict 41 % of patients one year after surgery. Currently, the treatment of LARS is reactionary to the development of symptoms, and post-treatment pelvic floor physical therapy (PFPT) is one form of treatment utilized to mitigate the symptoms of LARS and improve patient quality of life. Prehabilitation is the physical and/or lifestyle preparation that improves recovery following surgery. For rectal cancer patients, general prehabilitation while undergoing neoadjuvant chemoradiotherapy is safe and feasible. However, no studies have examined whether pelvic floor physical therapy prehabilitation, which we term “PrePFPT,” could mitigate the development of LARS. In this commentary, we argue that PrePFPT should become an active area of research in rectal cancer to improve functional and quality of life outcomes. We highlight two proposed international trials, which will evaluate pre- and postoperative PFPT as a strategy to reduce the incidence of LARS. We conclude with our own proposed PrePFPT study design.