Sacral neuromodulation (SNM) is a good treatment option for alleviating bowel and bladder symptoms in patients with low anterior resection syndrome (LARS). In addition it has beneficiary effects on erectile function and pain in these patients.

Low anterior resection, which is a sphincter preserving surgery, is a standard treatment for localized rectal cancer and some other indications (e.g. endometriosis) (1). A frequent adverse effect of this procedure is low anterior resection syndrome (LARS) which includes fecal urgency, frequency and/or fecal incontinence. A significant proportion of patients have associated urinary symptoms, pain, and/or erectile dysfunction. In our centre we offer sacral neuromodulation (SNM) for treatment of anal incontinence and associated bladder/erectile dysfunction in LARS patients. 
SNM electrode implantation was performed according to standard recommendations in general anesthesia. During surgery electromyographic (EMG) monitoring with monopolar needle electrode in external anal sphincter was performed to ensure optimal electrode placement. After test period (up to 2-4 weeks) the effects were assessed using questionnaires, bowel and bladder diaries and self-assessed quality of life improvement. In case of at least 50 % improvement in at least one modality the internal pulse generator was implanted.

Since December 2023 we performed 50 SNM procedures. 10 % were LARS patients (3 women, 2 men). All patients had anal incontinence, 3 had associated bladder emptying disorder, 2 had associated pain, both men had erectile dysfunction. Significant improvement in anal continence and pain was recorded within the first week after implantation. Patients reported of more than 90 % improvement. In addition, men observed a drastic improvement in erectile function.

SNM improved anal and urinary continence, diminished pelvic pain and improved erectile function.

Sacral neuromodulation is a procedure used to treat various pelvic organ dysfunctions. Indications are expanding fast. In a small group of our patients with LARS SNM was the single remaining treatment for incontinence and pain. Our results show that SNM is a very good treatment option in LARS patients as well with more than 90 % improvement in anal and urinary continence and significant improvement in pain. Additional positive effects were shown in erectile function. Therefore, we conclude that SNM significantly improves quality of life in these patients.

Sharp G, Findlay N, Clark D, Hong J. Systematic review of the management options available for low anterior resection syndrome (LARS). Tech Coloproctol. 2025 Feb 4;29(1):58. doi: 10.1007/s10151-024-03090-3. PMID: 39903381.