Low anterior resection (LAR) is a common surgical procedure used in the treatment of rectal cancer and other pelvic diseases. Following LAR, up to 80% of patients may develop LAR syndrome (LARS), characterized by pelvic floor dysfunctions such as variable or unpredictable bowel function, fecal incontinence, altered stool consistency, increased stool frequency, painful defecation, evacuation difficulties, urgency, and involuntary gas leakage. These issues significantly impact the patients' quality of life. The aim of this study was to retrospectively evaluate the effects of pelvic floor physiotherapy combined with biofeedback therapy on 16 patients who developed LARS, using the Measure Your Medical Outcome Profile (MYMOP2) questionnaire.

This retrospective study included 16 patients diagnosed with LARS, whose details are summarized in 
Table 1. All patients received a combination of pelvic physiotherapy and biofeedback therapy for 8-10 weeks, and their health outcomes were assessed using the MYMOP2 questionnaire both before and after the intervention. MYMOP2 allows patients to subjectively report their physical and psychological health status, symptoms, and overall quality of life (Figure 1). The changes in MYMOP2 scores from pre-treatment to post-treatment were analyzed.

Before treatment, the MYMOP2 scores indicated that patients commonly experienced symptoms such as anal/fecal incontinence, pelvic pain, and constipation. Following the biofeedback and pelvic physiotherapy treatment, all patients showed clinically significant improvements in their MYMOP2 scores. The average MYMOP2 score before treatment was 4.78 (Min: 4.0, Max: 5.5), and after treatment, it improved to 1.67 (Min: 0.75, Max: 4.3), with a statistically significant difference (p = 0.001). Specifically, symptoms of fecal and gas incontinence were reduced, pelvic floor function improved, and quality of life was enhanced. Both physical and psychological health scores improved, and symptom management also showed positive changes. The MYMOP2 results confirmed the positive effects of pelvic physiotherapy and biofeedback therapy on the patients’ overall health.
Note:
The MYMOP2 scores could not be compared with LARS scores, as the LARS scoring system had not been validated in Turkish during the course of this study. This is a limitation of the research.

A minimum clinically important change in score after intervention should be between 0.5-1.0: any change greater than 1.0 is considered clinically significant according to MYMOP2 evaluation  , and in this study, all patients experienced improvements above this threshold (above 1).  This finding suggests that pelvic floor rehabilitation, particularly biofeedback therapy, is an effective method in achieving functional recovery and improving quality of life in LARS patients.

Pelvic floor physiotherapy and biofeedback therapy following LAR led to significant improvements in the MYMOP2 scores of patients who developed LARS. These improvements were particularly noticeable in the reduction of pelvic pain, fecal and gas incontinence, and the enhancement of defecation. Additionally, the overall quality of life was notably improved. This therapeutic combination plays a crucial role in the rehabilitation process following LAR surgery and appears to be an effective initial approach to managing symptoms and improving quality of life. MYMOP2 is a valuable tool for evaluating the effects of such treatments. Future studies with larger patient groups and long-term follow-up are needed to further explore the sustained benefits of this intervention.

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