LARS Score

LARS Score (Past 4 Weeks)

These questions are about your current bowel function. Please answer based on your experience during the past 4 weeks.

5 Questions

1. Incontinence to flatus (passing wind unintentionally)

2. Incontinence to liquid stool

3. Frequency of bowel movements per day

4. Clustering (2 or more bowel movements within 1 hour)

5. Urgency (unable to defer defaecation for 15 min)

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LARS Score (0–42)

Interpretation

LARS Score	Category	Clinical Significance
0–20	No LARS	Bowel function does not significantly impact quality of life
21–29	Minor LARS	Some bowel dysfunction; may benefit from dietary advice and pelvic floor physiotherapy
30–42	Major LARS	Significant impact on quality of life; specialist referral recommended

Prevalence: LARS affects 40–60% of patients after low anterior resection (LAR). Major LARS occurs in approximately 30–40%.
Time course: Symptoms are worst in the first 6–12 months after reversal of defunctioning stoma. Improvement occurs gradually over 12–24 months in most patients.
Risk factors for Major LARS: Low anastomosis (≤5 cm from anal verge), neoadjuvant radiotherapy, defunctioning stoma reversal, younger age (paradoxically).
Radiotherapy impact: Long-course neoadjuvant chemoradiation significantly increases Major LARS rates compared to surgery alone.

Pre-operative counselling: Discuss LARS risk before sphincter-preserving surgery — this is essential for informed consent, particularly regarding stoma vs. anastomosis decisions.
Post-operative follow-up: Administer LARS Score at 3, 6, 12, and 24 months post-reversal to track recovery trajectory.
Major LARS management:
- Dietary modification (low residue, regular meal timing)
- Antidiarrhoeal agents (loperamide)
- Pelvic floor physiotherapy and biofeedback
- Transanal irrigation (TAI) — highly effective for clustering and urgency
- Sacral nerve stimulation for severe refractory cases
Stoma consideration: In patients with predicted Major LARS and existing co-morbidities (especially pre-existing incontinence), permanent stoma may have a better quality of life outcome than anastomosis.

Emmertsen KJ, Laurberg S. Low anterior resection syndrome score: development and validation of a symptom-based scoring system for bowel dysfunction after low anterior resection for rectal cancer. Ann Surg. 2012;255(5):922–928.
Juul T, et al. International validation of the low anterior resection syndrome score. Ann Surg. 2014;259(4):728–734.
Battersby NJ, et al. Prospective validation of a low anterior resection syndrome score. Ann Surg. 2016;263(6):1083–1091.