Pelvic Floor Muscle Exercise for Low Anterior Resection Syndrome: A Systematic Review and Meta-analysis with GRADE

Kuat Widodo; Saryono -; Novita Anggraeni

doi:10.31557/APJCC.2026.11.6.941

Authors

Kuat Widodo Departemen of Nursing, Jenderal Soedirman University of Purwokerto, Indonesia.
Saryono - Departemen of Nursing, Jenderal Soedirman University of Purwokerto, Indonesia.
Novita Anggraeni Departemen of Nursing, Jenderal Soedirman University of Purwokerto, Indonesia.

DOI:

https://doi.org/10.31557/APJCC.2026.11.6.941

Keywords:

colorectal surgery; Low Anterior Resection Syndrome; meta-analysis; pelvic floor muscle exercise; postoperative rehabilitation.

Abstract

Introduction: Low Anterior Resection Syndrome (LARS) is a common postoperative complication following sphincter-preserving rectal cancer surgery, significantly impairing bowel function and quality of life. Pelvic floor muscle exercise (PFME) is widely recommended; however, its effectiveness in LARS remains uncertain. This study aimed to systematically evaluate the effect of PFME on functional outcomes in patients with LARS and to assess the certainty of evidence using the GRADE framework.

Materials and Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Literature searches were performed in Scopus, Cochrane Library, ScienceDirect, PubMed, Wiley, and Sage Journals for studies published between January 2015 and February 2026. Search terms included pelvic floor muscle exercise, pelvic floor muscle training, low anterior resection syndrome, rectal cancer, and randomized controlled trial. Ten controlled experimental studies involving 655 participants (318 intervention, 337 control) were included. Effect sizes were calculated using Mean Difference (MD) and Standardized Mean Difference (SMD) with inverse variance methods. Statistical heterogeneity was evaluated using the I² statistic, and the certainty of evidence was assessed using the GRADE framework.

Results: Among 3,412 identified records, 10 studies met the inclusion criteria. The pooled analysis demonstrated no statistically significant effect of PFME on overall functional outcomes (SMD = −0.14; 95% CI −0.41 to 0.13; p = 0.30). Subgroup analyses suggested a potential improvement in LARS scores (MD = −3.31; 95% CI −4.82 to −1.80); however, these findings are based on a limited number of studies and should be interpreted as exploratory. The observed effect size, although statistically detectable in subgroups, may have limited clinical relevance.

Conclusion: PFME does not demonstrate a clear clinical benefit as a standalone intervention for LARS. It may be considered as part of a multimodal rehabilitation approach, although the certainty of evidence remains low.