Pelvic floor rehabilitation improves anorectal function after sphincter-preserving surgery for low rectal cancer

doi:10.4240/wjgs.118525

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Aug 27, 2026; 18(8): 118525
Published online Aug 27, 2026. doi: 10.4240/wjgs.118525

Pelvic floor rehabilitation improves anorectal function after sphincter-preserving surgery for low rectal cancer

Jing-Jing Qin, Li-Li Liu, Ming-Li Wei, Xiao-Jun Liu

Xiao-Jun Liu, Jing-Jing Qin, Wound and Ostomy Outpatient Clinic, The Second People’s Hospital of Huai’an/The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an 223600, Jiangsu Province, China

Ming-Li Wei, Department of Gastrointestinal Surgery, The Second People’s Hospital of Huai’an/The Affiliated Huai’an Hospital of Xuzhou Medical University, Huai’an 223600, Jiangsu Province, China

Li-Li Liu, Department of Colorectal Surgery, Huai’an First People’s Hospital, Huai’an 223002, Jiangsu Province, China

Author contributions: Liu XJ contributed to patient recruitment and follow-up, rehabilitation protocol implementation, drafting of the original manuscript; Wei ML contributed to perioperative management, surgical data acquisition, critical revision of the manuscript for important intellectual content; Liu XJ and Liu LL contributed to data collection; Liu LL contributed to anorectal function assessment, statistical analysis, critical revision of the manuscript; Liu XJ and Qin JJ contributed to conceptualization; Qin JJ contributed to study design, supervision, project administration, funding acquisition, final approval of the version to be published. All authors have read and approved the final manuscript.

AI contribution statement: Grammarly was used for language polishing, and DeepL was used for translation assistance. These tools were applied only to improve language clarity and did not contribute to scientific content, data analysis, or interpretation.

Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of The Second People’s Hospital of Huai’an (approval No. HEYLL2025126).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Corresponding author: Jing-Jing Qin, Wound and Ostomy Outpatient Clinic, The Second People’s Hospital of Huai’an/The Affiliated Huai’an Hospital of Xuzhou Medical University, No. 62 Huaihai South Road, Huai’an 223600, Jiangsu Province, China. 05130217@163.com

Received: January 30, 2026
Revised: March 12, 2026
Accepted: May 20, 2026
Published online: August 27, 2026
Processing time: 196 Days and 20.1 Hours

Abstract

BACKGROUND

Sphincter-preserving surgery with prophylactic colostomy is the benchmark treatment for low rectal cancer, although postoperative anorectal dysfunction significantly reduces quality of life. Although pelvic floor muscle training seems effective in functional recovery, there is currently little systematic evidence regarding the efficacy of this therapy in this specific population.

AIM

To investigate whether structured pelvic floor muscle rehabilitation training provides better anorectal functioning than standard postoperative care in patients with temporary colostomy following sphincter-preserving surgery for low rectal cancer.

METHODS

This was a retrospective study involving 100 patients with low rectal cancer who underwent sphincter-preserving surgery combined with prophylactic colostomy from January 2020 to December 2023. Patients were randomly assigned to receive structured pelvic floor muscle rehabilitative training (observation group, n = 52) or routine postoperative care without specific pelvic floor training (control group, n = 48). Group characteristics at baseline were similar. The primary end points were anorectal function parameters measured by anorectal manometry (resting anal pressure, maximum squeeze pressure, and thresholds of rectal sensation) and Wexner incontinence score. Secondary outcomes included various measures of defecation function, patient quality of life, and satisfaction.

RESULTS

Both parameters were found to be notably more superior in outcomes of the observation group over other groups. At 3 months after colostomy closure, resting anal pressure (65.3 ± 8.7 mmHg vs 52.4 ± 9.2 mmHg, P < 0.001) and maximum squeeze pressure (128.5 ± 15.3 mmHg vs 98.7 ± 16.8 mmHg, P < 0.001) were significantly higher in the observation group when compared with those in the surgical procedure group. The Wexner incontinence scores improved more (4.2 ± 1.8 vs 8.5 ± 2.3, P < 0.001), with good continence achieved by 73.1% of observation group patients versus 41.7% of controls (P = 0.001). Compared with the control group, the observation group recovered of normal defecation patterns (68.5 ± 12.3 days vs 95.8 ± 18.5 days, P < 0.001), bowel boom frequency (3.8 ± 1.2 times/day vs 6.5 ± 2.1 times/day, P < 0.001), and quality of life score (82.5 ± 8.3 vs 68.2 ± 10.5, P < 0.001). Multivariate analysis identified pelvic floor rehabilitation as an independent predictor of favorable anorectal function recovery (adjusted odds ratio = 8.73, 95% confidence interval: 3.15-24.18, P < 0.001).

CONCLUSION

Structured pelvic floor muscle rehabilitation training is associated with significant improvement of anorectal function recovery, fecal continence, bowel pattern normalization and quality of life in low rectal cancer patients post-sphincter-preserving surgery accompanied by temporary colostomy, which is a safe and practical postoperative functional rehabilitation method. All of these results require confirmation, ideally in prospectively randomised controlled trials.

Keywords: Anal sphincter-preserving surgery; Low rectal cancer; Anorectal function; Fecal incontinence workload rehabilitation; Prophylactic colostomy; Pelvic floor muscle

Core Tip: Postoperative anorectal dysfunction is one of the most difficult problems associated with sphincter-preserving surgery for low rectal cancer after temporary fecal diversion. In this retrospective study we demonstrate that a preoperative and postoperative structured pelvic floor muscle rehabilitation program enhances anorectal manometric parameters in addition to fecal continence and bowel function recovery as well as quality of life. These results reinforce the routine integration of pelvic floor rehabilitation in postoperative care in order to optimize functional outcomes for these patients.