A randomised study of pelvic floor muscle exercises compared to standard care to improve bowel function following ileostomy/colostomy reversal following a diagnosis of rectal cancer.

Interventions: Participants recruited to the intervention arm will receive Pelvic Floor Muscle (PFM) assessment and instruction about PFM exercises by qualified physiotherapists. This assessment with the physiotherapist should take 30 minutes and will be done at the following timepoints:
-6 weeks prior to to operation to reverse stoma
-2 weeks, 3 & 6 months after reversal
PFM assessment will be inclusive of peritron measurements and visual assessment. The assessment of PFM function involves patients laying on their left side, at this time a thin flexible catheter with a small anal sensor at the tip is passed through the anus and into the rectum. Participants will be asked to change into a hospital gown. The physiotherapist will explain the procedure to the participant and answer any questions they may have. Participants will be asked to lie down on their left side. A small anal sensor, connected by a tube to the peritron monitor will be inserted anally. The probe will be placed in a latex-free glove and a water based lubricant used to ensure this is as comfortable as possible for the participant. The Physiotherapist will ask the participant to squeeze, hold a contraction, and then relax three to four times. The anal sphincter muscle pressures are measured during each of these manoeuvres.
Based on the initial assessment by the physiotherapist, an individualised program will be designed and taught to the participant to undertake at home. The exercises will be designed to tighten the anal muscles as if trying to prevent anything from coming out of the rectum. The exercises are to be performed regularly by the participant as often as they choose pre-opertively and post-operatively and a patient diary will be used to monitor adherence with the intervention.
Primary outcome(s): Low Anterior Resection Syndrome (LARS) score to assess bowel function and frequency[Measured at baseline, pre-operatively, post-operatively at surgical review, 3 months and 6 months. Primary time point is 3 months.]
Study Design: Purpose: Treatment; Allocation: Randomised controlled trial; Masking: Open (masking not used);Assignment: Parallel;Type of endpoint: Efficacy