Earth to LARSians
If you've stumbled upon this article by accident or for someone else, I'm talking about managing LARS or Lower Anterior Resection Syndrome, which is a series of symptoms that occur after a lower anterior resection surgery that removes part or all of the sigmoid colon and/or part or all of the rectum. Symptoms can include but are not limited to:
Frequent bowel movements called clustering
Alternating clustering and constipation and/or diarrhea
Loose stools
Bowel movements that require a lot of pushing
Excessive gas and bloating
Pain or burning before, during and/or after pooping
Difficulty holding in flatulence or poo - bowel incontinence
Incomplete bowel movements
Sensitivity to certain foods
Tenesmus
Spasming after bowel movements
Sounds fun, right!? For some, these symptoms are short lived, for thousands of others, they last a lifetime. LARS is in fact an invisible disability that many colorectal/rectal cancer survivors and crohns disease sufferers live with every day. Navigating the shitstorm becomes central to their every day lives and for obvious reasons can adversely effect quality of life, socialization and self esteem. I am a stage 3b colorectal cancer survivor, and I have LARS. I vary between 34 and 39 on the LARS Score (out of a possible 42). This is considered major LARS and I still have it better than many!
BadAss Eating
In general, I am an everything in moderation gal when it comes to diet, but I focus most on fiber and variety. I still eat meat and even the occasional red meat and yes, some sugar, also in moderation. I eat dairy and grains (including gluten) as well. I do limit alcohol and caffeine as well as processed foods and processed meats. All depending on how it makes my body feel.
There is not ONE WAY of doing things during or after cancer. Every BODY is different and thus, one person’s method simply may not work for someone else. What I discuss in this article is my (current) method. I say current because like all things LARS, it could change as early as tomorrow morning! Of all the things you read here, your one take away should be LISTEN TO YOUR BODY AND TRUST IT! This is just a list of ideas. Take what you like and leave the rest.
Keep an eye on our social media as we often post the recipes of what we eat! Look for @CCnDoc and #BadassEating! We live rural in a land-locked state so we shop with Misfits Market (online food delivery service) to get most of our fresh (organic) produce, fish and meats! SAVE $25 ON YOUR FIRST ORDER!
Daily Routine for Fiber, Gas & Bloating!
I decided early on after colorectal cancer treatment and my (ileostomy) reconnect surgery that my gut microbiome was my main priority going forward, and so much of what I do now is to focus on keeping it as healthy as possible! If you’re like me you prefer to eat your fiber vs. getting it in supplement form. I honestly have a gag reflex aversion to the way some fiber supplements get thick and slimy. 🤮 So instead, I follow the 30-rule of thumb of eating 30 different vegetables, fruits, grains and herbs each week (Fiber Fueled). In this, I try to get a good mix of soluble and insoluble fiber - soluble is easier on our semicolons, but insoluble can be very helpful to bulk up that poop and minimize clustering. It seems counter-intuitive that more fiber makes less poops, but that's the science. 🤔 The 30-rule keeps your gut microbiome varied and healthier- and I usually I get in way more than thirty! It’s kind of challenge now to see how many things we can put into a meal, a soup, a salad (certain types of lettuce can give me me excess mucus but many other greens and herbs do not.)
Butt, What About the Backlash?
There can be a backlash for most of us with semicolons who eat a lot of fiber! The key to trying a high fiber diet with a semicolon is to start slow! Focus first on soluble fiber! Incorporate one new food in every couple of days and see how your body tolerates it. For instance, don’t eat a huge salad for dinner with 20 different varieties of ingredients and expect a good outcome right out the shoot. Speaking of shooting, I hope you have good aim! You will need it if you do this too fast. 💩💩💩
What Do I Do to Manage All of The Things?
I try to combat the clustering, gas and bloating by eating several small/mini meals each day and chewing everything until it’s liquified. I personally have a healthy fear of a blockage (I never want to go to the hospital again) so if there is any fiber, seed or sinew from veg or meat that I cannot completely chew, it goes into a napkin! That’s just me. I also avoid eating whole kernel/ear corn and popcorn for that and other semicolon-related reasons.
Because my average goes in a day is still more than I would like - and it can be the trade off for adding fiber - I incorporate a few different things, including OTC meds and supplements, and I change them up based on my body, which I really try to be in tune with. Different things can work better with different foods on different days. But don’t let that discourage you, all of is still manageable for most of us, though not without concerted effort. 🫤
One game changer for me is that I have started doing self-muscle testing to see what my body needs and wants, when. It may sound completely woo-woo but it's pretty cool and has been working for me.
Self-Muscle Testing
You can do it with food, supplements, beverages or just about anything you want to know will benefit your body. There are several ways to self muscle test - Google it and figure out which works best for you! I use what I call a Rocking Method:
I start by standing up straight with my legs shoulder width apart, relaxed, and I clear my mind with a few slow deep breaths in the nose and out the mouth. I find it works best in bare feet, but you do you.
Start by doing a level set: Say, “My Name Is (your name).” Your body should rock forward. If you want to test the opposite way, use someone else’s name and you should rock backward.
Then I hold the item, bottle, food, or capsule/pill to my gut and say (out loud or in my head) “My body needs this right now.”
If the item is good for me and my body needs it, I will gently rock forward. Sometimes the response is immediate and sometimes it takes a moment depending on how much my body needs it. Forward = Yes
If it’s not ideal or my body does not need it, my body rocks backward. Backward = No
If it’s neutral - meaning it won’t help or hurt me to take it, I will stay upright (no rocking).
You can always do best 2 out of 3 if you doubt your body’s wisdom. But it’s usually spot on. I also use this method to determine how many or how much of something I should have. For instance, let’s say that a probiotic recommended dose is 3 a day. I will start with three in my hand and if my body says NO I will test 2 and then 1 capsule until I know how many to take (or none). You can also ask your body “Should I take this in the morning?” (rock forward for yes) Or “Should I take this at night?” (two separate questions).
This can be time consuming which is why Doc and I do it monthly as we are setting up our supplements for the month. Bottom line: TRUST YOUR BODY!
My Current Routine
Most of the items mentioned below can be found at our Amazon Shopping List for LARS!
Baseline/daily
Vitamin I & Simethicone
I Typically I take 1 “Vit-I” (Imodium Multi Symptom) in the morning and 1 at night (this is a recent increase) - unless I'm getting stopped up - which can still happen despite all the fiber and the clustering - and I muscle test for these each time I take them, as well. The Larsian version of constipation is also miserable because the gas is constantly building behind it.
When my gas gets really bad, I take the simethicone/GasX though I try to use more natural options most of the time. I think the chewables work better and faster. Sometimes they just don't always cut it. I could take more Vit I (per my GI) but I choose to try to slow the roll in other ways. Such as…
NEW Discovery!!!
Recently, I was taking Claritin (Loratidine) for seasonal allergies issue and on day three I realized that it had slowed my roll! All of a sudden one day I was like, “I think I only went 4 times today!?” After some homework, I realized that it’s a Histamine blocker and our guts have Histamines that help regulate things. Without getting too technical - as I understand it - even though Claritin is an H1 histamine blocker (what’s in our gut is mostly H3) it can still work to slow the roll! It also can dehydrate you a bit, (which can also slow the roll but is NOT good for you) - so make sure you stay hydrated if you try this. FYI, Zyrtec works too and is less dehydrating, according to my sources. This has reduced my goes in a day by 1-3 (depending on the day), and while that may not sound like a lot, for those of us who have LARS, we’ll call that a BIG win! (You can muscle test this as well!)
Fermented Foods - Natural Pre/Probiotics & Enzymes
I eat or drink something fermented every day. Raw organic kombucha, yogurt, kefir, miso, sauerkraut, etc. I think it helps. Synergy brand kombucha has digestive enzymes in it. Some people swear by a warm beer a day. I haven’t tried it. If you do, let me know how it goes!
Gas & Bloating - Natural Remedies & Enzymes
I am not completely certain scientifically why most Larsians have SO MUCH GAS, but we do! Lord, I am not the person to have at the dinner table these days, unless you’re trying to impress your 8 year old nephew! It seems like I’ve become a human fart factory. I know it’s partly the semicolon, partly the diet and partly just the way my body is now processing, but it can be challenging and uncomfortable…
I have two things that I use interchangeably and try first before the simethicone:
VPM Health Bean-Zyme (like Beano but with no artificial additives) - many don’t know it but this is good for almost every food that causes gas, including cruciferous veggies and the obvious, beans.
Country Life Chewable Papaya Tablets - Papain is a digestive enzyme that is found in papaya and has been used for centuries to clear stomach upset, gas and bloating. It is said to make proteins easier to digest.
The challenge is that these are primarily only one enzyme each and generally our bodies can need a variety. So...
3) Recently I have found a third option, which I may try stand alone without 1 and 2: Garden of Eden Organic Digest+ (enzymes) Chewable - This one is all natural, organic and plant derived. I like that. UPDATE: I am loving this one! I think it works better for me than both of the others. Sometimes the beans are still tough so I may double up with some Bean-Zyme but for the most part, this one is awesome! ⭐️⭐️⭐️⭐️⭐️
Should you take Enzymes before or after meals?
The bean-zyme bottle says take with first bite of food, the papaya says after. But, I recently read something that said we should be taking them all before to prep our stomach for what’s coming. I think it’s trial and error based on you and your semicolon!
Movement Also Helps with Gas!
The more you move, the more it moves! Don’t like exercise for the sake of exercise? Me neither! Take a nature walk or just get up and dance to your favorite songs a few times a day, instead! One thing I absolutely swear by to break up the gas and to encourage my body to go on my schedule, as it seems to move things down the pipe, is hula hooping. I call it Poop Hooping! Plus, it’s SO fun!
How do I know what to take, when?
I’m sorry to say it’s a lot of trial and error, especially with the daily gas and bloating, but for everything else, once a month I do muscle testing with all my supplements. I vary a few different probiotics (some with and some without enzymes) and decide what my body needs that month. Sometimes it wants one kind, sometimes another, sometimes I mix and match, and then one month, none.
Supplementing with Prebiotics Probiotics & Enzymes
When it comes to probiotics, I do believe they work and I try to focus mostly on broad spectrum probiotics and sporebiotics. I have a great doc who said sporebiotics are the best to use because they don’t die off as easily and usually don’t have to be refrigerated - they can also be more potent. Plus, the idea is the same as the 30-rule. The more strains you get, the better for your microbiome.
I do not take all of these at once. There are four brands that I interchange based on self-muscle testing each month:
Syntol AMD - this one is a sporebiotic, has enzymes as well and can help with candida overgrowth - The dose is 4 a day but most of the time my body says to take 1 a day. and
Florastor -Though it is just one strain, it’s a good one - Saccharomyces Boulardii - which is often recommended after surgery or with/after antibiotics. I just recently muscle tested NO on this one after almost two years. Speaking of muscle testing, sometimes my body will say to take 1 of one in the morning and 1 of another at night.
Garden of Life Primal Defense Ultra Ultimate Probiotic - This is a new one for me but I really like their commitment to organic, natural, non-gmo and whole foods approach.
Too many enzymes can cause issues as well, so start out slow, see how your body does and change it up if something is off. I recently also read that if your butt is extra itchy, you could be getting too many of the enzymes. Also, my surgeon told me not to take enzymes until I was well-out from reconnect - I think she wanted me to see what my body would do on its own - so I waited 6-8 months. But with all the fiber, I think we need some help! A final note on enzymes is that not everyone’s body needs them, so if you have adverse effects from them, stop using them.
Other Supplements
I had a dermatologist once that said, he'd happily take a handful of supplements a day, if it meant preventing illness. I guess for me, supplements have always been a part of my world. Even growing up I can remember a few supplements at the breakfast table each morning. My Mom and my Gram were very conscious of the health benefits. That said, there are a few other supplements worth mentioning that I take/have taken to help with digestion, pooping, general health and of course cancer prevention:
I have become a firm believer in Mushrooms/Functional Mushrooms - Especially Lion’s Mane which is known to be good for a plethora of things including gut health and cancer prevention! Plus it helps focus, stress and anxiety, too. How can that be bad!?
Lion's Mane is good for everything from cancer prevention, heart health, brain health, focus and anxiety! My ADHD brain can attest to the help with focus! I prefer the tincture and organic.
I also take a 10 Mushroom complex from Natures Fusion.
My favorite night cap is a cup of OM Hot Chocolate with several functional mushrooms and ashwaganda.
Marshmallow Root & Slippery Elm can help the go! Marshmallow can slow the roll and slippery elm, well, it’s in the name - makes the go a little smoother and easier. Same for Aloe Vera - I prefer a gel cap to the slimy juice 🤢.
Let's Talk CBD/G and N! So many potential health benefits (Google it), and these products exist in THC-free versions - topical, edible and swallowable/pills. Don't get me started on the confusion and misconceptions between hemp and the other green leaf (mj) 🙄. I highly recommend doing your own homework here. I have always been a firm believer in the power of CBD - it has helped me in many ways over the years (menopause, mood, joint pain, etc.) and after talking extensively with a doctor and a cannabinoid pharmacist about these things, I added CBG to my regimen for it's cancer prevention benefits. The G and N (think night/sleep help) are not as much studied yet, but the information is growing so you can surely find it out there. The brands I prefer are based on my research are: Joy Organics and Lazarus Naturals because of their commitment to quality. Feel free to message me if you want to know more about my approach to these supplements.
Finally, 5-HTP which is well known as a "natural mood regulator for anxiety and depression" has had some success in it's use with LARS. I have actually taken it off and on for years, after reading a book by Julia Ross called The Mood Cure, and looking for remedies for anxiety that was brought on by menopause. I didn't know of it's benefits for LARS until I read this article on the Love Your Buns website - a fabulous resource! If you suffer from LARS, Love Your Buns is collecting LARS data and you can help by filling out this survey! Then, I did more homework and there are a few research studies out there that speak to its effectiveness. I can't say for sure whether it's helping in the area of LARS for me, I would probably have to take it in isolation to know for sure, but I know it works for me in other areas.
It works, until it doesn’t!
I don’t want to burst the gas bubble but sometimes it seems like I’ve just got a plan dialed in and then WHAM, something changes - a little extra stress, eating someone else’s cooking, a long stretch on the computer with little movement, not enough home cooking, or something else - and I’m back to square one! It’s unpredictable and will always be, but there are lots of tools we can use so I just keep adjusting and tweaking. While yes, that can be exhausting, and there are certainly parts of LARS that get real old - what's the alternative?
My mindset is that I just keep tooting along until I get it figured out. Life is full of change and so I just try to keep rolling with the punches. I recognize this is even more difficult for those who have day jobs outside of the home and families and events and travel and all of the things. I am lucky in that I am in a place where most of the time I can pick and choose my activities and I travel with a rolling toilet and a "GO Bag" 💩 almost all of the time! I guess after two years, it's just become a way of life and I've gotten used to most of it - I get A LOT done in my My #2 Office! I do have moments when I get tired of it all, like when it's midnight, I'm sleepy and I have to poop because I ate too late - pooping before CRC used to be reserved for mornings only. 😭 What I miss the most is that feeling of a good poop, you know the one, where you felt completely empty and 5 pounds lighter afterward and like, "Ahhhhhh". That doesn't happen anymore. 😢 But it is all manageable (at least in my and many other LARS thriver's cases), and I'm willing to do what I can to make it better for me and for others.
Sometimes I can feel it coming!
I just feel off, or I’ll have a really rough bathroom day and then I just take a break and go back to my “Toddler Diet” for a few days just to reset. This includes reducing fiber (especially insoluble fiber) and adding thickening foods like white rice and potatoes, cheese, nut butters and bready things - my favorite is Whole Grain Goldfish Crackers! For instance, if I have had Chickpeas, beans and broccoli (I LOVE bean salads) every day for several days and nothing seems to be curbing the gas and bloating, I might feel like I'm ready to take off like an air balloon and I'm farting sparkles! So I back off for a couple days. Usually I also find I’m overdue for a clean out! I’ve learned that just because we got to the bathroom 10 times a day with LARS doesn’t meant we are empty - Constipation can still happen even when you're clustering! Being miserable is miserable, so listen to your body!
Nothing is worth torturing ourselves over and we should be able to savor enjoy every moment of food we put into our mouths and bodies!
I’m not going to lie, some of the things I have mentioned here can get costly, but so is medical treatment, so as long as I can afford them, I will do it. There are less costly alternatives than some of these that I have suggested so it's still doable for many budgets, just do a little homework on your own.
Final Tip - STRESS LESS!
I am a firm believer in meditation, affirmations and visualizations! Because we are always so stressed out, it is crucial to slow down our brains and the brain in our gut on a regular basis! I love the free Insight Timer App for this!
I am not a doctor - Please do your own homework, including checking with your healthcare team. We are each other’s best resource for LARS tips and information! There is not nearly enough research nor interest from the medical community to solve our problems! We are it! So please, if you have suggestions and tips that work for you, please share them with others. That is how we THRIVE together!
If you have input to this article or just want to chat about your symptoms or process, feel free to contact me. I love to help others find the badass in their bad ass! 💪
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