Purpose: Urinary dysfunction (UD) and sexual dysfunction (SD) are recognised sequalae following anterior resection surgery, but their prevalence remains inconsistently described. This systematic review synthesises the prevalence of patient-reported UD and SD after anterior resection for sigmoid or rectal cancer. Methods: Medline, Embase, Scopus, CINAHL and CENTRAL were systematically searched from inception to November 2024. Studies reporting the prevalence of UD and SD using validated patient-reported outcome (PRO) instruments were included. Two independent reviewers extracted: (i) prevalence of UD or SD, grouped into Short Term (ST, =<12months post-surgery), Medium Term (MT, mean/median <5 years), Long Term (LT, mean/median >=5 years); (ii) factors associated with UD and SD. Study quality was assessed using the Downs and Black checklist. Results: Of 1,055 citations identified, 31 studies with data for 3021 patients were included (24 prospective, 7 retrospective). UD prevalence among females ranged from 29.4-72.2% ST (2 studies), 15.9% MT (1) and 15.4% LT (1). UD prevalence among males was 22.2-67.7% ST (2), 8.6-42.1% MT (4) and 8.7-25.8% LT (2). SD prevalence among females ranged from 20.0-39.2% ST (2 studies), 71.9-91.2% MT (2) and 35.5-78.6% LT (2). SD prevalence among males ranged from 8.9-82.0% ST (12), 38.5-66.0% MT (3) and 35.4-61.5% LT (3). Age, diabetes and extended hospitalisation were identified risk factors for UD. Age and major low anterior resection syndrome (LARS) were identified risk factors for SD. Conclusion: The prevalence of UD and SD, following anterior resection appears similar to that of major LARS and should be recognised as a potential concern when assessing patients with LARS. Assessment timelines and PRO instruments varied among the included studies. Assessment of UD and SD in future prospective studies will facilitate understanding of their trajectory, management, and impact on post-operative quality of life and cancer survivorship.