Purpose: To identify challenges and barriers in the management of Low Anterior Resection Syndrome (LARS) through exploration of clinician attitudes and decision-making practices around screening, diagnosis and management. Methods: One-to-one semi-structured interviews were undertaken. A reflexive thematic qualitative analysis was conducted using an iterative-inductive approach. Results: Eleven colorectal surgeons, six physiotherapists and three specialist nurses were interviewed. Data were grouped into four major themes. Variation in engagement with management of LARS was identified with clinicians’ knowledge, training and personal interest in managing patients raised as contributing factors. An absence of standardised management pathways presented challenges with the lack of structured multidisciplinary approaches and referral pathways combined with a perceived lack of established treatment guidelines impacting on clinical decision-making. Inequities in access to specialist pelvic services and treatment were identified as systemic limitations which influence clinical decision-making in relation to clinical practice and implementation of patient care. The interpretation of the patient experience with LARS and perceptions of treatment acceptability were identified to influence decision-making and demonstrated divergent perceptions of patient experience. Conclusion This study identified several challenges in LARS management. A lack of standardised treatment guidelines and pathways, limited treatment access, and inconsistent clinician engagement present challenges. Divergent perceptions of patient experience and treatment acceptability further complicate care. These findings highlight the urgent need to address these systemic limitations through enhanced surgeon education, standardised treatment/referral guidelines, improved patient resources, and expanded access to multidisciplinary care.