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BACKGROUND Bowel dysfunction is an important consequence of rectal cancer surgery and the specific quality of life domains that are affected remain unclear and unaddressed by generic surveys. OBJECTIVE To identify quality of life domains most affected by rectal cancer surgery. DESIGN Qualitative content analysis. SETTINGS Semi-structured interviews conducted by telephone with patients recruited from a single university-affiliated colorectal referral center. PATIENTS Adult patients who underwent rectal cancer surgery with sphincter preservation from 07/2017 to 07/2020. Patients were excluded if their surgery was <1 year since the recruitment date, received a permanent stoma, or developed recurrence or metastasis. MAIN OUTCOME MEASURES Bowel dysfunction was evaluated via the low anterior resection syndrome score. Interview transcripts were coded by 2 independent reviewers and evaluated for concordance. Qualitative content analysis was used to identify themes, with their frequency of occurrence quantified (percent total number of interviews). RESULTS A total of 54 patient interviews were conducted. Analysis revealed 5 quality of life related themes impacted by bowel dysfunction: experiencing psychological and emotional stress, challenging roles and relationships within society, encountering physical limitations, restricting leisure and recreational activities, and self-empowerment and adapting to change. Patients with minor and major bowel dysfunction were more likely to report disruption to social activities and role as a sexual partner versus those with no bowel dysfunction. Patients with major bowel dysfunction were more likely to report effects on sleep versus those with no and minor bowel dysfunction. LIMITATIONS Single center, self-reported, and observer bias. CONCLUSION The impact of bowel dysfunction on quality of life includes a wide range of themes that extend beyond the traditional measures. These results may help better inform patients in the preoperative setting and serve as a basis for the development of a more patient-centered quality of life survey.