Journal of Pediatric Gastroenterology and Nutrition

Original Articles: Gastroenterology

Bear-Down Maneuver Is a Useful Adjunct in the Evaluation of Children With Chronic Constipation

Corresponding Author

Jaime Belkind-Gerson

[email protected]

Neurogastroenterology Program and Department of Pediatric Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Address correspondence and reprint requests to Jaime Belkind-Gerson, MD, MSc, Neurogastroenterology Program, Massachusetts General Hospital for Children, Harvard Medical School, 175 Cambridge St, #575, Boston, MA 02114 (e-mail: [email protected]).Search for more papers by this author

Brian Surjanhata,

Brian Surjanhata

Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA

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Braden Kuo,

Braden Kuo

Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA

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Allan M. Goldstein,

Allan M. Goldstein

Neurogastroenterology Program and Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA

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Jaime Belkind-Gerson,

Corresponding Author

Jaime Belkind-Gerson

[email protected]

Neurogastroenterology Program and Department of Pediatric Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA

Brian Surjanhata,

Brian Surjanhata

Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA

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Braden Kuo,

Braden Kuo

Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA

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Allan M. Goldstein,

Allan M. Goldstein

Neurogastroenterology Program and Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA

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First published: 01 December 2013

https://doi.org/10.1097/MPG.0b013e3182a698df

Citations: 10

Partial financial support was provided as a grant from the International Foundation for Functional Gastrointestinal Disorders.

The authors report no conflicts of interest.

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ABSTRACT

Background and Objectives:

Chronic constipation is a common problem in pediatrics and often the result of obstructed defecation. The aim of this study was to determine the use of the bear-down maneuver (BDM) in the evaluation of children with chronic constipation and to establish optimal conditions for its performance.

Methods:

This retrospective study compares BDM with balloon expulsion testing (BET) during anorectal manometry in 38 children with chronic constipation. BDM was performed with 0-, 20-, 40-, and 60-mL balloon inflation. BET, performed with a 60-mL balloon, was considered normal if the balloon was expelled within 1 minute.

Results:

Rectal pressure during BDM was 48% higher in patients able to expel the balloon during BET compared with those who could not (P < 0.05). Anal canal pressure was 46% lower in patients able to expel the balloon (P < 0.05). A rectoanal pressure differential greater than zero during BDM was 90% predictive that the subject would be able to expel the balloon. The optimal balloon inflation volume was 60 mL.

Conclusions:

BDM using an inflated balloon provides valuable mechanistic information in the evaluation of children with dyssynergic defecation. We found that patients often had either an insufficient rectal pressure during bear-down or an abnormally high anal canal pressure. This information may be useful in planning further treatment for these children.

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Citing Literature

Volume57, Issue6

December 2013

Pages 775-779

Bear-Down Maneuver Is a Useful Adjunct in the Evaluation of Children With Chronic Constipation

ABSTRACT

Background and Objectives:

Methods:

Results:

Conclusions:

REFERENCES

Citing Literature

References

Information

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Bear-Down Maneuver Is a Useful Adjunct in the Evaluation of Children With Chronic Constipation

ABSTRACT

Background and Objectives:

Methods:

Results:

Conclusions:

REFERENCES

Citing Literature

References

Related

Information