Bear-down maneuver is a useful adjunct in the evaluation of children with chronic constipation.
OBJECTIVE
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.
*Neurogastroenterology Program and Department of Pediatric Gastroenterology †Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA ‡Neurogastroenterology Program and Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Jaime
J
Belkind-Gerson
Brian
B
Surjanhata
Braden
B
Kuo
Allan M
AM
Goldstein
D000293:Adolescent; D001003:Anal Canal; D002648:Child; D002908:Chronic Disease; D003248:Constipation / Q000175:diagnosis*; D003672:Defecation; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry / Q000379:methods*; D011312:Pressure; D012007:Rectum; D012189:Retrospective Studies