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Bear-down maneuver is a useful adjunct in the evaluation of children with chronic constipation

Jaime Belkind-Gerson1, Brian Surjanhata, Braden Kuo

  • 1*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.

Journal of Pediatric Gastroenterology and Nutrition
|August 16, 2013
PubMed

Insights

The bear-down maneuver (BDM) with a 60-mL balloon effectively evaluates children with chronic constipation. It identifies insufficient rectal pressure or high anal pressure, aiding treatment planning for dyssynergic defecation.

Area of Science:

  • Pediatric Gastroenterology
  • Physiology
  • Diagnostic Tools

Background:

  • Chronic constipation is prevalent in children, frequently stemming from obstructed defecation.
  • Evaluating the underlying mechanisms is crucial for effective management.

Purpose of the Study:

  • To assess the utility of the bear-down maneuver (BDM) in diagnosing pediatric chronic constipation.
  • To determine optimal conditions for performing BDM.

Main Methods:

  • A retrospective study compared BDM with balloon expulsion testing (BET) in 38 children.
  • BDM involved varying balloon inflations (0-60 mL); BET used a 60-mL balloon.

Main Results:

  • Higher rectal pressure (48%) and lower anal pressure (46%) were observed in children who successfully expelled the balloon.
  • A positive rectoanal pressure differential during BDM predicted successful expulsion with 90% accuracy.
  • Optimal balloon inflation for BDM was 60 mL.

Conclusions:

  • BDM with an inflated balloon offers valuable insights into defecation mechanics in children.
  • Identifying insufficient rectal or high anal pressures aids in diagnosing dyssynergic defecation.
  • Findings support BDM's role in guiding treatment strategies for pediatric constipation.
Abstract

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