A comparison of rectoanal pressures during Valsalva maneuver and evacuation uncovers rectoanal discoordination in defecatory disorders

Abstract

Background It is suggested that patients with defecation disorders (DD) strain excessively or do a Valsalva maneuver (VM) during evacuation, resulting in rectoanal discoordination, which hinders rectal evacuation. However, definitive data are lacking. Methods Rectoanal pressures during evacuation and a VM were measured with seated high‐resolution manometry (HRM) in 64 healthy and 136 constipated women with a normal (84 women, C‐normal) or prolonged (52 women, C‐abnormal) balloon expulsion time (BET). The number of abnormal rectoanal parameters during evacuation and the joint distribution of pressures during evacuation and a VM were used to discriminate between controls and C‐abnormal BET patients. Key Results The peak anal pressure (5 s) during a VM accounted for 0%, 26%, and 49% of the variance in anal pressure during evacuation in healthy women, C‐normal BET, and C‐abnormal BET. The association between anal pressure during a VM and evacuation was stronger in C‐abnormal BET than in healthy women and C‐normal BET (p for interaction <0.001). Fifty‐eight of 64 controls and 33 of 52 C‐abnormal BET patients had no or one abnormal parameter during evacuation; hence, the probability of C‐abnormal BET was 33/91 (36%). In patients with no or one abnormal parameter during evacuation, a logistic model based on anal pressures during evacuation and a VM discriminated between controls and patients with C‐abnormal BET with a sensitivity and a specificity of 67% and 75%. Conclusions Assessment of rectoanal pressures during evacuation and a VM uncovers rectaoanal discoordination and facilitates the diagnosis of DD in selected patients.

Diagnostic value of balloon expulsion test and anorectal manometry in patients with constipation: a systematic review and meta-analysis

“…The full texts of the remaining 67 articles were obtained for thorough reading, out of which 47 articles did not meet the inclusion criteria, and 7 articles lacked the required data. Finally, 13 articles were included for meta-analysis [18][19][20][21][22][23][24][25][26][27][28][29][30] (including 5 articles on BET, 11 articles on ARM, and 3 articles covering both BET and ARM). The specific process of literature selection is shown in Fig.…”

Review of the indications, methods, and clinical utility of anorectal manometry and the rectal balloon expulsion test

“…Many DD patients strain excessively or perform a Valsalva maneuver during evacuation, resulting in rectoanal discoordination, which hinders rectal evacuation. A simultaneous consideration of rectoanal pressures during evacuation and a Valsalva maneuver reveals rectoanal discoordination and facilitates a diagnosis of DD in selected patients 52 Investigate newer technologies for measuring anal sphincter functions .…”

“…13 The patient is asked to cough or exhale into a balloon attached to a sphygmomanometer to generate a pressure of 20 mm Hg. 52 Normally, the increased abdominal pressure triggers external sphincter contraction. Given the risk of exacerbating a retinopathy, a Valsalva maneuver should not be performed in patients with a history of retinopathy.…”

Optimizing techniques for measuring anal resting and squeeze pressures with high‐resolution manometry

“…Anorectal manometry is widely used to assess diagnose defecatory disorders (DD) and evaluate anorectal functions in patients with fecal incontinence (FI) 1–5 . There is consensus that anorectal pressures should be measured at rest, during squeeze, simulated evacuation, and a Valsalva maneuver 3,6,7 . The rectoanal inhibitory reflex and rectal sensation are also evaluated during this test.…”

“…[1][2][3][4][5] There is consensus that anorectal pressures should be measured at rest, during squeeze, simulated evacuation, and a Valsalva maneuver. 3,6,7 The rectoanal inhibitory reflex and rectal sensation are also evaluated during this test. Some centers also evaluate rectoanal pressures during a cough maneuver.…”