Tu2011 Bear-Down Maneuver Using Balloon Insufflation During High-Resolution Ano-Rectal Manometry in Adults and Children and Its Correlation to the Balloon Expulsion Test

Abstract

Background: Dyssynergic defecation is a common cause of chronic constipation in both adults and children, but it is difficult to study the mechanisms contributing to outlet obstruction. The balloon expulsion test while sitting (BET) is a helpful screening test but the results do not provide specific guidance towards a mechanistic defect. In our institution during high-resolution Ano-Rectal Manometry (ARM), we can take advantage of simultaneous rectal and anal pressure recording and perform a bear-down maneuver (BDM) with an inflated balloon, whichmight give some additional physiological insights. Aims: To investigate if the measurements taken during BDM correlated with the balloon expulsion test and if they provide additional information on rectal propulsive forces and anal canal resistance, which could be used clinically. Methods: Retrospective review of 8 chronically constipated children (11-19 yrs) and 20 adults (Rome 3 criteria, >age 19) who underwent ARM and BET. The BDM was done with 60 ml of insufflation. The recto-anal pressure differential (RAPD) (rectal pressure anal resistance) during BDM was measured. We correlated the results of both tests and investigated whether the measurements of the BDM led to a change in management. Normal BET: balloon was passed ≤ 60 sec. Results: 1) When RAPD was ≥ 10: 15/18 patients had a normal BET. When RAPD 10mm Hg, between rectal pressure minus anal sphincter pressure (recto-anal pressure difference), the propulsive forces will usually be adequate and patient will be able to expel a 60 ml balloon with good sensitivity and specificity. 3) In our experience, the BDM test can be done in adults and children 11 yo or older.