{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T22:45:05Z","timestamp":1784241905173,"version":"3.55.0"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2013,12,1]],"date-time":"2013-12-01T00:00:00Z","timestamp":1385856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100009398","name":"International Foundation for Functional Gastrointestinal Disorders","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009398","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objectives:<\/jats:title><jats:p>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\u2010down maneuver (BDM) in the evaluation of children with chronic constipation and to establish optimal conditions for its performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods:<\/jats:title><jats:p>This retrospective study compares BDM with balloon expulsion testing (BET) during anorectal manometry in 38 children with chronic constipation. BDM was performed with 0\u2010, 20\u2010, 40\u2010, and 60\u2010mL balloon inflation. BET, performed with a 60\u2010mL balloon, was considered normal if the balloon was expelled within 1 minute.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results:<\/jats:title><jats:p>Rectal pressure during BDM was 48% higher in patients able to expel the balloon during BET compared with those who could not (<jats:italic>P<\/jats:italic> &lt; 0.05). Anal canal pressure was 46% lower in patients able to expel the balloon (<jats:italic>P<\/jats:italic> &lt; 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>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\u2010down or an abnormally high anal canal pressure. This information may be useful in planning further treatment for these children.<\/jats:p><\/jats:sec>","DOI":"10.1097\/mpg.0b013e3182a698df","type":"journal-article","created":{"date-parts":[[2013,8,9]],"date-time":"2013-08-09T11:24:56Z","timestamp":1376047496000},"page":"775-779","source":"Crossref","is-referenced-by-count":11,"title":["Bear\u2010Down Maneuver Is a Useful Adjunct in the Evaluation of Children With Chronic Constipation"],"prefix":"10.1002","volume":"57","author":[{"given":"Jaime","family":"Belkind\u2010Gerson","sequence":"first","affiliation":[{"name":"Neurogastroenterology Program and Department of Pediatric Gastroenterology Massachusetts General Hospital Harvard Medical School Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Surjanhata","sequence":"additional","affiliation":[{"name":"Gastrointestinal Unit Massachusetts General Hospital Harvard Medical School Boston 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