{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T07:14:06Z","timestamp":1770966846623,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,11,4]],"date-time":"2020-11-04T00:00:00Z","timestamp":1604448000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anorectal manometry is the most commonly performed test of anorectal function. The cough\u2010anorectal response is frequently assessed as part of a routine manometric investigation but has not previously been the subject of detailed analysis. This study systematically examined anorectal pressure responses to cough in health and evaluated the impact of parity and symptoms of fecal incontinence (FI) on measurements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>High\u2010resolution anorectal manometry (HR\u2010ARM) traces from nulliparous (n\u00a0=\u00a025) and parous (n\u00a0=\u00a025) healthy volunteers (HV: aged 41, range 18\u201064), and 57 parous patients with FI (age 47, range 28\u201072) were retrospectively reviewed. Cough\u2010anorectal pressure responses were analyzed between groups by qualitative and quantitative approaches.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key results<\/jats:title><jats:p>In health, traditional anal pressure measurements (\u201crest\u201d and \u201csqueeze\u201d) were similar between nulliparous and parous women. In contrast, incremental anal\u2010rectal pressure difference during cough significantly differed: nulliparous 42\u00a0mm\u00a0Hg (95% CI: 21\u201064) vs. parous 6\u00a0mm\u00a0Hg (\u221214\u201025), <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.036). This measure also differed significantly between nulliparous HVs and patients with FI (\u22122\u00a0mm\u00a0Hg (95% CI: \u221215\u201012), <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), but not between parous HVs and FI. Qualitatively, a color\u2010contour trace resembling a \u201cspear\u201d in the upper anal canal was observed uniquely in FI. Of 25 patients with normal anal function by traditional measures, cough parameters were abnormal in 52%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and inferences<\/jats:title><jats:p>Novel HR\u2010ARM measures during coughing revealed differences in anal function between nulliparous and parous HV, and patients with FI, which were not detected by traditional measures. Cough\u2010anorectal measurements may improve manometric yield, though clinical utility would require assessment by longitudinal studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.13999","type":"journal-article","created":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T05:03:49Z","timestamp":1604552629000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Systematic evaluation of cough\u2010anorectal pressure responses in health and in fecal incontinence: A high\u2010resolution anorectal manometry study"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4184-8150","authenticated-orcid":false,"given":"Annika M. 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