{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:58:55Z","timestamp":1781661535509,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T00:00:00Z","timestamp":1617321600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005440","name":"Center for Scientific Review","doi-asserted-by":"publisher","award":["R01 DK78924"],"award-info":[{"award-number":["R01 DK78924"]}],"id":[{"id":"10.13039\/100005440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Rectoanal pressures during evacuation and a VM were measured with seated high\u2010resolution manometry (HRM) in 64 healthy and 136 constipated women with a normal (84 women, C\u2010normal) or prolonged (52 women, C\u2010abnormal) 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\u2010abnormal BET patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Results<\/jats:title><jats:p>The peak anal pressure (5\u00a0s) during a VM accounted for 0%, 26%, and 49% of the variance in anal pressure during evacuation in healthy women, C\u2010normal BET, and C\u2010abnormal BET. The association between anal pressure during a VM and evacuation was stronger in C\u2010abnormal BET than in healthy women and C\u2010normal BET (<jats:italic>p<\/jats:italic> for interaction &lt;0.001). Fifty\u2010eight of 64 controls and 33 of 52 C\u2010abnormal BET patients had no or one abnormal parameter during evacuation; hence, the probability of C\u2010abnormal 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\u2010abnormal BET with a sensitivity and a specificity of 67% and 75%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Assessment of rectoanal pressures during evacuation and a VM uncovers rectaoanal discoordination and facilitates the diagnosis of DD in selected patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nmo.14126","type":"journal-article","created":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T08:31:33Z","timestamp":1617352293000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["A comparison of rectoanal pressures during Valsalva maneuver and evacuation uncovers rectoanal discoordination in defecatory disorders"],"prefix":"10.1111","volume":"33","author":[{"given":"Sushmitha Grama","family":"Srinivasan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology (Drs Srinivasan and Sharma, Ms. Feuerhak, and Dr. Bharucha) and Division of Biomedical Statistics and Informatics (Dr Bailey) Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayank","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology (Drs Srinivasan and Sharma, Ms. Feuerhak, and Dr. Bharucha) and Division of Biomedical Statistics and Informatics (Dr Bailey) Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Feuerhak","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology (Drs Srinivasan and Sharma, Ms. Feuerhak, and Dr. Bharucha) and Division of Biomedical Statistics and Informatics (Dr Bailey) Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent R.","family":"Bailey","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology (Drs Srinivasan and Sharma, Ms. Feuerhak, and Dr. Bharucha) and Division of Biomedical Statistics and Informatics (Dr Bailey) Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7644-0390","authenticated-orcid":false,"given":"Adil E.","family":"Bharucha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology (Drs Srinivasan and Sharma, Ms. Feuerhak, and Dr. Bharucha) and Division of Biomedical Statistics and Informatics (Dr Bailey) Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,2]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/1520-6777(2001)20:1<31::AID-NAU5>3.0.CO;2-P"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001920200027"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-005-1308-3"},{"issue":"1","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.2340\/1650197785171524","article-title":"Intra\u2010abdominal pressure and trunk muscle activity during lifting. 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