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Clinical subgroups were defined using validated questionnaires: St. Mark's score for anal incontinence (AI) and Knowles\u2010Eccersley\u2010Scott Symptom score for chronic constipation (CC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anal incontinence (AI) was highly prevalent (81.7%), with 75.7% reporting moderate\u2010to\u2010severe fecal incontinence. CC was present in 56.7%, and 49.1% showed overlapping symptoms. The most frequent major finding was rectal hyposensitivity (43.3%) and anal normotension with hypocontractility (16.3%). Anal normotension with hypocontractility best correlated with AI [OR 14.5 (95% CI 1.9\u2013110.2;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.010)], while anal hypertension was more frequent in CC [OR 2.2 (95% CI 1.3\u20133.9;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005)]. Rectoanal coordination disorders were common, with inconclusive patterns in 54.4%, limiting diagnostic precision. Among constipated patients with obstructive defecation syndrome (ODS), pathological coordination was more frequent [OR 3.5 (95% CI 1.1\u201312.1;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.040)]. Additional parameters not included in the LC\u2014reduced functional anal canal length and shorter sustained squeeze duration\u2014were more evident in women with AI, whereas ultraslow waves were associated with CC. Sphincter defects were detected in 13%, mainly in women and AI patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The LC enables consistent phenotyping of anorectal dysfunction, highlighting major abnormalities as highly prevalent. However, frequent minor and inconclusive findings\u2014particularly in defecatory coordination\u2014underscore limitations of the current classification and the need for refinement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70248","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T06:11:37Z","timestamp":1768889497000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Application of the London Classification in\n                    <scp>3D<\/scp>\n                    High\u2010Definition Anorectal Manometry: Prevalence, Limitations, and Complementary Metrics"],"prefix":"10.1111","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1892-6317","authenticated-orcid":false,"given":"Alberto","family":"Ezquerra\u2010Dur\u00e1n","sequence":"first","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department Hospital 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Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jhoana","family":"Siles","sequence":"additional","affiliation":[{"name":"Instituto Gastroenterol\u00f3gico Boliviano Japon\u00e9s  La Paz Bolivia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7827-8019","authenticated-orcid":false,"given":"Isis K.","family":"Araujo","sequence":"additional","affiliation":[{"name":"Neurogastroenterology and Motility Unit, Gastroenterology Department Hospital Clinic of Barcelona  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Ros","sequence":"additional","affiliation":[{"name":"Pelvic Floor Unit, ICGON, Hospital Clinic of Barcelona University of Barcelona  Barcelona 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