Talk:Valsalva maneuver

Hernias and straining on the toilet
The article says that the Valsalva Maneuver is used for a bowel movement. This is only the case when using the sitting position (on a conventional toilet). Two-thirds of the world use squat toilets and avoid the deleterious effects of this maneuver -- both for defecation and for childbirth.

One example is hinted at in the article: "This maneuver is also sometimes used to discover an inguinal hernia in men." The daily use of this maneuver for excretion is the main reason why 700,000 hernia repair operations are performed each year in the U.S. See this link to verify the number.

This link http://naturesplatform.com/health_benefits.html explains how sitting toilets force people to injure themselves thru the unnatural use of the Valsalva Maneuver, and how squatting would prevent much needless suffering.

~ Jonathan --65.146.211.39 16:58, 30 September 2005 (UTC)


 * Your link only verifies the number of hernia operations done and does not prove what caused those hernias. Please submit some evidence that the Valsalva maneuver causes these hernias. Alex.tan 13:07, 2 October 2005 (UTC)


 * Yes, I know that it does not "prove" that the hernia is caused by straining on the toilet. But common sense would tell us that a maneuver that makes a hernia pop out (to be "discovered") is the most likely reason why it developed in the first place -- especially since this maneuver is (1) used multiple times for each daily bowel movement and (2) completely alien to natural bodily functioning.  No other animal uses this maneuver.


 * In addition, all the conventional medical websites list straining on the toilet as a major cause of hernias and pelvic floor prolapse. The experience of those who have switched to squatting is that there is virtually no straining, or holding of breath.  The posture naturally compresses the colon, eliminating the need to use the diaphragm for this purpose.


 * Many studies by Dr. B.A. Sikirov (see medline) have verified the greater ease of defecation in the squatting position. Here is his most recent study: []


 * I think it's a topic at least worth mentioning in the article.


 * ~ Jonathan --65.151.216.207 17:48, 2 October 2005 (UTC)


 * As far as I know, constipation is a much bigger factor in causing hernias than whether you sit or squat on the toilet. Constipation, of course, can be caused by many factors other than just toileting position. Straining on the toilet does lead to hernias, but this is a result of constipation - there is no evidence that toileting position (sitting versus squatting) causes this. If you have any evidence to support this, I would like to read it. By the way, your quoted study by Dr. Sikirov is hardly a well constructed study and does not really prove anything. Alex.tan 16:02, 3 October 2005 (UTC)


 * I think you are confusing the order of causality. I'm a nurse and nurses deal a lot with constipation in their patients from a practical standpoint, and of course our education also provides both information and practical instructions of how to remedy and prevent it. So, from my understanding, when it reads somewhere that constipation causes hernias, I'd read into that the need of a constipated patient to employ forcefully and frequently the technique known as "straining on the toilet", i.e. even if there is no actual mention of this phrase or of "Valsalva's maneuver" they are still implied as the cause. However, you being a physician, you could perhaps supply me with some elaboration on what yuo have written to extend my general and vocational education? __meco (talk) 15:41, 30 May 2010 (UTC)

Getting back to the Valsalva Maneuver, you can easily prove to yourself that it is not required when squatting. Even if you don't buy all the implications for prevention and treatment of disease, the article needs to be corrected so it does not imply that the Valsalva Maneuver is involved in natural defecation. --Jonathan108 16:48, 4 October 2005 (UTC)

Function of the Diaphragm
This article incorrectly describes the function of the diaphragm. The diaphragm, like all muscles, can only contract in one direction. Muscles pull, they cannot push. That said, when the diaphragm contracts, it pulls down in the thoracic cavity causing inhalation of air into the lungs by creating a negative pressure (via cavity expansion). The diaphragm does NOT contract to cause exhalation of air.

68.63.28.61 06:19, 20 February 2006 (UTC)

Air expelled through eye
Is there any documentation on the Valsalva meaneuver where the air is expelled through your tear-duct? This happens to me.


 * Yes : http://www.emedicine.com/OPH/topic592.htm Specifically, if the valve of Hasner and valve of Rosenmüller in the nasolacrimal duct are missing increased pressure in the nasal cavity (as with nose-blowing or the Valsalva maneuver) an cause retrograde passage of air or fluids through the nasolacrimal duct onto the eye.


 * In an episode of _Ripley's Believe it or Not_ Jim Cichon was documented as the world record holder for squirting milk from his tear duct.

This article has been referenced by a Slate magazine article. I think there is a template that can be added to the top of this page to say that but am quite new so can't find it. Any ideas? --Wikipediatastic 10:57, 17 March 2006 (UTC)

The article is here: http://www.slate.com/id/2137959/?nav=fo

When viewed just now, the image in this article showed just the Wiki sample default image. Also, a few sentences below that is the sentence "Blood pressure (systolic and diastolic) and pulse rate during a normal response to Valsalva’s manoever." which is missing a key word... the longer description described increases and decreases, and my non-medical self can't figure out which should go in the sentence. Ricky 00:15, 7 October 2006 (UTC)


 * Ah, looks like a new user did major edits yesterday. Could somebody who knows something about the topic look at this? It seems bad to me, but not knowing anything about the topic, and being a newish Wikipedian myself, I don't feel bold enough. Ricky 00:25, 7 October 2006 (UTC)

Abuse of this Mechanism?
I remember when I was in school we once did this "trick," where you stood against a wall and held your breath, then someone applied pressure to your chest and would then suddenly stop pressing. Which made you fade. Does that work in the same way as the Valsalva maneuver?83.118.38.37 00:02, 3 November 2006 (UTC)
 * Pretty much! InvictaHOG 19:22, 6 November 2006 (UTC)
 * I am just curious. Does fade mean the same thing as faint here? I am unfamiliar with this usage. -- trlkly 10:32, 29 July 2007 (UTC)


 * See Fainting game. Can cause brain damage and even kill you... --TiagoTiago (talk) 04:36, 6 November 2011 (UTC)

only good in descent?
I'm removing the following unsourced text: It is important to note that the maneuver is only helpful during a descent, either in the air or water. During an ascent, the increasing pressure in the middle ear relative to the decreasing ambient pressure will generally escape through the Eustachian tubes without assistance. In any case, attempting to force additional air into an already over-pressurized middle ear is almost certainly a bad idea, and potentially dangerous. I'm not sure this is true. Even if the middle ear is overpressurized, it makes sense to me that the V maneuver, by opening the Eustachian tubes, might ultimately allow air to flow out of the middle ear after an initial further increase in pressure. My own experience and some Googling seems to support this. (Most websites refer to the V maneuver as a way to equalize pressure in general, and don't say it's only for cases where pressure is too low.) --Allen 04:12, 19 May 2007 (UTC)

This was added back without citations. I'm removing it again. I'm a certified diver and have never heard this warning --sc  — Preceding unsigned comment added by 136.183.177.6 (talk) 19:08, 12 June 2014 (UTC)

Certified PADI divemaster here, i can confirm that the manoeuver is mainly used during descent but can be and is definitely used during ascent too - especially if accompanied by hyperextending the neck towards the back and/or wiggling the head to one side and the other while doing so - to ease the exit of air from the middle ear. Since this latter use during ascent requires more care to avoid damaging the inner ear the procedure is rarely recommended for beginner divers, that usually perform shallower and shorter dives. — Preceding unsigned comment added by 5.99.125.86 (talk) 22:37, 14 October 2015 (UTC)

Removed Psychiatic applications
I removed the following because it seemed completely nonsensical


 *  == Psychiatric applications == 


 * Factitious disorders: multiple cases of factitious pheochromocytoma by way of conscious altering of autonomic function with Valsalva maneuver.

-- trlkly 10:48, 29 July 2007 (UTC)

Exhaling Against Closed Lips Not The Only Method
When performing the Valsalva maneuver, neither I nor other fliers I know do it against closed lips. Everyone I know does it by closing off the back of the mouth with the tongue. This is less fatiguing if you have to do it many times, gives more direct pressure, and also doesn't look goofy. Shawn D. (talk) 16:32, 18 November 2007 (UTC)

Other Warnings for Self-Treatment via Valsalva Manuever
Chrishibbard7 (talk) 18:39, 6 January 2009 (UTC) There are caveats to self-treatment via Valsalva maneuver: it does increase blood leakage between the two upper chambers of the heart for anyone with a PFO, currently estimated as 10-30% of healthy humans alive today. I was told to use this method during a PFO test to increase surgically aerated blood between chambers in order to determine the size of the inter-chamber opening. I was warned by the tech performing the test not to purposely execute this maneuver again and also warned not to 'strain too hard' during BM for the same reason.

Also, moving the jaw forward and down or simply downward in order to open eaustacian tubes to relieve ear pressure can contribute to TMJ syndrome (pain in the TurboMandibular Joints).

No references
While this article is well-composed, it has no sources or references.Wuapinmon (talk) 22:46, 10 February 2008 (UTC)
 * Who cares?

Opening those tubes
Am I the only person who needs not yawn or swallow, but can simply conciously open those tubes? to 'click one's ears' ... I've been able to since I was little. —Preceding unsigned comment added by 75.73.70.113 (talk) 02:38, 5 April 2009 (UTC)

When defecating
I see no mention in the article of this applied in relation to defecation, i.e. to assist or trigger bowel movement. Reading the topmost post on this page I gather that the article in a previous state has discussed this. So why doesn't it anymore? __meco (talk) 15:25, 30 May 2010 (UTC)


 * It is mentioned briefly in the  Valsalva retinopathy section, but the early sentence "It is also often used to aid in the expulsion of feces from the rectum during a bowel movement" was removed as "redundant" by this edit in February 2006. It was unsourced, so liable to be removed. I would suggest finding a reliable source that describes this application and use it to expand the article. --RexxS (talk) 18:10, 30 May 2010 (UTC)
 * According to Barry B. White, the main causes of Valsalva Maneuver are: 1. Straining at stool due to constipation. 2. Straining to urinate. 3. Straining to raise up in bed or to get in or out of bed... See Barry B. White, Therapy in Acute Coronary Care (1971), p.65. According to Sharon Mantik Lewis, Margaret McLean Heitkemper and Shannon Ruff Dirksen, “Valsalva maneuver … occurs during straining to pass a hardened stool.” “If defecation is suppressed over long periods, problems can occur, such as constipation or stool impaction. Defecation can be facilitated by the Valsalva maneuver. This maneuver involves contraction of the chest muscles on a closed glottis with simultaneous contraction of the abdominal muscles.” See Sharon Mantik Lewis, Margaret McLean Heitkemper, Shannon Ruff Dirksen, eds., Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 6th edition, Volume 2 (2004), p.951. Gladys Nite and Frank Neal Willis write that it has been pointed out “that the danger of a Valsalva maneuver is increased by constipation.” See Gladys Nite and Frank Neal Willis, The Coronary Patient: Hospital Care and Rehabilitation (1964), p.164. Onefortyone (talk) 00:49, 3 June 2010 (UTC)

Valsalva Maneuver And Weightlifting
The Valsalva Maneuver (modified version against a closed glottis) is frequently used in weightlifting to stabilize the core during exercises such as the Squat, Deadlift, and Bench Press. How can we best incorporate this into the article. It seems like an extraneous use of the Maneuver, since it doesn't rely on any of the four physiological responses currently in the article.

Greggor88 (talk) 00:36, 19 June 2012 (UTC)


 * I agree that the modified maneuver (against a closed glottis) is used in those three exercises of powerlifting, and would add it is also used in both lifts of Olympic weightlifting. I suspect it is also used in other sports, such as discus throwing. Perhaps the groan of (particularly female) tennis players indicates they do this too. --SpecMade (talk) 17:22, 3 October 2013 (UTC)


 * I agree that it should be included. It would be very arguable that this is actually the most common (and natural) instance of the Valsalva manuever. — Preceding unsigned comment added by 152.19.172.74 (talk) 21:56, 4 March 2014 (UTC)


 * Added a section on weightlifting. -- Dandv  03:59, 9 June 2015 (UTC)

No mention of Vagus Nerve Stimulation?
I believe that performing the valsalva maneuver causes the stimulation of the Vagus nerve. If so, shouldn't there be at least a mention of (if not a section about) the Vagus nerve? (talk · contribs · email) Maestroso simplo (talk) 04:01, 10 February 2015 (UTC)

Two - two - two things in one?
Not that there isn't one to be found but so far I can’t find a reliable source that states that the Valsalva maneuver is both closing the glottis and is also closing the nose and mouth. One is used to raise blood pressure in the body and the other is to clear the ears. Are both actually “the Valsalva maneuver” or has one been confused with the other? Unconventional2 (talk) 18:35, 14 March 2016 (UTC)
 * Closing the nose and mouth and exhaling will cause the responses described in the Physiological response section. It will also increase air pressure in the Eustachian tubes and thence the middle ear, which clears the ears. The maneuver as originally described by Antonio Valsalva in 1704 was performed against a closed glottis, which only elicits the increase in intrathoracic and intra-abdominal pressure. Both are described as the Valsalva maneuver, but only the variant which pressurises the nasopharynx is useful in scuba diving. Presumably the minor difference in techniques has historically been viewed as not significant enough for a different name to be needed. The abstract or the full text (available as a PDF at http://archive.rubicon-foundation.org/xmlui/bitstream/handle/123456789/6264/SPUMS_V26N1_3.pdf ) provide a concise but comprehensive overview of the Valsalva maneuver.
 * The article by Taylor (1996) is already cited in this article and reading it would have answered your question and also provided the verification for several of the citation needed notices that you added to the lead. Gibran et al (2007) - current ref no 17 - examines the problem of Valsalva retinopathy which accounts for another of your requests. There is a convention in Wikipedia that the lead summarises the body of the article, and therefore doesn't normally need to repeat the citations already used to verify the corresponding content in the body. This is documented at WP:LEADCITE, although there is no prohibition against placing citations in the lead. You could, of course, have repeated the relevant citations yourself. --RexxS (talk) 20:21, 14 March 2016 (UTC)
 * The article by Taylor (1996) is already cited in this article and reading it would have answered your question and also provided the verification for several of the citation needed notices that you added to the lead. Gibran et al (2007) - current ref no 17 - examines the problem of Valsalva retinopathy which accounts for another of your requests. There is a convention in Wikipedia that the lead summarises the body of the article, and therefore doesn't normally need to repeat the citations already used to verify the corresponding content in the body. This is documented at WP:LEADCITE, although there is no prohibition against placing citations in the lead. You could, of course, have repeated the relevant citations yourself. --RexxS (talk) 20:21, 14 March 2016 (UTC)


 * Thanks for the info and the links! My concern is that these appear to me to be two different but related things like coughing and sneezing, laughing and crying, or chewing gum and eating. Clearing your ears and holding your breath and bearing down may both colloquially be referred to as the Valsalva maneuver, but I question what the original “official” definition was and if it hasn't just been confused over time or if it was originally used for both. None of the things I have seen so far address this they seem to just start from the assumption that both are a Valsalva maneuver and move on from there. Maybe we are passed the point that we can ever know for sure if one is the truer meaning than the other, or if both have always been known by the same name. Unconventional2 (talk) 20:29, 18 March 2016 (UTC)


 * This might be useful in sorting this out http://www.ijporlonline.com/article/S0165-5876%2815%2900415-2/fulltext "Conclusions: Two questions remain: 1. What should be done with the eponymous appellation of the manoeuvre with closed mouth and nostrils? Certainly to keep it, even if Valsalva was not the first to clearly describe it. 2. What to do with the eponymous appellation of the manoeuvre with a closed glottis? It would be ideal to change it, as it is misnamed, confusing, and only recently formulated." Unconventional2 (talk) 14:52, 21 March 2016 (UTC)

Reference to "Ganong" in "Heart" section
The section presently concludes with the following paragraph: BP rises at onset of straining-because the increased intrathoracic pressure (ITP) is added to the pressure in the aorta. It then falls because the ITP compresses the veins, decreasing the venous return and cardiac output. This inhibits the baroreceptors causing tachycardia and a rise in peripheral vascular resistance (PVR). When the glottis is opened and the ITP returns to normal, cardiac output is restored but the peripheral vessels are constricted. The blood pressure therefore rises above normal and this stimulated the baroreceptors, causing bradycardia and a drop in BP to normal level - Ganong I've added a tag behind the unexplained word "Ganong". If you hover over that, you'll see my reason pop up. Perhaps there's a form of that template that lets one state a reason more simply, not needing the work-around I've used here, viz., replacing space by underscores? For all I know, the present text could be an extended quotation without proper attribution. Whatever the case, we can do better.

Anyway, I'd never encountered "Ganong" before, and a quick Google turned up "Ganong's Review of Medical Physiology", a textbook now in its 25th edition (2015), originally written by William Francis Ganong Jr. So, after editing the stub-class article on the author, I've now returned here. Can somebody with access to (a reasonably current edition of) "Ganong", or some other reliable source, improve this para of the article, with citation? yoyo (talk) 03:26, 23 July 2018 (UTC)

Anger management
Would this technique benefit anger management 49.224.196.120 (talk) 04:34, 17 November 2022 (UTC)