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Frequency of digital rectal examination in children with chronic constipation
D M Gold1, J Levine, T A Weinstein
1Division of Pediatric Gastroenterology, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA. kiddygi@aol.com
Insights
Digital rectal examination is underutilized in pediatric chronic constipation cases. This common exam can identify fecal impaction and guide effective treatment, improving outcomes for constipated children.
Area of Science:
- Pediatric Gastroenterology
- Clinical Practice Guidelines
- Diagnostic Procedures
Background:
- Chronic constipation is a common pediatric issue.
- The role of digital rectal examination (DRE) in diagnosing pediatric constipation is debated.
- Primary care practitioners' adherence to guidelines for DRE in children with constipation is unclear.
Purpose of the Study:
- To determine the frequency of digital rectal examination (DRE) performance by primary care practitioners in children with chronic constipation.
- To assess the impact of DRE on subsequent therapeutic decisions and outcomes.
Main Methods:
- A cohort of 128 children referred for chronic constipation was surveyed regarding prior DRE.
- Children underwent DRE by a pediatric gastroenterologist.
- Pre-referral and post-referral treatment regimens were compared.
Main Results:
- 77% of referred children had no prior DRE.
- 54% of these children presented with fecal impaction.
- DRE identified organic causes in 3 patients and guided enema therapy in 70%.
Conclusions:
- Digital rectal examination is infrequently performed by primary care practitioners for pediatric chronic constipation.
- DRE is crucial for differentiating functional from organic constipation and significantly influences treatment strategies.
Objectives:
To determine the frequency of performance of digital rectal examination by primary care practitioners on children with chronic constipation and to assess its effect on therapy.
Patients And Methods:
One hundred twenty-eight children referred for chronic constipation to the Division of Pediatric Gastroenterology at Schneider Children's Hospital, New Hyde Park, NY, as well as their parents were questioned as to whether a digital rectal examination was ever performed prior to referral. All children underwent subsequent digital rectal examination by a pediatric gastroenterologist and recommended treatment regimens were compared with pretreatment regimens. The patients evaluated were a mix of private-insurance and Medicaid patients referred by pediatricians in the general community.
Results:
Ninety-eight (77%) of the children referred for chronic constipation were found to have never had a digital rectal examination performed prior to referral. Fifty-three (54%) of these children were found to have fecal impaction. Only 19 (21%) were found to have minimal to no stool retention on digital examination. Enema therapy had been infrequently used to "clean out" the colon in referred children. Seventy percent were treated with multiple enema therapy following digital rectal examination. Organic causes of constipation were identified in 3 patients.
Conclusions:
Digital rectal examination is often not performed in the examination of the child with chronic constipation. The digital examination can help differentiate functional constipation from an organic process and may alter the course of therapy.