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Pediatric Rectal Exam: Why, When, and How
Susan R Orenstein1, Arnold Wald2
1University of Pittsburgh School of Medicine, 303 Church Ln, Pittsburgh, PA, 15238-1063, USA. sro.pitt.edu@verizon.net.
Insights
The digital rectal examination (DRE) is underutilized in pediatrics despite its broad clinical utility for various symptoms. This article reviews indications, techniques, and strategies to improve DRE performance in children.
Area of Science:
- Pediatric Gastroenterology
- Clinical Examination Techniques
Background:
- The digital rectal examination (DRE) is indicated for numerous pediatric conditions but is performed infrequently.
- Common indications include constipation, diarrhea, fecal incontinence, abdominal pain, and GI bleeding.
- Less recognized indications involve abdominal masses, urinary, neurologic, or gynecologic symptoms, and anemia.
Purpose of the Study:
- To summarize the rationale and clinical utility of the pediatric DRE.
- To present the components of a complete pediatric DRE.
- To offer suggestions for obtaining patient and parental consent and cooperation.
Main Methods:
- Review of existing literature and clinical guidelines on pediatric DRE.
- Discussion of common barriers to DRE performance in children.
- Presentation of a standardized approach to the pediatric DRE.
Main Results:
- The DRE is valuable for diagnosing various pediatric conditions, including those beyond common gastrointestinal complaints.
- Physicians' reluctance stems from discomfort, perceived lack of utility, inadequate training, and concerns about patient/parental refusal.
- Effective communication and a structured approach can overcome barriers to DRE performance.
Conclusions:
- The digital rectal examination (DRE) should be considered a crucial part of the complete physical examination for children with diverse symptoms.
- Addressing provider concerns and improving training can increase DRE utilization.
- Optimizing consent and cooperation strategies is essential for successful pediatric DRE.
Abstract:
The digital rectal examination (DRE) is performed in children less often than is indicated. Indications for the pediatric DRE include diarrhea, constipation, fecal incontinence, abdominal pain, gastrointestinal bleeding, and anemia. Less well-recognized indications may include abdominal mass, urinary symptoms, neurologic symptoms, urogenital or gynecologic symptoms, and anemia. Indeed, we believe that it should be considered part of a complete physical examination in children presenting with many different complaints. Physicians avoid this part of the physical examination in both children and adults for a number of reasons: discomfort on the part of the health care provider; belief that no useful information will be provided; lack of adequate training and experience in the performance of the DRE; conviction that planned "orders" or testing can obviate the need for the DRE; worry about "assaulting" a patient, particularly one who is small, young, and subordinate; anticipation that the exam will be refused by patient or parent; and concern regarding the time involved in the exam. The rationale and clinical utility of the DRE will be summarized in this article. In addition, the components of a complete pediatric DRE, along with suggestions for efficiently obtaining the child's consent and cooperation, will be presented.
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