Comparing Diagnostic Methods for Fecal Impaction in Children: Abdominal Exam, Digital Rectal Examination, Medical History, and Trans-abdominal Radiography

Background: In diagnosing and tracking fecal impaction in children with functional constipation, a variety of methods such as history taking, physical examination, digital rectal examination (DRE), and, if needed, imaging-based methods are used. However, the most effective method for tracking this condition remains unclear. Our objective was to evaluate the agreement of medical history and DRE with trans-abdominal radiography as the gold standard for diagnosing childhood fecal impaction. Material and Methods: In this cross-sectional study, two subgroups of children aged 4 to 10 years with and without fecal impaction were included and evaluated through physical examination, DRE, and trans-abdominal radiography (as the standard), along with a detailed medical history. Results:  The positive abdominal examination in the groups with and without fecal impaction was 33.5% and 7.9%, respectively, indicating a significant difference (p 0.001). In the groups with and without fecal impaction, positive medical history related to functional constipation was revealed in 85.3% and 4.2%, respectively, indicating a significant difference (p 0.001). Also, in the DRE method, compared to abdominal radiography, fecal impaction was positive in 85.9% of patients with fecal impact. In comparison, only 8.5% of the control group indicated a significant difference (p 0.001). Conclusion: A combination of history taking, DRE, and, if necessary, abdominal radiography should be considered to diagnose fecal impaction in children with functional constipation.