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.