Which rectal exam findings are characteristic of pediatric constipation?

Updated: Dec 14, 2018
  • Author: Stephen M Borowitz, MD; Chief Editor: Carmen Cuffari, MD  more...
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The most important part of the physical examination is the rectal examination. Perform a rectal examination in any child with chronic constipation, regardless of age, to exclude underlying anatomic abnormalities that might account for the constipation, such as an imperforate anus with perineal fistula, intestinal obstruction (mass effect), or Hirschsprung disease. In young infants, the anus should be sufficiently large to permit the introduction of a pinkie finger.

Upon digital examination, note the size of the anal canal, the size of the rectum, and whether any intrarectal masses are present. Also, note if the rectum is empty or filled with stool and note the consistency of the stool.

Among children with Hirschsprung disease, the rectum is typically quite small and empty of stool. Following the digital examination, the infant may have a gush of liquid stool, because the functional obstruction has transiently been relieved.

Among children with functional constipation, the rectum is generally enlarged, and stool is present just beyond the anal verge.

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