title: Pediatric Rectal Exam: Why, When, and How.
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.
authors.affiliation: University of Pittsburgh School of Medicine, 303 Church Ln, Pittsburgh, PA, 15238-1063, USA. sro.pitt.edu@verizon.net.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Orenstein
authors.affiliation: Division of Gastroenterology & Hepatology, University of Wisconsin School of Medicine & Public Health, Centennial Building, 1685 Highland Ave, Madison, WI, 53705-2281, USA. axw@medicine.wisc.edu.
authors.forename: Arnold
authors.initials: A
authors.lastname: Wald
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D051517:Digital Rectal Examination / Q000523:psychology / Q000706:statistics & numerical data; D005767:Gastrointestinal Diseases / Q000175:diagnosis*; D006801:Humans; D010817:Physician-Patient Relations
keywords: Anus; Child; Digital rectal exam; Pediatric; Pediatric rectal exam; Rectal exam