Table 3Key components of physical examination to diagnose idiopathic constipation

Key componentsFindings and diagnostic clues that indicate idiopathic constipation‘Red flag’ findings and diagnostic clues that indicate an underlying disorder or condition: not idiopathic constipation
Inspection of perianal area: appearance, position, patency, etcNormal appearance of anus and surrounding areaAbnormal appearance/position/patency of anus: fistulae, bruising, multiple fissures, tight or patulous anus, anteriorly placed anus, absent anal wink
Abdominal examinationSoft abdomen. Flat or distension that can be explained because of age or overweight childGross abdominal distension
Spine/lumbosacral region/gluteal examinationNormal appearance of the skin and anatomical structures of lumbosacral/gluteal regionsAbnormal: asymmetry or flattening of the gluteal muscles, evidence of sacral agenesis, discoloured skin, naevi or sinus, hairy patch, lipoma, central pit (dimple that you can't see the bottom of), scoliosis
Lower limb neuromuscular examination including tone and strengthNormal gait. Normal tone and strength in lower limbsDeformity in lower limbs such as talipes

Abnormal neuromuscular signs unexplained by any existing condition, such as cerebral palsy
Lower limb neuromuscular examination: reflexes (perform only if ‘red flags’ in history or physical examination suggest new onset neurological impairment)Reflexes present and of normal amplitudeAbnormal reflexes

From: 1, Guidance summary

Cover of Constipation in Children and Young People
Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care.
NICE Clinical Guidelines, No. 99.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2010.
Copyright © 2010, National Collaborating Centre for Women's and Children's Health.

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