The purpose of a new study published in the Journal of Pediatrics Gastroenterology and Nutrition was to determine the frequency of impaction detectable only on digital rectal examination (DRE) among children satisfying Rome III criteria without requiring DRE and the inter-observer influences on impaction detection by DRE. This study assessed children between 6 months and 13 years of age, presenting with history suggestive of constipation. Children with suspicion of organic etiology, those who needed DRE for diagnosis of constipation, and those who do not satisfy Rome III criteria without DRE were excluded. Those who satisfied Rome III criteria were assessed for impaction by palpable fecoliths or constipation-associated fecal incontinence. Those without such impaction were randomized to 2 examiners for DRE to diagnose impaction, in the absence of contraindications. One hundred and sixty-nine children satisfied Rome III without needing DRE. Among these, 28.4% had detectable impaction without DRE. Among the rest, 30.1% were diagnosed with impaction by DRE. There was no difference between the frequencies of impaction detected by the 2 examiners. Moreover, clinical characteristics were similar between those with impaction detectable by DRE and those without. Hence, the findings indicated that DRE can detect cases of impaction not discernible by other means. It was also stated that these children may be identified by other clinical characteristics.