“…For this reason, at any age, it is mandatory to consider red flags and alarm signs suggestive of an organic condition. Medical history and a physical exam should include and evaluate the lumbosacral, perianal, and abdominal regions, and a high index of suspect for signs of spinal dysraphism, abdominal masses, malignant infiltration of the vertebrae or the spinal cord, infections such as spondylodiscitis, or the onset of a Guillain Barré syndrome should be considered [ 14 , 15 , 16 , 17 , 18 ]. As a rule, digital rectal examination should be avoided because it could be distressing for the child, except for the diagnosis of Hirschsprung’s disease where explosive stools, abdominal distension, and a history of recurrent enterocolitis are highly suggestive of the condition [ 19 ].…”