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219 Guideline adherence 10 Diagnostics Perianal inspection was frequently (often or always on the 5-point Likert scale) conducted by 78% [CI 73-82%] of responders in the evaluation of children with FC. DRE was frequently performed by 42% [CI 36-47%] and inquiry about sexual abuse was frequently made by 18% [CI 14-22%]. Comparisons between different groups of physicians are shown in Table 2. Frequently reported reasons for omitting these items in the diagnostic workup for FC were discomfort for the child, parent or physician (see Figure 2). Most physicians (65% [CI 60-70%]) reported no suspicion of sexual abuse as the primary reason not to elicit a history of sexual abuse. An important reason not to perform perianal inspection was the perception that this would not provide useful information (11% [CI 8-14%]). The most commonly reported reason for not performing a DRE was if a child fulfilled sufficient criteria for the diagnosis of FC based on the history (40% [CI 35-46%]). Moreover, 17% [CI 13-21%] of responders reported to avoid a DRE because they felt that this would not provide useful information. Significantly more U.S. responders compared to Dutch responders reported both child and parental discomfort as reasons not to perform a DRE (43% [CI 36-50%] vs. 27% [CI 20-37%], P = .010 and 16% [CI 11-22%] vs. 5% [CI 2-10%], P = .003 respectively). Treatment Most commonly implemented non-pharmacological interventions included instating a toilet training program (89% [CI 85-92%]), optimizing fluid and fiber intake (86% [CI 81- 89%] and 81% [CI 77-85%]), keeping a defecation diary (62% [CI 56-67%]), instating a reward system (60% [CI 54-65%]) and prescribing pre- or probiotics (23% [CI19-28%]). Comparisons between different groups of physicians are shown in Table 2. PEG was the most prescribed medication for disimpaction (68% [CI 64-74%]), followed by enemas (25% [CI 21-30%]). The preference of 6% [CI 4-9%] of responders was unclear since they checked both boxes (PEG and enemas). The primary reasons for choosing PEG over enemas for disimpaction were patient comfort (69% [63-75%]), the drug being well-tolerated by patients (53% [CI 46-60%]) and its easiness to use (47% [CI 40-54%]). The primary reasons for choosing enemas over PEG were a more rapid effect (63% [CI 52-74%]) and perceived higher effectiveness (56% [CI 45-67%]). For infants, PEG was the preferred medication for maintenance treatment in 57% [CI 51- 62%], followed by lactulose (31% [CI 26-36%]), either PEG or lactulose (7% [CI 4-10%]) and milk of magnesia/magnesium hydroxide (5% [CI 3-8%]). For children ≥1 year of age, 97% [CI 94-99%] of responders preferred PEG as laxative for maintenance treatment.