Rome IV Diagnostic Criteria for Functional Constipation

Rome IV Functional Constipation

Straining (>25% of defecations)

Lumpy or Hard Stools (>25% of defecations)

Sensation of Incomplete Evacuation (>25%)

Sensation of Anorectal Obstruction (>25%)

Manual Maneuvers to Facilitate (>25%)

Fewer than 3 Spontaneous Defecations per Week

Symptoms ≥3 months (onset ≥6 months ago)

Criteria Met: 0 / 6

Criteria Not Met

0 of 6 criteria present. Rome IV requires ≥2 criteria for functional constipation diagnosis.

Official Rome IV criteria for the diagnosis of functional constipation.

Why Use

Used to diagnose functional constipation in the absence of secondary causes of constipation. Making a diagnosis will help guide need for further work-up and management. Can be used to discuss signs and symptoms of constipation with patients.

When to Use

Patients presenting with symptoms suggestive of constipation for at least the past 6 months. The diagnosis of functional constipation should be made by clinical history, physical examination, and minimal laboratory tests. Colonoscopy or other tests should be done if clinically indicated.

Formula

The following three criteria must be fulfilled for the last 3 months with symptom onset ≥6 months ago: Must have ≥2 of the following, each for >1/4 (25%) of defecations except (f): Straining. Lumpy or hard stools (form 1 or 2 on the Bristol Stool Form Scale - see below). Sensation of incomplete evacuation. Sensation of anorectal obstruction/blockage. Manual maneuvers to facilitate defecation (e.g. digital evacuation, pelvic floor support). <3 spontaneous bowel movements per week. Loose stools rarely present without use of laxatives. Does not meet Rome IV Criteria for IBS. Bristol Stool Form Scale: From Chumpitazi 2016 .

Pearls / Pitfalls

In clinical practice, functional constipation is also referred to as chronic idiopathic constipation. Functional constipation is diagnosed in the absence of secondary causes of constipation. These secondary causes may include, but are not limited to, mechanical obstruction, medication side effects (e.g. opioids), and systemic illness. These criteria should be used in the setting of symptoms that occur when they are not using medications for constipation. Use the Bristol Stool Form Scale to determine stool form. It is important that patients look at both the pictures and the text. If abdominal pain is present in addition to constipation symptoms, a diagnosis of the constipation-predominant irritable bowel syndrome (IBS-C) should be considered.

Management

Management of functional constipation (also known as chronic idiopathic constipation) may include: Adequate dietary fiber intake and supplementation. Osmotic laxatives (e.g. PEG-3350, lactulose). Stimulant laxatives (e.g. bisacodyl, senna). Secretagogues (e.g. linaclotide, plecanatide, lubiprostone). 5-HT4 receptor agonist (e.g. prucalopride). The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Critical Actions

This calculator should only be used in patients where a secondary cause of constipation (e.g. mechanical obstruction, systemic illness, medications) is not suspected based on clinical history, physical exam, and initial workup.

Advice

If diagnosis not met (negative): Symptoms unlikely to be caused by functional constipation. Consider further assessment as clinically indicated. If meets diagnosis (positive): Likely diagnosis of functional constipation. Consider initiating treatment.