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Rome IV Diagnostic Criteria for Functional Anorectal Pain
Diagnostic checklist distinguishing levator ani syndrome, unspecified anorectal pain, and proctalgia fugax.
Rome IV Diagnostic Criteria for Functional Anorectal Pain
Pain pattern
Tenderness to posterior traction on the puborectalis muscle (digital exam)
Only assessed for the chronic pattern; determines levator ani syndrome vs unspecified anorectal pain.
Other structural/organic causes of rectal pain excluded (e.g. IBD, abscess, fissure, thrombosed haemorrhoid, tumour)
Criteria fulfilled for the last 3 months with symptom onset ≥6 months before diagnosis
Applies to the chronic pattern only.
ResultCriteria not met
Chronic anorectal pain requires exclusion of organic causes and ≥3 months' duration with onset ≥6 months before diagnosis; puborectalis tenderness then differentiates levator ani syndrome from unspecified anorectal pain.
When to use
- Classifying chronic or episodic anorectal pain once structural/organic causes have been excluded on examination.
Formula
Proctalgia fugax: recurrent brief pain (seconds to <30 min), pain-free between episodes, other causes excluded. Levator ani syndrome/unspecified anorectal pain: chronic/recurrent pain ≥30 min per episode for ≥3 months (onset ≥6 months prior), other causes excluded; puborectalis tenderness on traction = levator ani syndrome, absent = unspecified.