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Rome IV Diagnostic Criteria for Functional Constipation
Diagnostic checklist for functional constipation in adults.
Rome IV Diagnostic Criteria for Functional Constipation
Straining during >25% of defecations
Lumpy or hard stools (Bristol type 1-2) in >25% of defecations
Sensation of incomplete evacuation in >25% of defecations
Sensation of anorectal obstruction/blockage in >25% of defecations
Manual manoeuvres needed to facilitate >25% of defecations (e.g. digital evacuation, pelvic floor support)
Fewer than 3 spontaneous bowel movements per week
Loose stools are rarely present without the use of laxatives
Insufficient criteria for irritable bowel syndrome
Criteria fulfilled for the last 3 months with symptom onset ≥6 months before diagnosis
ResultCriteria not met
Diagnosis requires ≥2 of the 6 core features, loose stools rarely occurring without laxatives, insufficient criteria for IBS, for the last 3 months with onset ≥6 months before diagnosis.
- Core criteria present
- 0 of 6
When to use
- Diagnosing functional constipation in an adult after excluding secondary causes (medications, metabolic, structural).
Formula
≥2 of: straining, lumpy/hard stools, incomplete evacuation, anorectal obstruction sensation, or need for manual manoeuvres in >25% of defecations, or <3 spontaneous bowel movements/week — plus loose stools rarely present without laxatives and insufficient criteria for IBS — for the last 3 months with onset ≥6 months before diagnosis.
Pearls and pitfalls
- Overlap with IBS-C is common; the distinguishing feature is the prominence of abdominal pain, which favours IBS.