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Rome IV Diagnostic Criteria for Functional Defecation Disorders
Diagnostic checklist for dyssynergic defecation and inadequate defecatory propulsion in adults.
Rome IV Diagnostic Criteria for Functional Defecation Disorders
Meets Rome IV criteria for functional constipation and/or constipation-predominant IBS
Abnormal balloon expulsion test
Abnormal anorectal evacuation pattern on manometry or anal surface EMG
Impaired rectal evacuation demonstrated by imaging (e.g. defecography)
Predominant physiologic pattern (if criteria are met)
ResultCriteria not met
Diagnosis requires symptomatic functional constipation/IBS-C plus ≥2 of 3 objective tests of impaired evacuation (balloon expulsion, manometry/EMG, imaging).
- Abnormal objective tests
- 0 of 3
When to use
- Working up chronic constipation refractory to laxatives to identify a pelvic-floor evacuation disorder amenable to biofeedback therapy.
Formula
Patient meets criteria for functional constipation and/or IBS-C, plus ≥2 of 3 objective tests of impaired evacuation: abnormal balloon expulsion test, abnormal anorectal manometry/surface EMG pattern, or impaired evacuation on imaging.
Pearls and pitfalls
- Biofeedback therapy is the treatment of choice once a defecation disorder is confirmed, and outperforms laxatives alone in this group.