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Rome IV Diagnostic Criteria for Opioid-Induced Constipation
Diagnosis of new or worsening constipation temporally linked to opioid therapy.
Rome IV Diagnostic Criteria for Opioid-Induced Constipation
New or worsening constipation symptoms when initiating, changing, or increasing opioid therapy
Straining during more than 1/4 (25%) of defecations
Lumpy or hard stools (Bristol type 1-2) in more than 1/4 of defecations
Sensation of incomplete evacuation in more than 1/4 of defecations
Sensation of anorectal obstruction/blockage in more than 1/4 of defecations
Manual maneuvers needed to facilitate more than 1/4 of defecations
Fewer than 3 spontaneous bowel movements per week
Loose stools are rarely present without the use of laxatives
ResultCriteria not met
Does not meet Rome IV criteria for opioid-induced constipation (0 of 6 supporting features present; requires new/worsening symptoms tied to opioid therapy, ≥2 features, and rarely loose stools without laxatives).
- Supporting features present
- 0 / 6
When to use
- Patient on opioid therapy with new or worsening constipation, to confirm an opioid-attributable cause and guide use of a peripherally acting mu-opioid receptor antagonist.
Formula
New or worsening constipation with opioid initiation, dose change, or increase, plus ≥2 of: straining, lumpy/hard stools, sensation of incomplete evacuation, sensation of anorectal blockage, or manual maneuvers in >1/4 of defecations; or fewer than 3 spontaneous bowel movements/week. Loose stools are rarely present without laxatives.
Pearls and pitfalls
- Because it is defined operationally, opioid-induced constipation does not require the 6-month/3-month duration threshold used by other Rome IV bowel disorders.