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    Rome IV Diagnostic Criteria for Opioid-Induced Constipation

    Official Rome IV criteria for the diagnosis of opioid-induced constipation.

    INSTRUCTIONS

    Use in patients with symptoms suggestive of constipation in the setting of opioid use.

    Patients with any of the following features must be evaluated clinically for other diagnoses even though opioid induced constipation may be present:

    • Signs or symptoms of gastrointestinal bleeding.

    • Unexplained iron deficiency anemia.

    • Unintentional weight loss.

    • Palpable abdominal mass or lymphadenopathy on exam.

    • Family history of colon cancer and have not had age-appropriate colon cancer screening.

    • Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.

    • Sudden or acute onset of new change in bowel habit that occurred prior to initiation or dose change of an opioid.

    When to Use
    Pearls/Pitfalls
    Why Use

    Use in patients with symptoms suggestive of constipation in the setting of initiation of, changes to or increasing opioid therapy. This diagnosis should be made after a complete history, physical examination and limited diagnostic tests are performed.

    • Opioid induced constipation should be considered in patients with new onset constipation in the setting of starting opioids

    • Opioid induced constipation can overlap with or exacerbate functional constipation (i.e., opioid associated constipation).

    • If clinically indicated, simple laboratory tests (e.g. CBC, complete metabolic profile, serum calcium and thyroid-stimulating hormone) are reasonable to obtain.

    • Some patients with opioid induced constipation may experience overflow diarrhea or incontinence related to significant constipation. An abdominal x-ray (KUB) can identify fecal impaction and the level and degree of stool burden. 

    • Consider narcotic bowel syndrome when patients on opioids get increasing abdominal pain.

    • Secondary causes of constipation can occur in patients taking opioids and thus taking a history is necessary to determine if any red flag symptoms are present.

    • Bowel habits while taking opioids should be compared to baseline bowel habits prior to initiation of opioids.

    • Use the Bristol Stool Form Scale to determine stool form. It is important that patients look at both the pictures and the text.

    • To establish a diagnosis of opioid induced constipation.

    • Establishing this diagnosis can help guide management of constipation symptoms.

    • To help guide conversations with patients regarding etiology of constipation symptoms.

    Must have new, or worsening, symptoms of constipation when initiating, changing, or increasing opioid therapy that must include ≥2 of the following:
    Must have the following:

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Dr. Lin Chang
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Dr. Lin Chang