Rome IV Diagnostic Criteria for Fecal Incontinence
INSTRUCTIONS
Use in patients with recurrent fecal staining or uncontrolled passage of stool for the past 3 months.
Do NOT use in patients with:
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Clear mucous secretion alone.
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Remote, isolated episodes of fecal incontinence.
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Developmental age <4 years old or before toilet training has occurred.
Use in patients with recurrent fecal staining or uncontrolled passage of stool for the past 3 months.
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Patients often will not volunteer this symptom and rapport is critical.
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Rule out if fecal staining of underwear is due to poor hygiene rather than true fecal incontinence.
Important clinical questions:
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Awareness of need to stool (i.e. rectal urgency) prior to incontinence episodes?
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If not aware = passive incontinence.
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If aware but unable to reach toilet in time = urge incontinence.
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Occasional large hard stools with leakage of small liquid stool without awareness?
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Suggestive of fecal retention and overflow incontinence.
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Use Bristol Stool Chart to clarify.
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Characterization of incontinence?
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Type (solid, liquid, and/or gas).
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Timing (during/after events such as meals, exercise, nocturnal).
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Severity/quantity (seepage < staining < soiling of underwear, clothing, bedding).
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Frequency.
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Impact on quality of life.
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Important risk factors:
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Laxatives, artificial sweeteners, magnesium supplements, lactose.
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Anorectal surgeries.
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Prior obstetric procedures/complications and multi-parity.
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Constipating agents leading to fecal retention and overflow.
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Secondary causes: multiple sclerosis, diabetic neuropathy, Parkinson’s, scleroderma, rectal prolapse, central nervous system disorders (e.g. dementia, stroke, brain tumors, spinal cord lesions), bile acid associated diarrhea.
Thorough digital rectal exam is critical:
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Assess if anal “wink” reflex absent suggestive of neurologic damage.
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Assess anal pressures when patient resting, squeezing, and simulating defecation.
NOTE: Nocturnal incontinence is more frequently associated with other conditions affecting GI motility (diabetes, scleroderma, etc).
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Fecal incontinence can have significant impact on quality of life.
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Frequently under-reported symptom requiring adept clinical history taking.
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Multi-factorial disease process often requiring multidisciplinary management approach.
Diagnostic Result:
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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
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
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
- Justin Brandler, MD
- Max J. Schmulson W., MD