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    Rome IV Diagnostic Criteria for Proctalgia Fugax

    Official Rome IV criteria for the diagnosis of proctalgia fugax.


    • Use in patients with sudden, infrequent anorectal pain lasting <30 minutes (often seconds to minutes) and often described as cramping, gnawing, aching, or stabbing with severity ranging from uncomfortable to intolerable.

    • Can interrupt normal activities and even awaken patients from sleep.

    • Can be triggered by stress or anxiety.


    Do NOT use these criteria in patients with:

    • Tenderness on posterior traction of rectum when not having symptoms.

    • Anorectal or pelvic floor structural pathology explaining symptoms.

    • Frequent pain related to defecation

    When to Use
    Why Use

    Use in patients with sudden, infrequent anorectal pain lasting <30 minutes (often seconds to minutes) and often described as cramping, gnawing, aching, or stabbing with severity ranging from uncomfortable to intolerable.

    • If pain is >30 minutes, consider levator ani syndrome.

    • Episodes are often infrequent and self-limited. If more frequent and longer duration consider other diagnoses such as structural anorectal pathology or Levator Ani Syndrome.

    • Digital rectal exam should be normal without tenderness on posterior traction of rectum if the patient is not symptomatic at the time of the exam.

    • Initial lab studies include complete blood count, electrolytes, and inflammatory markers such as C-reactive protein if infection or inflammatory bowel disease is being considered.

    • In men, perform prostate exam and consider chronic prostatitis.

    • In women, consider endometriosis or other pelvic pain disorders as alternative diagnoses.

    • Structural evaluation such as sigmoidoscopy or colonoscopy with close anorectal inspection must occur prior to diagnosis as management for structural causes such as anal fissures or peri-anal Crohn’s disease greatly differs.

    • Given short duration and infrequency of symptoms (typically <5 episodes per year), treatment and prevention can be impractical and reassurance alone may be adequate. However, in some patients, consider treatment with nitrates or antispasmodics when symptoms begin.

    • Frequently under-reported symptom requiring adept clinical history taking and focused exam including careful digital rectal exam.

    • While under-reported, can negatively affect quality of life and lead to school and work absenteeism if frequent and severe.

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    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
    • Justin Brandler, MD
    Reviewed By
    • Max J. Schmulson W., MD
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Justin Brandler, MD
    Reviewed By
    • Max J. Schmulson W., MD