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    Rome IV Diagnostic Criteria for Child Non-retentive Fecal Incontinence

    Official Rome IV criteria for the diagnosis of child nonretentive fecal incontinence.


    Use in a child or adolescent with fecal incontinence for at least 1 month.  

    Patients with any of the following alarm features must be evaluated clinically for other diagnoses even though nonretentive fecal incontinence may be present:

    • Physical exam findings suggesting structural disease, such as:

      • Fistulous opening.

      • Abnormalities of the back (Hair tuft, gluteal cleft deviation, sacral dimple).

      • Anal tenderness or tags.

      • Absent anal or cremasteric reflex.

      • Decreased lower extremity strength/tone/reflexes.

    • Anal scars.

    • Hematochezia or melena.

    • Abdominal distension.

    • Vomiting.

    • Urinary retention or incontinence.

    When to Use
    Why Use

    Children and adolescents presenting with symptoms suggestive of non retentive fecal incontinence for 1 month. The diagnosis of nonretentive fecal incontinence should be made by clinical history, positive symptom criteria, physical examination, and minimal diagnostic testing as clinically indicated.

    • Nonretentive fecal incontinence (NFI) is diagnosed based on history and physical exam.

    • It is important to differentiate NFI from incontinence secondary to overflow in functional constipation. In case of the latter, a large stool burden is noted in the rectum (on digital rectal exam or abdominal exam).

    • Fecal incontinence may be due to excessive laxative use in pediatric patients with constipation. When suspected, discontinuation of laxatives will result in resolution of incontinence. 

    • When it is not clear if there is constipation, a colonic transit study can be considered. A simple abdominal radiograph is not sensitive or specific to make a diagnosis of constipation. 

    • Colonic transit is normal in children with NFI compared to those with functional constipation

    • NFI can be the symptom of an emotional disturbance. Therefore, psychological evaluation is very important.

    • Any abnormality on history or physical exam should prompt appropriate testing such as an MRI of the spine to detect spinal defects. 

    • It is a challenging condition to treat with frequent relapses.

    • Used to establish the diagnosis of non-retentive fecal incontinence in children and adolescents who present with fecal incontinence.

    • Can be used to discuss the diagnosis of nonretentive fecal incontinence with patients and initiate treatment.

    • Making a diagnosis will help minimize unnecessary diagnostic evaluations and allow early treatment.

    Must have the following:

    (for ≥1 month prior in patients with a developmental age ≥4 years)

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    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
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH