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    Rome IV Diagnostic Criteria for Constipation

    Official Rome IV criteria for the diagnosis of functional constipation.

    INSTRUCTIONS

    Use in patients with symptoms suggestive of constipation for at least the last 3 months.

    Patients with any of the following features must be evaluated clinically for other diagnoses even though functional 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.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients presenting with symptoms suggestive of constipation for at least the past 6 months. The diagnosis of functional constipation should be made by clinical history, physical examination, and minimal laboratory tests. Colonoscopy or other tests should be done if clinically indicated.

    • In clinical practice, functional constipation is also referred to as chronic idiopathic constipation.
    • Functional constipation is diagnosed in the absence of secondary causes of constipation. These secondary causes may include, but are not limited to, mechanical obstruction, medication side effects (e.g. opioids), and systemic illness.  
    • These criteria should be used in the setting of symptoms that occur when they are not using medications for constipation. 
    • Use the Bristol Stool Form Scale to determine stool form.  It is important that patients look at both the pictures and the text.
    • If abdominal pain is present in addition to constipation symptoms, a diagnosis of the constipation-predominant irritable bowel syndrome (IBS-C) should be considered.
    • Used to diagnose functional constipation in the absence of secondary causes of constipation.

    • Making a diagnosis will help guide need for further work-up and management.

    • Can be used to discuss signs and symptoms of constipation with patients.

    Must have ≥2 of the following:

    For ≥3 months prior with symptom onset ≥6 months ago

    Must have both of 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 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

    Are you Dr. Douglas Drossman? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Lin Chang, MD (Rome Foundation)
    About the Creator
    Dr. Douglas Drossman
    Are you Dr. Douglas Drossman?
    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Lin Chang, MD (Rome Foundation)