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    Rome IV Diagnostic Criteria for Constipation

    Provides criteria for diagnosis of functional constipation.
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    INSTRUCTIONS

    • Use in patients with symptoms suggestive of constipation for at least the last 3 months with symptom onset ≥6 months ago.
    • Do NOT use in patients with alarm symptoms such as GI bleeding, unexplained iron deficiency anemia, unintentional weight loss, palpable abdominal mass, family history of colon cancer or symptom onset ≥50 years of age and not yet screened for colon cancer, or sudden/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 last 3 months with symptom onset ≥6 months ago.
    • Do NOT use in patients with alarm symptoms such as:
      • 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.
    • Developed in order to diagnose functional constipation in the absence of secondary causes of constipation. These secondary causes may include, but are not limited to, mechanical obstruction, medication side effects, and systemic illness.

    • Patients are often on medications to treat constipation. These criteria should be used in the setting of what symptoms occur when they are not using medications. Start questions with “When you are not on medications to treat constipation...”  For example: “When you are not on medications to treat constipation, how often do you strain to have a bowel movement?”

    • If abdominal pain is present or is a predominant symptom in addition to constipation symptoms, a diagnosis of the constipation subtype of irritable bowel syndrome (IBS) should be considered.

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

    • Helps 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:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    If diagnosis not met (negative):

    Symptoms unlikely to be caused by functional constipation. Consider further assessment as clinically indicated.

    If meets diagnosis (positive):

    Likely diagnosis of functional constipation. Consider initiating treatment.

    Management

    • Management of functional constipation may include:
      • Ensure adequate dietary fiber intake and supplementation if required.
      • Osmotic laxatives (e.g. PEG-3350, lactulose).
      • Stimulant laxatives (e.g. bisacodyl, senna).
      • Secretagogues (e.g. linaclotide, lubiprostone).
      • 5-HT4 receptor agonist (e.g. prucalopride, but note this is not currently FDA approved).
    • The choice of therapy is outside the scope of this calculator and will depend on clinical context.

    Critical Actions

    This calculator should only be used in patients where a secondary cause of constipation (e.g. mechanical obstruction, systemic illness, medications) is not suspected based on clinical history, physical exam, and initial workup.

    Content Contributors
    • Colleen Parker, MD
    About the Creator
    Dr. Douglas Drossman
    Are you Dr. Douglas Drossman?
    Content Contributors
    • Colleen Parker, MD