Rome IV Diagnostic Criteria for Functional Constipation
Rome IV criteria for functional constipation in adults: criteria met for the last 3 months with symptom onset at least 6 months before diagnosis.
Score interpretation
Insufficient criteria for functional constipation diagnosis
→ Consider alternative diagnoses: secondary constipation (hypothyroidism, hypercalcaemia, diabetes, Parkinson's, spinal cord pathology -- check TFTs, Ca2+, HbA1c); medication review (opioids, antidepressants, anticholinergics, calcium channel blockers, iron); colonoscopy if alarm features or age > 60; if IBS criteria met: diagnose IBS-C and manage accordingly.
Rome IV criteria satisfied for functional constipation
→ Diagnosis confirmed (after excluding secondary causes and alarm features); first-line: lifestyle -- increased fibre (25-30 g/day), fluid intake (1.5-2 L/day), physical activity, bowel routine (attempt 15-20 min post-breakfast -- gastrocolic reflex); laxative if lifestyle inadequate: macrogol (PEG, first-line) 1-4 sachets/day; lactulose as alternative (more bloating); bisacodyl 5-10 mg PRN; second-line: prucalopride 2 mg OD (NICE TA211: women in whom at least two laxatives from different classes at the highest tolerated doses for at least 6 months have failed); linaclotide is licensed for IBS with constipation, not functional constipation; refer gastroenterology if refractory to 12 weeks treatment; anorectal physiology and defecography if obstructed defecation suspected (Wexner Score, RAIR assessment, biofeedback).
Interpretation bands for the Rome IV Constipation. Apply clinical judgement and local guidance.
References
- Mearin F, Lacy BE, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393–1407.
- NICE TA211. Prucalopride for the treatment of chronic constipation in women. 2010.
Related
Curated clinical cross-links plus same-class fallbacks.
- Manning Criteria for Irritable Bowel Syndrome · Functional GI Disorders
- Kruis Score for Diagnosis of Irritable Bowel Syndrome · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Dyspepsia · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Chest Pain · Functional GI Disorders
- Rome IV Diagnostic Criteria for Globus · Functional GI Disorders
- Rome IV Diagnostic Criteria for Cyclic Vomiting Syndrome (CVS) · Functional GI Disorders
- Macrogol (Polyethylene Glycol) · Osmotic Laxative — Bowel Preparation / Constipation
- Sodium Picosulfate · Stimulant Laxative / Bowel Preparation Agent
- Magnesium citrate · Osmotic laxative / bowel-prep component
- Risperidone (Paediatric) · Atypical Antipsychotic — Autism Spectrum Disorder / Schizophrenia / Tic Disorders
- Lactulose (Paediatric) · Osmotic Laxative — Constipation / Hepatic Encephalopathy
- Senna (Paediatric) · Stimulant Laxative — Constipation in Children
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
