The Rome IV Criteria for Functional Digestive Disorders

The Rome IV criteria system was developed to classify the functional gastrointestinal disorders (FGDs) based on their clinical symptoms. Since by definition, evidence of FGDs does not show up through standard diagnostic testing, the Rome criteria are designed to help healthcare providers to make diagnoses of FGDs with confidence. The Rome criteria also allow for standardized diagnostic criteria to be used in the process of research trials.

A doctor diagnosing her patient
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The Rome criteria are developed through a collaboration of researchers, healthcare providers, and other health professionals from around the world. The Rome IV criteria reflect the fourth revision of the FGD diagnostic criteria and were published in 2016.

Types of Functional Gastrointestinal Disorders

Each FGD disorder has its own set of criteria. The following are the major categories of FGDs according to the Rome IV criteria:

  • Esophageal Disorders
  • Gastroduodenal Disorders
  • Bowel Disorders
  • Centrally Mediated Disorders of Gastrointestinal Pain
  • Gallbladder and Sphincter of Oddi Disorders
  • Anorectal Disorders
  • Childhood Functional GI Disorders: Neonate/Toddler
  • Childhood Functional GI Disorders: Child/Adolescent

The Rome IV Criteria for IBS

The criteria for a diagnosis of irritable bowel syndrome (IBS) require that a person be experiencing recurrent abdominal pain on average at least one day a week in the last three months, with an onset of symptoms at least six months prior. Pain must be associated with two or more of the following:

Because IBS can have variable symptoms, the condition is classified into four subtypes:

  • IBS with predominant constipation (IBS-C)
  • IBS with predominant diarrhea (IBS-D)
  • IBS with mixed bowel habits (IBS-M)
  • IBS unclassified (IBS-U)

Although the Rome IV criteria are followed strictly in clinical research trials, in the real world, healthcare providers often give a diagnosis of IBS to anyone who is experiencing bowel symptoms without any visible inflammation or other signs of disease showing up through standard digestive testing.

Other Functional Bowel Disorders

The following are other types of functional bowel disorders. A person would be diagnosed with one of these other disorders when they don't fit the diagnostic criteria for IBS (or any other disease or FGD). Often these other disorders are differentiated from IBS due to the lack of pain as a symptom.

Functional abdominal bloating/distension: Chronic feelings of bloating and/or visible distension occur. The symptom must have occurred at least one day a week over the last three months with symptom onset at least six months prior to diagnosis. However, abdominal bloating and/or distension must be the main symptom and other functional GI disorders should be excluded.

Functional diarrhea: Loose or watery stools (without predominant pain or bloating) are experienced in at least 25% of bowel movements for at least three months with symptom onset at least six months prior. IBS with predominant diarrhea should be excluded.

Functional constipation: Symptoms must include at least two of the following and have been experienced for at least three months with symptom onset at least six months prior:

  • Straining (during at least 25% of bowel movements)
  • Hard stools at least 25% of the time
  • A feeling of incomplete evacuation (at least 25% of the time)
  • Sensation of blockage or obstruction in the anus or rectum area (at least 25% of the time)
  • Manual efforts to enable the passage of stool at least 25% of the time (e.g. digital evacuation)
  • Less than three spontaneous bowel movements (SBM) per week
  • A rare occurrence of loose stools without the use of a laxative
  • Insufficient criteria for IBS

Unspecified functional bowel disorder: Bowel symptoms are not attributable to an organic etiology that does not meet the criteria for IBS or functional constipation, diarrhea, or abdominal bloating/distension disorders. Symptoms must have occurred for the last three months with onset at least six months prior to diagnosis.

Opioid-induced constipation: New or worsening symptoms of constipation occur when initiating, changing, or increasing opioid therapy, that must include two or more of the following:

  • Straining (during at least 25% of bowel movements)
  • Hard stools at least 25% of the time
  • A feeling of incomplete evacuation (at least 25% of the time)
  • Sensation of blockage or obstruction in the anus or rectum area (at least 25% of the time)
  • Manual efforts to enable the passage of stool at least 25% of the time (e.g., digital evacuation, support of the pelvic floor)
  • Fewer than three SBM per week

Opioid-induced constipation is also defined as loose stools rarely being present without the use of laxatives.

Rome IV in the Real World

As designed, the Rome IV criteria provide a strong basis for identifying patients for research studies. However, healthcare providers in their clinical practice don't always focus on such exacting criteria when offering functional diagnoses to their patients. Thus, there is no need to be overly concerned if you receive a diagnosis that doesn't completely conform to the criteria. But if you still have any questions about your diagnosis, ask your healthcare provider for clarification.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Drossman DA, Hasler WL. Rome IV—Functional GI disorders: disorders of gut-brain interactionGastroenterology. 2016;150(6):1257-1261. doi:10.1053/j.gastro.2016.03.035

  2. Schmulson MJ, Drossman DA. What Is New in Rome IV. J Neurogastroenterol Motil. 2017;23(2):151-163. doi:10.5056/jnm16214

  3. Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology. Published online February 18, 2016. doi:10.1053/j.gastro.2016.02.031

Barbara Bolen, PhD

By Barbara Bolen, PhD
Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.