The Rome IV criteria can be used to diagnose functional defecation disorder (FDD) and its subcategories inadequate defecatory propulsion and dyssynergic defecation.
Criteria for the diagnosis of functional defecatory disorder (FDD):
(1) The patient meets the criteria for functional constipation or irritable bowel syndrome with constipation.
(2) The patient experiences impaired evacuation during repeated attempts at defecation.
(3) The patient has at least 2 of the following:
(3a) abnormal balloon expulsion test
(3b) abnormal anorectal evacuation pattern (by manometry or anal surface EMG)
(3c) impaired rectal evacuation on imaging studies
(4) The onset of symptoms is >= 6 months prior to diagnosis.
(5) Symptoms have been present for the past 3 months.
Criteria for inadequate defecatory propulsion:
(1) The patients meet the criteria for FDD.
(2) The patient has inadequate propulsive forces by manometry.
(3) The findings are present with or without inappropriate contraction of the anal sphincter and/or pelvic floor muscles.
Criteria for dyssynergic defecation:
(1) The patients meet the criteria for FDD.
(2) There are adequate propulsive forces during attempted defecation.
(3) The patient has inappropriate contraction of the pelvic floor (by manometry or anal surface EMG).
