The Rome IV criteria system was developed to classify functional gastrointestinal disorders (FGD) based on clinical symptoms. By definition, evidence of FGD does not appear on standard diagnostic tests, so the Rome criteria are designed to help health care providers diagnose her FGD with confidence. The Rome criteria also allow for the use of standardized diagnostic criteria in the course of research trials.

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The Rome Standards were developed through collaboration with researchers, health care professionals, and other health professionals from around the world. The Rome IV criteria reflect his fourth revision of the FGD diagnostic criteria and were published in 2016.

Types of functional gastrointestinal disorders

Each FGD disorder has its own criteria. The main categories of FGD according to the Rome IV criteria are:

  • esophageal disease
  • gastroduodenal disease
  • intestinal disease
  • Central disease of gastrointestinal pain
  • Diseases of the gallbladder and sphincter of Oddi
  • anorectal disease
  • Pediatric functional gastrointestinal diseases: neonates/infants
  • Functional gastrointestinal disorders in childhood: children/adolescents

Rome IV standard for IBS

Diagnostic criteria for irritable bowel syndrome (IBS) include experiencing chronic abdominal pain or discomfort at least one day a week for the past 3 months, and symptoms beginning at least 6 months ago. You will be asked for it. It must also be associated with two or more of the following criteria:

  • related to defecation
  • Associated with changes in bowel frequency
  • Associated with changes in stool appearance

Because the symptoms of IBS vary, the condition is divided 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 strictly adhered to in clinical research trials, in the real world, health care providers often treat intestinal symptoms that show no visible inflammation or other signs of disease on standard gastrointestinal tests. IBS is often diagnosed in people who experience it.

Other functional bowel diseases

Below are other types of functional bowel diseases. If you do not meet the diagnostic criteria for IBS (or any other disease or FGD), you will be diagnosed with one of these other disorders. These other conditions are often distinguished from IBS because they do not have pain as a symptom.

Functional bloating/bloating: Chronic bloating and/or visible bloating. Symptoms must have occurred at least 1 day per week for the past 3 months and must have started at least 6 months before diagnosis. However, bloating and/or distension must be the main symptom and other functional gastrointestinal disorders must be excluded.

Functional diarrhea: Experience of having had loose or watery stools (without major pain or bloating) in at least 25% of bowel movements for at least 3 months, and a history of symptoms in the previous 6 months. IBS with prominent diarrhea should be excluded.

Functional constipation: Symptoms include at least two of the following, must have been present for at least 3 months, and must have started at least 6 months ago:

  • Straining (during at least 25% of bowel movements)
  • Hard stools at least 25% of the time
  • Feels that evacuation is incomplete (at least 25% of the time)
  • Obstruction or sensation of obstruction in the anal or rectal area (at least 25%)
  • Manual efforts to ensure stool evacuation at least 25% of the time (e.g. digital defecation)
  • Defecation less than 3 times a week
  • Loose stools rarely occur if laxatives are not used.
  • Inadequate standards for IBS

Real World Rome IV

As designed, the Rome IV criteria provide a strong basis for identifying patients for study. However, healthcare providers in clinical settings do not always focus on such rigorous criteria when providing functional diagnosis to their patients. So if you receive a diagnosis that doesn’t quite fit your criteria, don’t worry too much. However, if you still have questions about the diagnosis, ask your doctor for clarification.


Written by Dr. Barbara Bolen

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

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