Rome IV Diagnostic Criteria for Functional Anorectal Pain
Official Rome IV criteria for the diagnosis of levator ani syndrome or unspecified functional anorectal pain.
Use in patients with chronic, recurrent anorectal pain lasting >30 minutes that is often worse with sitting than standing or lying down, often described as a vague, dull ache, or pressure high in rectum.
Digital rectal exam:
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Levator Ani Syndrome: tenderness on palpation of pelvic floor or vagina.
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Pain during posterior traction of puborectalis.
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Pain often asymmetric, more often on left side (but not universally).
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Posterior massage may elicit characteristic discomfort.
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Unspecified Functional Anorectal Pain:
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NO pain during posterior traction of puborectalis.
Do NOT use in patients with:
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Anorectal or pelvic floor structural pathology explaining symptoms.
Diagnostic Result
Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.
Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.
The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.
| Committees | Chair | Co-Chair |
| Esophageal Disorders | Ronnie Fass, MD | John Pandolfino, MD |
| Gastroduodenal Disorders | Nicholas J. Talley, MD, PhD, FRACP | Vincenzo Stanghellini, MD |
| Bowel Disorders | Fermin Mearin, MD | Brian Lacy, MD, PhD |
| Gallbladder and Sphincter of Oddi Disorders | Grace Elta, MD | Peter Cotton, MD |
| Centrally Mediated Disorders of Gastrointestinal Pain | Peter J. Whorwell, MD | Laurie Keefer, PhD |
| Anorectal Disorders | Adil E. Bharucha, MD, MBBS | Satish S. C. Rao, MD, PhD, FRCP |
| Childhood Functional Gastrointestinal Disorders: Neonate/Toddler | Sam Nurko, MD | Marc A. Benninga, MD |
| Childhood Functional Gastrointestinal Disorders: Child/Adolescent | Carlo Di Lorenzo, MD | Jeffrey S. Hyams, MD |
Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs
Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.
- Justin Brandler, MD