Management of constipation: A narrative review of evolving strategies and methodological challenges

Table 2 Rome IV diagnostic criteria for functional constipation (diagnosis requires the presence of at least two or more of six symptoms in criteria 1 for the last 3 months, with symptom onset at least 6 months prior to diagnosis)

No.	Criterion
1	Must include two or more of the following: (1) Straining during > 25% of defecations; (2) Lumpy or hard stools > 25% of defecations (Bristol Stool Form Scale 1 or 2); (3) Sensation of incomplete evacuation > 25% of defecations; (4) Sensation of anorectal obstruction/blockage > 25% of defecations; (5) Manual maneuvers to facilitate > 25% of defecations (digital evacuation, support of the pelvic floor); and (6) Fewer than three spontaneous bowel movements per week
2	Loose stools are rarely present without the use of laxatives
3	Insufficient criteria for irritable bowel syndrome