Constipation in chronic kidney disease: it is time to reconsider

Table 1 Rome IV diagnostic criteria for functional constipation and irritable bowel syndrome with constipation

Diagnostic criteria for functional constipation^a
1. Must include 2 or more of the following^b: a. Straining during more than 25% of defecations b. Lumpy or hard stools (the Bristol Stool Form Scale^c 1-2) more than 25% of defecations c. Sensation of incomplete evacuation more than 25% of defecations d. Sensations of anorectal obstruction/blockage more than 25% of defecations e. Manual maneuvers to facilitate more than 25% of defecations (e.g., digital evacuation, support of the pelvic floor) f. Fewer than 3 spontaneous bowel movements per week 2. Loose stools are rarely present without the use of laxatives 3. Insufficient criteria for irritable bowel syndrome
Diagnostic criteria for irritable bowel syndrome with predominant constipation^d
1. Recurrent abdominal pain, on average, at least 1 day per week in the last 3months, associated with 2 or more of the following criteria: a. Related to defecation b. Associated with a change in frequency of stool c. Associated with a change in form (appearance) of stool 2. More than 25% of bowel movement with Bristol stool form type 1 or 2, and less than 25% of bowel movement with Bristol stool form type 6 or 7

^aCriteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis
^bFor research studies, patients meeting criteria for opioid-induced constipation should not be given a diagnosis of functional constipation because it is difficult to distinguish between opioid side effects and other causes of constipation. However, clinicians recognize that these 2 conditions might overlap
^cThe Bristol Stool Form Scale is shown in Table 2
^dIrritable bowel syndrome subtype can only be confidently established when the patient is evaluated off medication used to treat bowel habit abnormalities

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