Table 4.

Rome IV diagnostic criteria for opioid-induced constipation [54, 55]

1. New or worsening symptoms of constipation when initiating, changing or increasing opioid therapy that must include two or more of the following symptoms:

a. Straining for more than 25% of defecation attempts

b. Lumpy or hard stools (BSFS 1–2) for more than 25% of defecation attempts

c. Sensation of incomplete evacuation for more than 25% of defecation attempts

d. Sensation of anorectal obstruction or blockage for more than 25% of defecation attempts

e. Manual manoeuvres required to defecate for at least 25% of defecation attempts

f. < 3 spontaneous bowel movements per week

2. Loose stools are rarely present without the use of laxatives

BSFS Bristol Stool Form Scale