Understanding the Etiology and ROME Criteria for Constipation

29.6% of children worldwide suffer from a common functional gastrointestinal disorder (FGID) or a form of constipation.

A child suffering from constipation can suffer a host of symptoms that impact their daily lives and that of their family too. 

Diagnosing constipation relies heavily on medical history and the ROME criteria for constipation.

Is your child blocked up? Recent studies have shown that as many as one-third of kids who suffer from constipation also have behavioral problems related to constipation.

If your child is all blocked up, they are likely to be more irritable, anxious, or show signs of OCD, especially increased prior to a bowel movement.

Read on to learn more about the science of constipation and the ROME criteria for constipation diagnosis. 

The ROME Criteria for Constipation

In 2016, the ROME IV criteria were updated. These criteria are used in the diagnosis of irritable bowel syndrome as well as functional constipation. 

The criteria say the patient must include two or more of the following criteria for a diagnosis:

• Straining during at least 25% of stooling
• Having the sensation of incomplete evacuation for at least 25% of stools
• Lumpy or hard stools in at least 25% of stooling
• Physical maneuvers to help at least 25% of stooling
• Having the sensation of obstruction/blockage for at least 25% of stools
• Fewer than three poops per week

The patient will rarely have loose stools. They may have liquid stools or small pellets around a large stool mass. Encopresis is liquid stool around a mass of constipated stool.  Think of constipation like a blocked pipe.

Causes of Constipation 

There are several reasons that a patient might be suffering from constipation. Some of the most common causes include: 

• Dietary factors like lack of fiber
• Not getting enough fluids
• Not getting enough exercise
• Behavioral actions like not taking the time to poop or listening to when their body needs to go

Studies show that all of these could cause constipation.

Etiology of Constipation

Beyond diet, why does constipation occur?

Anatomic or mechanical issues can also cause constipation. A patient might have:

• Hemorrhoids
• Anal stenosis
• Strictures
• Rare tumors
• Conditions that make going painful or difficult

Abnormal muscle movement and peristalsis can occur when things like low muscle tone and mitochondrial dysfunction happen.

Patients with spinal cord abnormalities like tethered cord or spina bifida, and Hirschsprung disease might suffer from intestinal nerve abnormality.

Drugs like narcotics (like morphine and codeine), antidepressants (like fluoxetine), antiepileptics (like carbamazepine), antipsychotics (like clozapine), and supplements containing iron can also trigger constipation.

Some patients have metabolic and endocrine conditions. Causes like thyroid problems or diabetes that will trigger constipation. Many other causes should also be investigated including psychological issues, dysautonomia, and other disorders such as celiac disease or inflammatory bowel disease.

Treatments for Constipation

The first line of treating constipation is always diet, fiber and fluid intake, physical activity, and establishing routines around toileting.

It's recommended to increase fiber intake gradually. Patients need to focus on getting plenty of fluids, especially water. Dehydration can exacerbate constipation.

Also, the more you move, the more your body can move stool through your body. Regular exercise is always a good beginning option to treat constipation. Physical activity promotes good pooping.

Understanding other natural interventions for constipation

Magnesium, especially citrate or oxide formulations, can be a very safe and effective interventions for constipation.  Aloe, especially the gel from the plant in a certified form, can be an excellent stimulant laxative and anti-inflammatory. 

Other nutraceuticals to consider together with a qualified practitioner include ascorbic acid, senna, carnitine and other motility activators as warranted.

To learn more about treatments for constipation, check out our membership today.