A patient is assessed for chronic functional constipation. According to the Rome criteria, for how long must symptoms have been present?

Answer: C. More than 3 months with characteristic symptoms

Chronic functional constipation (Rome criteria)

Chronic constipation is defined as symptoms lasting more than 3 months, with two or more of the characteristic Rome features.

The Rome features (any two or more)

• Fewer than three bowel movements per week.
• Straining during at least 25% of defecations.
• Passing hard or pellet-like stools in at least 25%.
• Sense of incomplete emptying in at least 25%.
• Sensation of anorectal obstruction/blockage.
• Need for manual manoeuvres to facilitate defecation (e.g. digital evacuation, pelvic floor support).

Acute versus chronic

• < 3 months (acute): think mechanical cause.
• > 3 months (chronic): distinguish slow-transit from obstructed defaecation.

Clinical relevance

Defining the duration and pattern guides whether to investigate for mechanical disease versus functional subtypes.