Rome II Diagnostic Criteria 1.Functional Bowel Disorders The diagnosis of a Functional Bowel Disorder always presumes the absence of a structural or biochemical explanation for the symptoms. (1) Irritable Bowel Syndrome At least 12 weeks, which need not be consecutive, in the preceding 12 months of abdominal discomfort or pain that has two out of three features: 1. Relieved with defecation; and/or 2. Onset associated with a change in frequency of stool; and/or 3. Onset associated with a change in form (appearance) of stool. Symptoms that Cumulatively Support the Diagnosis of Irritable Bowel Syndrome 1. Abnormal stool frequency (for research purposes “abnormal” may be defined as greater than 3 bowel movements per day and less than 3 bowel movements per week); 2. Abnormal stool form (lumpy/hard or loose/watery stool); 3. Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation); 4. Passage of mucus; 5. Bloating or feeling of abdominal distension. (2) Functional Abdominal Bloating At least 12 weeks, which need not be consecutive, in the preceding 12 months of: 1. Feeling of abdominal fullness, bloating, or visible distension; and 2. Insufficient criteria for a diagnosis of functional dyspepsia, irritable bowel syndrome, or other functional disorder. (3) Functional Constipation At least 12 weeks, which need not be consecutive, in the preceding 12 months of two or more of: 1. Straining > 1.4 of defecations; 2. Lumpy or hard stools > 1.4 of defecations; 3. Sensation of incomplete evacuation > 1.4 of defecations; 4. Sensation of anorectal obstruction/blockage > 1.4 of defecations; 5. Manual maneuvers to facilitate > 1.4 of defecations (e.g., digital evacuation, support of the pelvic floor); and/or 6. < 3 defecations per week. Loose stools are not present, and there are insufficient criteria for IBS. (4) Functional Diarrhea At least 12 weeks, which need not be consecutive, in the preceding 12 months of: 1. Loose (mushy) or watery stools 2. Present > 3.4 of the time; and 3. No abdominal pain. (5) Unspecified Functional Bowel Disorder Bowel symptoms in the absence of organic disease that do not fit into the previously defined categories of functional bowel disorders. 2.Functional Disorders of the Anus and Rectum The diagnosis of a Functional Disorder of the Anus and Rectum always presumes the absence of a structural or biochemical explanation for the symptoms. (1) Functional Fecal Incontinence Recurrent uncontrolled passage of fecal material for at least one month, in an individual with a developmental age of at least 4 years, associated with: 1. Fecal impaction; or 2. Diarrhea; or 3. Nonstructural anal sphincter dysfunction. (2) Functional Anorectal Pain <1> Levator Ani Syndrome At least 12 weeks, which need not be consecutive, in the preceding 12 months of: 1. Chronic or recurrent rectal pain or aching; 2. Episodes last 20 minutes or longer; and 3. Other causes of rectal pain such as ischemia, inflammatory bowel disease, cryptitis, intramuscular abscess, fissure, hemorrhoids, prostatitis, and solitary rectal ulcer have been excluded. <2> Proctalgia Fugax 1. Recurrent episodes of pain localized to the anus or lower rectum; 2. Episodes last from seconds to minutes; and 3. There is no anorectal pain between episodes. (3) Pelvic Floor Dyssynergia 1. The patient must satisfy diagnostic criteria for functional constipation in Diagnostic Criteria of Functioanl Constipation; 2. There must be manometric, EMG, or radiologic evidence for inappropriate contraction or failure to relax the pelvic floor muscles during repeated attempts to defecate; 3. There must be evidence of adequate propulsive forces during attempts to defecate, and 4. There must be evidence of incomplete evacuation.