# Rome IV levator ani syndrome

Rao 2016 Rome IV levator ani syndrome

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/rome_iv_levator_ani`
HTML: https://magentlab.com/docs/rome-iv-levator-ani
Markdown: https://magentlab.com/docs/rome-iv-levator-ani.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Apply the Rao 2016 Rome IV levator ani syndrome (F2a) diagnostic criteria and return whether the published levator ani box holds (rome_iv_levator_ani).

## When to use

When an agent already has the six caller-assigned Rao 2016 Rome IV levator ani syndrome flags and needs whether the published F2a box holds. magent does not perform traction on the puborectalis.

## When not to use

- Not a medical device.
- Not a diagnosis. magent does not diagnose levator ani syndrome.
- The caller assigns the six flags. magent does not perform traction on the puborectalis.
- This tool is Rao 2016 Rome IV levator ani syndrome (F2a) only. Not proctalgia fugax. Not unspecified functional anorectal pain (F2b).

## Formula

```
rome_iv_levator_ani iff chronic_or_recurrent_rectal_pain_or_aching and episodes_last_30_minutes_or_longer and tenderness_during_puborectalis_traction and other_causes_of_rectal_pain_excluded and fulfilled_last_3_months and onset_at_least_6_months (Rao 2016 Rome IV levator ani syndrome)
```

## Citation

[Anorectal Disorders](https://doi.org/10.1053/j.gastro.2016.02.009)
Rao SSC, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, Wald A
Gastroenterology. 2016;150(6):1430-1442
DOI: [10.1053/j.gastro.2016.02.009](https://doi.org/10.1053/j.gastro.2016.02.009)

## Worked example

### All six required flags

Given: `chronic_or_recurrent_rectal_pain_or_aching=true, episodes_last_30_minutes_or_longer=true, fulfilled_last_3_months=true, onset_at_least_6_months=true, other_causes_of_rectal_pain_excluded=true, tenderness_during_puborectalis_traction=true`

1. Chronic or recurrent rectal pain or aching lasting 30 minutes or longer is true
2. Tenderness during puborectalis traction is true (caller assigns; magent does not examine)
3. Other causes of rectal pain are excluded
4. Criteria fulfilled for the last 3 months and onset at least 6 months prior are true
5. rome_iv_levator_ani is true


### Five required flags without puborectalis tenderness

Given: `chronic_or_recurrent_rectal_pain_or_aching=true, episodes_last_30_minutes_or_longer=true, fulfilled_last_3_months=true, onset_at_least_6_months=true, other_causes_of_rectal_pain_excluded=true, tenderness_during_puborectalis_traction=false`

1. Five required flags hold
2. Tenderness during puborectalis traction is false
3. That pattern is unspecified functional anorectal pain (F2b), not this tool
4. rome_iv_levator_ani is false


### Five required flags without 6-month onset

Given: `chronic_or_recurrent_rectal_pain_or_aching=true, episodes_last_30_minutes_or_longer=true, fulfilled_last_3_months=true, onset_at_least_6_months=false, other_causes_of_rectal_pain_excluded=true, tenderness_during_puborectalis_traction=true`

1. Five required flags hold
2. Onset at least 6 months prior is false
3. rome_iv_levator_ani is false


## Also searched as

- Rome IV levator ani
- Rome IV levator ani syndrome
- Rao 2016 levator ani
- levator ani syndrome Rome IV
- Rome IV F2a
- functional anorectal pain levator
- puborectalis tenderness
- chronic rectal pain Rome IV

## Parameters

- `chronic_or_recurrent_rectal_pain_or_aching` (boolean, required): Chronic or recurrent rectal pain or aching (Rao 2016 Rome IV levator ani syndrome F2a). true or false as assigned by the caller. magent does not take a history.
- `episodes_last_30_minutes_or_longer` (boolean, required): Episodes last 30 minutes or longer (Rao 2016). true or false as assigned by the caller. magent does not take a history.
- `tenderness_during_puborectalis_traction` (boolean, required): Tenderness during posterior traction on the puborectalis (Rao 2016 F2a). true or false as assigned by the caller. magent does not perform traction on the puborectalis.
- `other_causes_of_rectal_pain_excluded` (boolean, required): Other causes of rectal pain excluded (IBD, intramuscular abscess, anal fissure, thrombosed hemorrhoids, prostatitis, coccygodynia, major pelvic-floor structural alteration), as assigned (Rao 2016). true or false as assigned by the caller. magent does not examine the patient.
- `fulfilled_last_3_months` (boolean, required): Criteria fulfilled for the last 3 months, as assigned (Rao 2016). true or false as assigned by the caller. magent does not take a history.
- `onset_at_least_6_months` (boolean, required): Symptom onset at least 6 months prior to diagnosis, as assigned (Rao 2016). true or false as assigned by the caller. magent does not take a history.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/rome_iv_levator_ani`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "chronic_or_recurrent_rectal_pain_or_aching": "true",
      "episodes_last_30_minutes_or_longer": "true",
      "fulfilled_last_3_months": "true",
      "onset_at_least_6_months": "true",
      "other_causes_of_rectal_pain_excluded": "true",
      "tenderness_during_puborectalis_traction": "true"
    },
    {
      "chronic_or_recurrent_rectal_pain_or_aching": "true",
      "episodes_last_30_minutes_or_longer": "true",
      "fulfilled_last_3_months": "true",
      "onset_at_least_6_months": "true",
      "other_causes_of_rectal_pain_excluded": "true",
      "tenderness_during_puborectalis_traction": "true"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rome-iv-levator-ani

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/rome_iv_levator_ani",
  "items": [
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Rao SSC, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, Wald A",
        "doi": "10.1053/j.gastro.2016.02.009",
        "id": "rao-2016",
        "pmid": "27144630",
        "source": "Gastroenterology. 2016;150(6):1430-1442",
        "title": "Anorectal Disorders"
      },
      "formula": "rome_iv_levator_ani",
      "formula_expression": "rome_iv_levator_ani iff chronic_or_recurrent_rectal_pain_or_aching and episodes_last_30_minutes_or_longer and tenderness_during_puborectalis_traction and other_causes_of_rectal_pain_excluded and fulfilled_last_3_months and onset_at_least_6_months (Rao 2016 Rome IV levator ani syndrome)",
      "criteria": [
        {
          "factor": "chronic_or_recurrent_rectal_pain_or_aching",
          "met": true
        },
        {
          "factor": "episodes_last_30_minutes_or_longer",
          "met": true
        },
        {
          "factor": "tenderness_during_puborectalis_traction",
          "met": true
        },
        {
          "factor": "other_causes_of_rectal_pain_excluded",
          "met": true
        },
        {
          "factor": "fulfilled_last_3_months",
          "met": true
        },
        {
          "factor": "onset_at_least_6_months",
          "met": true
        }
      ],
      "rome_iv_levator_ani": true
    },
    {
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Rao SSC, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, Wald A",
        "doi": "10.1053/j.gastro.2016.02.009",
        "id": "rao-2016",
        "pmid": "27144630",
        "source": "Gastroenterology. 2016;150(6):1430-1442",
        "title": "Anorectal Disorders"
      },
      "formula": "rome_iv_levator_ani",
      "formula_expression": "rome_iv_levator_ani iff chronic_or_recurrent_rectal_pain_or_aching and episodes_last_30_minutes_or_longer and tenderness_during_puborectalis_traction and other_causes_of_rectal_pain_excluded and fulfilled_last_3_months and onset_at_least_6_months (Rao 2016 Rome IV levator ani syndrome)",
      "criteria": [
        {
          "factor": "chronic_or_recurrent_rectal_pain_or_aching",
          "met": true
        },
        {
          "factor": "episodes_last_30_minutes_or_longer",
          "met": true
        },
        {
          "factor": "tenderness_during_puborectalis_traction",
          "met": true
        },
        {
          "factor": "other_causes_of_rectal_pain_excluded",
          "met": true
        },
        {
          "factor": "fulfilled_last_3_months",
          "met": true
        },
        {
          "factor": "onset_at_least_6_months",
          "met": true
        }
      ],
      "rome_iv_levator_ani": true
    }
  ]
}
```

## Response fields

- `formula` (string): rome_iv_levator_ani
- `formula_expression` (string): Rao 2016 Rome IV levator ani syndrome F2a: chronic or recurrent rectal pain or aching lasting 30 minutes or longer, tenderness during puborectalis traction, other causes of rectal pain excluded, last-3-months criteria, and 6-month onset
- `rome_iv_levator_ani` (boolean): true only when all six required flags hold. Not a diagnosis.
- `criteria` (array): Per-factor rows with factor and met for the six required flags
- `citation` (object): Rao 2016 Gastroenterology citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Rao SSC, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, Wald A",
    "doi": "10.1053/j.gastro.2016.02.009",
    "id": "rao-2016",
    "pmid": "27144630",
    "source": "Gastroenterology. 2016;150(6):1430-1442",
    "title": "Anorectal Disorders"
  },
  "formula": "rome_iv_levator_ani",
  "formula_expression": "rome_iv_levator_ani iff chronic_or_recurrent_rectal_pain_or_aching and episodes_last_30_minutes_or_longer and tenderness_during_puborectalis_traction and other_causes_of_rectal_pain_excluded and fulfilled_last_3_months and onset_at_least_6_months (Rao 2016 Rome IV levator ani syndrome)",
  "criteria": [
    {
      "factor": "chronic_or_recurrent_rectal_pain_or_aching",
      "met": true
    },
    {
      "factor": "episodes_last_30_minutes_or_longer",
      "met": true
    },
    {
      "factor": "tenderness_during_puborectalis_traction",
      "met": true
    },
    {
      "factor": "other_causes_of_rectal_pain_excluded",
      "met": true
    },
    {
      "factor": "fulfilled_last_3_months",
      "met": true
    },
    {
      "factor": "onset_at_least_6_months",
      "met": true
    }
  ],
  "rome_iv_levator_ani": true
}
```

## Errors

- HTTP 400 `invalid_rome_iv_levator_ani`: Rome IV levator ani syndrome needs the Rao 2016 anorectal levator-ani flags. Returned before settlement; you are not charged.
- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [Rao 2016 Rome IV proctalgia fugax](https://magentlab.com/docs/rome-iv-proctalgia-fugax) — Apply the Rao 2016 Rome IV proctalgia fugax (F2c) diagnostic criteria and return whether the published proctalgia fugax box holds (rome_iv_proctalgia_fugax).
- [Rome IV FC](https://magentlab.com/docs/rome-iv-fc) — Apply the Mearin 2016 Rome IV C2 functional constipation criteria and return symptom_count (0-6) and whether the published C2 box holds (rome_iv_fc).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional.
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.