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39 Prevalence of functional defecation disorders 1 TABLE 1. (continued) North America Lewis, 2016 46 United States Online panel 949 (47.7) 4-18 Parental questionnaire QPGS-RIII † 122 (12.9) 0.7:1* Phatak, 2014 47 United States Primary care clinic sample 450 (44.9) 4-18 Child interview Rome III criteria 80 (17.8) n/a Van Tilburg, 2015 48,‡ United States Online panel 264 (52.3) 0-3 Parental questionnaire QPGS-RIII-IT † <1y: (4.7) 1-3y: (9.4) n/a Central America Lu, 2016 49 Panama School sample (3 schools) 321 (38.9) 8-14 Child questionnaire QPGS-RIII in Spanish † 51 (15.9) n/a Zablah, 2015 50 El Salvador School sample (2 schools) 399 (41.1) 8-15 Child questionnaire QPGS-RIII in Spanish † 41 (10.3) n/a Africa Udoh, 2017 51 Nigeria School sample (11 schools) 818 (50.0) 10-18 Child questionnaire Rome III criteria 223 (27.3) 1:1 n/a = not applicable, m = months, y = year, QPGS-RIII = Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version † validated questionnaire; * statistically significant; ‡ excluded from meta-analysis a Iowa criteria: ≥2 of the following criteria during the previous 8 weeks: (1) less than three bowel movements per week, (2) one or more episode of fecal incontinence per week, (3) large stools in the rectum or felt on abdominal examination, (4) passing of stool so large that they obstruct the toilet, (5) retentive posturing and painful defecation. b Modified Rome III: ≥2 of the following during the previous 8 weeks: (1) two or fewer defecations in the toilet per week, (2) a history of painful or hard bowel movements, (3) hard stools that resembled a sausage but have cracks on their surface or separate hard lumps, (4) a sensation of incomplete evacuation, (5) a history of large diameter stools that may obstruct the toilet and (6) a history of fecal incontinence. c Modified Rome III: ≥2 of the following during the previous 8 weeks: (1) frequency of bowel movements less than three per week, (2) more than one episode of fecal incontinence per week, (3) the passing of stools so large that they obstruct the toilet, (4) retentive posturing and withholding behavior, and (5) painful defecation. d Modified Rome III: ≥2 Rome criteria during the previous 4 weeks.