Warning flags to refer^1,3

Any blood in the stools or coming from the rectum. Although blood may be a sign of haemorrhoids, it can also be an indicator of something more serious, such as cancer of the colon or ulcerative colitis.

Customers with dark, black stools – this could be a sign of bleeding in the digestive tract. However, check if the customer takes any other tablets; for example, unabsorbed iron from iron tablets can turn stools black.

Customers who have tried products for constipation or made dietary changes that haven't helped, have unexpectedly lost weight, feel tired all the time, or have symptoms that have lasted for more than two weeks.

Additional symptoms: dry skin, thinning hair, feeling tired and putting on weight may indicate hypothyroidism; colicky pain and diarrhoea may indicate faecal impaction; constipation alternating with diarrhoea may indicate another condition such as irritable bowel syndrome (IBS) or diverticular disease.