Q: What are the 'red flags' that require referral?

A:

• Constipation for more than seven days with no identifiable cause.
• Recurrent constipation.
• Colicky pain, nausea and vomiting, and abdominal distension (may indicate bowel obstruction).
• Constipation accompanied by weight and appetite loss (may indicate carcinoma).
• Blood in stools, which appear tarry and red or black (may indicate carcinoma).
• Bright blood on stools or in lavatory pan (usually indicates haemorrhoids, which is often not serious but should be diagnosed by a doctor).
• Alternating constipation and diarrhoea (in elderly patients may indicate faecal impaction and overflow; may indicate irritable-bowel syndrome in younger patients).
• Constipation with associated weight gain, lethargy, coarse hair or dry skin (may indicate hypothyroidism).
• Constipation due to suspected drug side-effects (see above).