The patient should be advised to consult a doctor before use in the following circumstances:
• first presentation of these symptoms for confirmation of IBS
• aged 40 years or over and it is some time since the last attack, or the symptoms have changed
• blood has been passed from the bowel
• there is a feeling of sickness or there is vomiting
• loss of appetite or loss of weight
• paleness and tiredness
• severe constipation
• fever
• recent foreign travel
• pregnancy or planning a pregnancy or possibly pregnant
• abnormal vaginal bleeding or discharge
• difficulty or pain in passing urine