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Jul 2015;21(7):430-8

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Immediate medical attention is required for: Severe abdominal pain , particularly if localized, progressively worsening, or accompanied by fever Abdominal distension with inability to pass gas or stool, suggesting possible bowel obstruction Rectal bleeding or black, tarry stools indicating potential gastrointestinal bleeding Persistent nausea and vomiting preventing adequate oral intake Signs of dehydration including decreased urination, dizziness, or confusion Routine consultation is appropriate when: Constipation persists beyond 23 weeks despite conservative measures and over-the-counter laxatives Bowel movement frequency decreases to fewer than 3 per week Significant straining or sensation of incomplete evacuation occurs regularly New or worsening symptoms develop after previously stable bowel patterns Quality of life is substantially impacted, affecting daily activities or treatment adherence Unexplained weight loss, anemia, or new-onset constipation in older adults Family history of colorectal cancer with new constipation symptoms Healthcare providers should evaluate for potential complications such as fecal impaction, particularly in elderly patients or those with pre-existing motility disorders

Research demonstrates it is safe and effective for weight control, with most patients tolerating it well in pre-surgical regimens