Irritable Bowel Syndrome

Has a qualified medical practitioner diagnosed you with Irritable bowel syndrome?

Yes

No

Does any of these describe you?
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Can we share this information with your General practitioner?
Providing us with your physician's address means that you allow us to share this information with him/her for updated medical records if need be. It also allows our clinician to access your medical records if there is a need for that. We advice you share this treatment with your doctor for him/her to update your medical records.

Yes

No

Are you the actual consumer of this medicine?
If not, please describe in detail who the intended consumer is and how old he/she is.

Yes

No

What symptoms do you intend to treat using this medicine?
Please provide more information

For how long has the consumer of this medicing experienced these symptoms?
Please select your option

At least 72 hours

A week

A month

More than a month

Has the target user tried a different medicine to address the symptoms before?
If yes, what medicine was consumed and how effective was it?

Yes

No

What is your biological gender?
Please select your option

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Can you relate to any of the following?
You have an underlying medical condition
You've been through a major surgical procedure
You have allergic reactions
You have cardiovascular conditions or might have had suffered a stroke
You suffer from a low liver or kidney function

Yes

No

Are you experiencing any of the following signs and symptoms:
Over 40 years old and experiencing symptoms for the first time
Weight loss that was unexpected
Rectal hemorrhage that hasn't been explained (specifically if the blood is darker in colour)
Stools or vomit containing blood (may appear dark or sticky)
A lack of iron (anaemia)
Swallowing problems
Consistent pain in the stomach or intestines
Ulcers in the stomach or esophagus
A bulge or enlargement in your stomach or lower abdomen
Fatigue and a lack of energy

Yes

No

Are you currently receiving any treatment or under any medication?
Please provide more information of the medication being used if any.

Yes

No

If female or transmale, are you currently pregnant, breastfeeding or planning to do so?
Please select your option

Presently Pregnant

Presently Breastfeeding

Planning on getting pregnant

Neither Pregnant nor Breastfeeding

What's your gender?

Male

Female

Transmale (Born a female)

Transfemale (Born a male)

Please identify some of the symptoms you may be experiencing?
Please select your option

Stomach discomfort

Bloating Constipation

Diarrhoea

A lot of wind

Are you experiencing any other symptoms other those listed above?

Yes

No

Please choose one of the options below that best describes your IBS symptoms:
Please select your option

Passing stool eases your symptoms

You have a clogged bowel movement hence you experience straining; urgency; or incomplete passing of a stool Bloating or abdominal distension/hardness is a problem for you

Eating can often aggravate your symptoms

When you pass a stool

mucus passes through your body.

For how long have you experienced these issues?

Are you aware of anything that seems to trigger or aggravate your symptoms?

Does any of the following statements apply to you:
Orlistat causes an allergic reaction or hypersensitivity in you.
You've previously used Orlistat and experienced serious side effects.
You are experiencing rectal bleeding.
You have chronic malabsorption syndrome, which has been identified by a doctor.
You have been diagnosed with cholestasis (condition where the flow of bile from the liver is blocked)

Yes

No

Are younexperiencing any of the following signs and symptoms:
Over 40 years old and experiencing symptoms for the first time
Weight loss that was unexpected
Rectal hemorrhage that hasn't been explained (specifically if the blood is darker in colour)
Stools or vomit containing blood (may appear dark or sticky)
A lack of iron (anaemia)
Swallowing problems
Consistent pain in the stomach or intestines
Ulcers in the stomach or esophagus
A bulge or enlargement in your stomach or lower abdomen
Fatigue and a lack of energy

Yes

No

Has your doctor prescribed Alverine Citrate Capsules to you lately?
If so, how effective were they?

Yes

No

Are you aware of the following:
It is never a good idea to self-diagnose and treat urine incontinence.
At the very least, you should see your doctor for a checkup once a year.
You must follow your doctor's instructions for any treatment.
You should only order repeat supplies of medicines that your doctor has prescribed.

Yes

No

Has your doctor prescribed Mebeverine Tablets to you lately?
If so, how effective were they?

Yes

No

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Irritable Bowel Syndrome

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