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Perineal disease and faecal incontinence


Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Persistent perineal sepsis

  • Category 2
    (appointment within 90 calendar days)
    • Symptomatic obstetric anal sphincter injury (OASIS)
    • Fissure not responding to maximal medical treatment after 6 weeks
    • External rectal prolapse
  • Category 3
    (appointment within 365 calendar days)
    • Pilonidal disease/sinus
    • Warts
    • Uncomplicated haemorrhoids
    • Anal skin tags and benign peri-anal polyps
    • Uncomplicated fistula in ano
    • Faecal incontinence

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Management to date including timeline, medication and lifestyle
  • History of previous drainage operation

3. Additional referral information Useful for processing the referral

  • Previous gastroenterologist investigations and results (date, report and histology results) e.g. last 2-3 clinic letters


  • Assess sphincter function and integrity and endoanal USS results

4. Request

Last updated: 13 June 2023