Perineal disease and faecal incontinence

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

      Hernia

    • Suspected strangulated/incarcerated or obstruction of any hernia

      • Hepatobiliary/pancreatic surgery

    • New onset of obstructive jaundice
    • Acute cholecystitis
    • Gallstones with symptoms of cholangitis
    • Acute pancreatitis

      • Colorectal bowel disease

    • Bowel obstruction
    • Severe per rectum bleeding
    • Acute abscess at any site
    • Bowel perforation

      • Perineal disease and faecal incontinence

    • Acute painful perianal conditions with intractable pain
    • Perianal abscess

      • Other referrals to emergency

    • Acute, severe abdominal pain with or without associated sepsis
    • Acute painful perianal conditions
    • Refer to HealthPathways or local guidelines
    • Local application of cold packs and oral anti-inflammatory medications
    • Patients with haemorrhoids or any other functional disorders should be discouraged from straining excessively or sitting on the toilet for prolonged periods (<5 minutes)
    • Lifestyle modification (e.g., increased physical activity, balanced healthy diet, weight reduction, smoking and alcohol cessation) can be very useful for a wide range of functional bowel and anorectal issues
    • Referral to pelvic floor physiotherapist is very useful for faecal incontinence or bowel evacuatory dysfunction
    • Education around specific techniques for defecation:
      • Positioning: elevated feet
      • Stool modification: use of aperients to achieve soft, but formed, stool
      • Increase water intake (>2L/day) and dietary fibre, including fibre supplementation (e.g., Metamucil, Benefibre, psyllium husk)

    Anal fissure

    • In addition to best supportive care (i.e., stool modification, salt baths for symptomatic relief), Glyceryl trinitrate 0.2% ointment (Rectogesic®) TDS for should be prescribed (and used strictly) for six weeks

    Pilonidal sinus

    • Advice on hygiene, sweating activity, activity associated with sitting and buttock friction, depilation treatments (e.g., laser hair removal)

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)
  • Anal fissure not responding to maximal medical treatment after 6 weeks
  • External rectal prolapse
  • Uncomplicated fistula-in-ano
Category 3
(appointment within 365 calendar days)
  • Pilonidal disease/sinus
  • Perianal warts
  • Uncomplicated haemorrhoids
  • Anal skin tags and benign peri-anal polyps
  • Faecal incontinence
  • Pruritis ani

Please insert the below information and minimum referral criteria into referral

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
  • Details and results/reports of most recent gastrointestinal/perianal investigations or procedures (e.g. imaging, colonoscopy, biopsy/polypectomy results) including letters of correspondence

3. Additional referral information Useful for processing the referral

  • Digital anorectal examination findings

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    Relevant clinical information about the condition

    • Presenting symptoms (evolution and duration)
    • Physical findings
    • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
    • Body mass index (BMI)
    • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
    • Current medications and dosages
    • Drug allergies
    • Alcohol, tobacco and other drugs use

    Reason for request

    • 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

    Clinical modifiers

    • Impact on employment
    • Impact on education
    • Impact on home
    • Impact on activities of daily living
    • Impact on ability to care for others
    • Impact on personal frailty or safety
    • Identifies as Aboriginal and/or Torres Strait Islander

    Other relevant information

    • Willingness to have surgery (where surgery is a likely intervention)
    • Choice to be treated as a public or private patient
    • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 5 April 2019

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