Perineal disease and faecal incontinence
ADULT
-
Emergency
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.
- Suspected strangulated/incarcerated or obstruction of any hernia
- Acute, severe abdominal pain with or without associated sepsis
- New onset of obstructive jaundice
- Acute painful perianal conditions
- Acute cholecystitis
- Gallstones with symptoms of cholangitis
- Acute pancreatitis
- Bowel obstruction
- Severe per rectum bleeding
- Acute abscess at any site
- Acute testicular pain
-
Other useful information for referring practitioners Not and exhaustive list
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
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
- 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
OASIS
- Assess sphincter function and integrity and endoanal USS results
4. Request
-
General referral information
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.)
-
Notes
-
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: 13 June 2023
