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Perineal disease and faecal incontinence

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • 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 (Does your patient meet the minimum criteria?)

Does your patient meet the minimum referral criteria?

Category 1
(appointment within 30 calendar days)

If you feel your patient meets Category 1 criteria, please mark "urgent" on your referral

  • Persistent perineal sepsis
Category 2
(appointment within 90 calendar days)
  • Anal fissure not responding to maximal medical treatment after 6 weeks
  • Symptomatic obstetric anal sphincter injury (OASIS)
  • 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

If your patient does not meet the minimum referral criteria

  • Assessment and management information can be found on a range of conditions at Brisbane South HealthPathways
  • If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested:
    • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Standard referral information (To be included in all referrals)

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

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
  • All conservative options that have been pursued unsuccessfully prior to referral
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
  • Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • A comprehensive capture of information in relation to MSH Referral Criteria

Clinical modifiers

  • The presence of clinical modifiers may impact the categorisation of the patient.
  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living functioning – low/medium/high
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Patient's Demographic Details

  • Full name (including aliases)
  • Date and country of birth
  • Residential and postal address including whether patient resides at an aged care facility
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Name of delegate and contact details (Department of Corrective Services)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

 

Essential referral information for Perineal disease and faecal incontinence referrals (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

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional referral information for Perineal disease and faecal incontinence referrals

  • Digital anorectal examination findings

Out of catchment

Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Last updated 21 December 2023