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Pelvic floor dysfunction - prolapse or incontinence

Find assessment and management information at Brisbane South HealthPathways under:

Useful management information

  • Patients with chronic pelvic pain following mesh procedures can be referred to the Queensland Pelvic Mesh Service (QPMS) for assessment. This service offers comprehensive, interdisciplinary assessment and treatment for women with complications from pelvic mesh. 
  • Medical management
    • Consider referral to women’s health physiotherapist for the following:
      • Prolapse –pelvic floor exercise program, consider pessary
      • Stress incontinence – pelvic floor exercises,bowel management and consideration of supportive devices(e.g Contiform) and bladder retraining for 3 months prior to referral
      • overactive bladder symptoms-bladder training; consider for tibial nerve
        stimulation; exclude infection
    • Consider trial of anticholinergics or Mirabegron
    • Treat constipation
    • Consider topical oestrogen in post-menopausal women
    • Lifestyle modification (Increased activity, dietary, weight, smoking, alcohol)

Clinical resources

Patient resources

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

  • Uterine procidentia
  • Difficulty voiding with renal impairment 
Category 2
(appointment within 90 calendar days)
  • Difficulty voiding +/- significant residuals on bladder screening (without renal impairment)
  • Recurrent UTIs
  • Genital fistulae
  • Mesh erosion or bleeding/pain refer to Pelvic mesh (referral to Queensland Pelvic
    Mesh Service (QPMS) CPC)
Category 3
(appointment within 365 calendar days)
  • Any other prolapse or incontinence
  • Obstructive defecation

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 Pelvic floor dysfunction - prolapse or incontinence referrals (Referral will be returned without this)

  • Obstetric and gynaecological history
  • History of:
    • prolapse symptoms
    • protruding lump
    • dragging sensation
    • difficulty with defecation (requiring manual evacuation)/micturition including incontinence
  • MSU M/C/S results

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 Pelvic floor dysfunction - prolapse or incontinence referrals

  • BMI
  • Previous failed or complicated prolapse surgery
  • Pelvic USS (TVS preferable) if available
  • Bladder diary
  • Renal USS if major uterine procidenta

Emergency

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

  • Ectopic pregnancy
  • Ruptured haemorrhagic ovarian cyst
  • Torsion of uterine appendages (ovarian)
  • Acute/severe pelvic pain
  • Significant or uncontrolled vaginal bleeding
  • Severe infection
  • Abscess intra pelvis or PID
  • Bartholin’s abscess / acute painful enlargement of a Bartholin’s gland/cyst
  • Acute trauma including vulva/vaginal lacerations, haematoma and/or penetrating injuries
  • Post-operative complications within 6 weeks including wound infection, wound breakdown, vaginal bleeding/discharge, retained products of conception post-op, abdominal pain
  • Urinary retention
  • Acute urinary obstruction
  • Unstable molar pregnancy
  • Inevitable and / or incomplete abortion
  • Hyperemesis gravidarum
  • Ascites, secondary to known underlying gynaecological oncology
     

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