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Referral
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Constipation, faecal incontinence and rectal prolapse
Key Messages
The Plymouth Pelvic Floor Unit (PPFU) is part of the Colorectal team and is a multi-disciplinary team based at University Hospitals Plymouth.
Indications for referral include:
- Patients with rectal prolapse (not vaginal prolapse or rectocele).
- Patients with bowel related symptoms with presence of mesh from complex prolapse surgery i.e., previous laparoscopic ventral mesh rectopexy.
- Patients with faecal incontinence and have met the following criteria:
- No red flag symptoms
- After maximal community management (community continence team)
- Patients with chronic constipation and have met the following criteria:
- No red flag symptoms
- After maximal community management
- Have used laxatives from at least 2 classes (bulk-forming, softener, osmotic, stimulant)
Scope
Patients over age 18 with the above problems who are fit/suitable to attend an appointment at UHP
Out of Scope
Suspected fistula – refer to general Colorectal clinic.
Suspected IBS or IBD – refer to Gastroenterology, following local guidance Pathway for Diagnosis and Management of Irritable Bowel Syndrome in Adults Aged 18-50 years old
Vaginal prolapse, including rectocele – refer to Urogynaecology.
Patients requiring bowel/bladder physiotherapy – women can self-refer to Women’s Health Physiotherapy at Derriford
Refer to the community continence team for the following:
- Faecal incontinence (no red flags)
- Unresolving constipation (no red flags)
- Faecal urgency (no red flags)
- Learning disabilities/dementia/frailty/care home
- Spinal injuries
- Patients who have already has 2ww pathway investigations and no pathology but still symptomatic.
Contact details for the Continence Service: 01752 434759 Mon-Fri 08.30-16.30pm Livewell.continence@nhs.net
History
Symptoms, duration, diet, exercise, treatments tried, other medication, previous surgery.
Examination
Abdominal examination
Digital Rectal Examination (DRE)
Differential Diagnosis
Overflow faecal incontinence.
Haemorrhoids – see local guidance Haemorrhoids Management
Criteria for referral via 2ww Suspected Lower GI Cancer pathway:
- Adult with a rectal or abdominal (but not pelvic) mass that you suspect could be cancer.
- Aged under 50 with rectal bleeding and any of the following:
- Abdominal pain
- Change in bowel habit.
- Weight loss
- Iron deficiency anaemia
- Aged 40 or over with unexplained weight loss and abdominal pain.
- Aged 50 or over with unexplained rectal bleeding.
- Aged 60 or over with either of:
- Iron deficiency anaemia
- Change in bowel habit.
- Positive qFIT test
- Suspected anal cancer – unexplained anal mass or ulceration.
qFIT when lower GI cancer is suspected (see Red Flags above).
Consider FBC / U&Es / calcium (bone chemistry) / thyroid function / coeliac screen / stool culture as indicated to exclude reversible causes.
Constipation
Please refer to Management of constipation in adults
Consider referral to the community continence team for unresolving constipation or faecal urgency.
Faecal incontinence
Manage constipation causing overflow incontinence.
Consider referral to the community continence team.
Rectal prolapse
Refer to Plymouth Pelvic Floor Unit (PPFU)
Referral Criteria
Indications for GP direct referral to Plymouth Pelvic Floor Unit (PPFU) via DRSS:
- Patients with rectal prolapse (not vaginal prolapse or rectocele)
- Patients with bowel related symptoms with presence f mesh from complex prolapse surgery
- Patients with faecal incontinence and have met the following criteria:
- No red flag symptoms
- After maximal community management (community continence team +/- physiotherapy)
- Patients with chronic constipation and have met the following criteria:
- No red flag symptoms
- After maximal community management
- Have used laxatives from at least 2 classes (bulk-forming, softener, osmotic, stimulant)
Indications for GP referral to community continence team via DRSS:
- FI (no red flags)
- Unresolving constipation (no red flags)
- Faecal urgency (no red flags)
- LD / dementia / frailty / care home patients
- Spinal injuries
- Patients who have already had a 2ww pathway and no pathology but symptomatic.
Contact details for the Continence Service: 01752 434759 Mon-Fri 08.30-16.30pm Livewell.continence@nhs.net
Patients requiring bowel/bladder physiotherapy – women can self-refer to Women’s Health Physiotherapy at Derriford
Referral Instructions
e-Referral Service Selection
Specialty:
Clinic Type:
Service:
Referral Form
Patient Information
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: March 2024
