Continence

Scope

All patients must be referred to the Community Continence Advisory Service for a programme of conservative management

  • Patients will be assessed in a community based clinic (Mount Gould LCC, South Hams Hospital and Tavistock Hospital)
  • Any adult (over 18) with involuntary urinary or faecal loss
  • Patients will be holistically assessed and will be supported using a conservative based programme to improve management of their continence problems
  • The assessment will include bladder scanning, pelvic floor strengthening and lifestyle which may include advice on fluid intake, diet, and smoking
  • Following initial GP assessment, the majority of patients with incontinence will benefit from an assessment at the community continence clinic
  • Housebound patients are encouraged to attend the clinic if they are able to access through personal or ambulance transport

Please Note: Pre-Choice Triage is currently active for this specialty and referrals submitted without this information may be returned.

Key pre-referral criteria summary:

Physical examination is indicated prior to referral in order to exclude significant genital prolapse, prostate disease or other significant pathology e.g. malignancy. If physical examination is not appropriate please include reason in referral.

Out of scope

  • Symptomatic Prolapse visible at or below the vaginal intriotus, pelvic masses or urogenital fistulae should be referred to secondary care urogynaecology
  • Enlarged Prostate, Recurrent UTI should be referred to urology
  • Haematuria should be referred in accordance with local guidelines
  • A small minority of patients may be deemed unsuitable for onward referral to the clinic e.g. patients at end of life. Please refer to Community District Nurse Service
  • Some patients may be unable to be transported to the clinic because they are clinically unable to use ambulance transport. Please refer to Community Continence Clinic
  • Patients requiring urinary catheter services. Please refer to District Nurse
  • Patients who have a Registered Learning Disability may be referred, following initial GP assessment, to the Learning Disability Service at the Westbourne Unit
  • Children (up to 18 years old) should be referred to the Child Development Centre at Scott Business Park 01752 435232
  • Recurrent UTI in children should be referred to the Derriford nurse led clinic

Assessment

History and Examination

Physical examination is indicated where appropriate prior to referral in order to exclude significant genital prolapse, prostate disease or other significant pathology e.g. malignancy

  • Vaginal and abdominal examination (women)
  • PR examination (men)
  • Urine test to exclude UTI. If UTI present, treat then reassess
  • Assessment of pelvic floor
  • Review medication, lifestyle changes including diet, fluid intake, bowels, caffeine, pelvic floor training
  • Pads can be purchased from chemists or supermarkets. Sanitary towels are not suitable for urinary or faecal loss

Investigations

  • Urine test to be carried out prior to referral in order to exclude UTI. If UTI present, treat then reassess prior to referral
  • Vaginal and abdominal examination prior to referral where appropriate (women)
  • PR examination to exclude prostate problems prior to referral (men)

Referral

Referral Criteria

Physical examination is indicated where appropriate prior to referral in order to exclude significant genital prolapse, prostate disease or other significant pathology e.g. malignancy

Please include in referral:

  • Vaginal and abdominal examination (women)
  • PR examination (men)
  • If physical examination is not appropriate include reason
  • Urine test to exclude UTI. If UTI present, treat then reassess
  • Review medication, lifestyle changes including diet, fluid intake, bowels, caffeine, pelvic floor training
  • If patient is housebound and requires a home visit

Please Note: Pre-Choice Triage is currently active for this specialty and referrals submitted without this information may be returned.

Referral Instructions

Refer using e-Referrals:

  • Specialty: Urology
  • Clinic Type: (In) Continence
  • Service: DRSS-Western-Urology-(In) Continence-Devon CCG-15N

Referral Forms

DRSS referral form

Supporting Information

Patient Information

Livewell Southwest

Pathway Group

This pathway was signed off by the New Devon CCG Western Locality Clinical Pathway Group.

Publication date: August 2017

 

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