Perineal disease and faecal incontinence

Emergency department referrals

All urgent cases must be discussed with the on call Surgical Registrar to obtain appropriate prioritisation and treatment. Contact through:

Royal Brisbane and Women's Hospital (07) 3646 8111
The Prince Charles Hospital (07) 3139 4000
Redcliffe Hospital (07) 3883 7777
Caboolture Hospital (07) 5433 8888

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Persistent perineal sepsis

Category 2

Appointment within 90 days is desirable

Symptomatic obstetric anal sphincter injury (OASIS)
Anal fissure not responding to maximal medical treatment after 6 weeks
External rectal prolapse
Acute testicular pain
Uncomplicated fistula-in-ano

Category 3

Appointment within 365 days is desirable

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

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

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

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available
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)

Referral requirements

A referral may be rejected without the following information.

Essential referral information

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

Additional referral information useful for processing the referral

Digital anorectal examination findings

Out of catchment

Metro North 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 North 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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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