Urinary incontinence and enuresis

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment.

Contact through:

  • Caboolture Hospital (07) 5433 8888
  • Redcliffe Hospital (07) 3883 7777
  • Royal Brisbane and Women's Hospital (07) 3646 8111

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.

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

Recent onset of polyuria/polydipsia that might suggest diabetes (mellitus or insipidus)

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

  • Poor urinary stream in a boy
  • New onset of daytime urinary incontinence in a previously dry child
  • A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service

Category 2

Appointment within 90 days is desirable

  • Primary daytime incontinence

Refer to general paediatrics if there are no structural abnormalities.
Refer to paediatric urology or paediatric surgery if concerned with renal or structural abnormalities.

Category 3

Appointment within 365 days is desirable

  • Nocturnal enuresis without significant daytime incontinence and unresponsive to medical management including alarm
  • Children with long term (> 6 months) daytime urinary incontinence who have had previous specialist assessment.

Refer to general paediatrics if there are no structural abnormalities.
Refer to paediatric urology or paediatric surgery if concerned with renal or structural abnormalities.

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
  • Sudden onset incontinence who have previously been dry can be a marker of serious pathologies (e.g. DM, GU tumours, spinal cord problems) and should be assessed urgently
  • In the majority of cases it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
  • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: Department of Children, Youth Justice and Multicultural Affairs
  • Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC.

Referral requirements

A referral may be rejected without the following information.

History and Examination

  • Is there daytime incontinence of urine?
  • Is there nocturnal enuresis?
  • Report presence or absence of concerning features 
    • poor urinary stream in a boy
  • Physical examination, including abdominal examination, spine and lower limbs
  • Weight gain
  • Confirmation of OOHC (where appropriate)

Pathology and Test Results

  • Urinalysis (dipstick)
  • Fingerpick blood glucose if recent onset of symptoms

Imaging and reports

Morphology scan (if available)

Additional referral information, (Useful for processing the referral)

Highly desirable information – may change triage category.

  • What is the impact on the child? (teasing or social exclusion at school, family conflict over wetting, anxiety or distress about incontinence)
  • Description of the pattern incontinence:
    • is there daytime incontinence? How frequent is the incontinence? Is the incontinence new?
    • primary or secondary (>6 months dryness previously)
  • What treatments have been tried and efficacy

Desirable information-will assist at consultation

  • Family history of nocturnal enuresis or daytime urinary symptoms
  • Diet history
  • Bowel habit history or history of constipation
  • Treatments used for constipation if present
  • Developmental history
  • Other past medical history
  • Immunisation history
  • Medication history
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any relevant laboratory results or medical imaging reports, urinalysis results
  • Consider renal tract USS with pre- and post-void volumes if there is daytime incontinence. Not required for isolated nocturnal enuresis.

 

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.

  • 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
  • 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
  • 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
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • 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.)

Send referral

Hotline: 1300 364 938

Medical Objects ID: MQ40290004P
HealthLink EDI: qldmnhhs

Mail: 
Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road
ASPLEY QLD 4034

Health pathways

Access to Health Pathways is free for clinicians in Metro North Brisbane.

For login details email:
healthpathways@brisbanenorthphn.org.au

Login to Brisbane North Health Pathways:
brisbanenorth.healthpathwayscommunity.org

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