Referral to 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.

  • acute pseudo-obstruction, potential symptoms include
    • inability to pass any bowel motions or gas
    • significant change in bowel habits
    • distended abdomen, abdominal pain and cramping
    • nausea/vomiting
  • rectal prolapse causing circulatory compromise
  • irreducible rectal prolapse with concerns of mucosal ulceration

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network 

Southern Adelaide Local Health Network

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • symptomatic obstetric anal sphincter injury (OASIS) within 12 weeks post-partum
  • concerns of symptomatic occult sphincter injury post-partum
  • reducible external rectal prolapse

Category 3 (appointment clinically indicated within 365 days)

  • faecal incontinence
  • symptomatic isolated rectocele
  • obstructive defecation unresponsive to first-line management with underlying/suspected colorectal diagnosis, for example prolapse
  • chronic constipation unresponsive to first-line management

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • past medical/surgical history
  • medications and allergies
  • age
  • presenting symptoms
    • onset/duration
    • description of symptoms, including stool frequency/consistency/character
    • social and emotional impact, for example, acts of daily living/employment
    • previous management trialled and outcomes
    • reports/summaries from allied health involvement
  • height/weight
  • body mass index (BMI)
  • examination findings
    • abdominal
    • digital rectal examination (DRE), note sphincter tone
  • reports of prior colonoscopies and pathology of specimens removed
  • relevant diagnostic/imaging reports, including location of company and accession number

Additional information to assist triage categorisation

  • defecating proctogram report
  • anorectal physiology and ultrasound (US)

Clinical management advice

Physiotherapy and/or continence nurse management should be considered as part of initial management for bowel incontinence, for example pelvic floor muscle exercises and bowel training.

Obstructive defecation is a condition characterized by difficulty or inability to pass stool due to problems in the rectum or pelvic floor muscles. Common causes of obstructive defecation include dysfunction of the pelvic floor muscles, rectal prolapse (protrusion of the rectum through the anus), rectocele (weakening of the rectal wall), rectal intussusception (telescoping of the rectum), and anismus (impaired relaxation or coordination of the pelvic floor muscles during defecation).

Refer to colorectal when prolapse is contributing to bowel elimination, particularly external rectal prolapse. Symptoms may include:

  • a feeling of a lump/bulge in the rectum or coming out of the anus
  • bowel symptoms such as:
    • difficulty with bowel motions
    • incomplete defecation sensation
    • needing to press on the vaginal wall to evacuate bowel (splinting) in women

Obstructive defecation associated with genitourinary prolapse can be referred to Vaginal Prolapse/Pelvic Floor - Adult Gynacology CPC

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • 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

Clinical modifiers

  • 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

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.