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
- inability to pass any bowel motions or gas
- 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 metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.
Central Adelaide Local Health Network
- Royal Adelaide Hospital (08) 7074 0000
- The Queen Elizabeth Hospital (08) 8222 6000
Northern Adelaide Local Health Network
- Lyell McEwin Hospital
(08) 8182 9000
Southern Adelaide Local Health Network
- Flinders Medical Centre (08) 8204 5511
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
For more on outpatient referrals, see the general referral information page.
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.
- identifies as Aboriginal and/or Torres Strait Islander
- relevant social history, including identifying if you feel your patient is from a vulnerable population and/or requires a third party to receive correspondence on their behalf
- interpreter required
- 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
- National Institute for Health and Care Excellence - Clinical Guideline - Faecal incontinence in adults management
- The American Society of Colon and Rectal Surgeons – Anorectal physiology testing and pelvic floor terminology (PDF 400KB)
- The American Society of Colon and Rectal Surgeons – Management of faecal incontinence (PDF 938KB)
- The American Society of Colon and Rectal Surgeons – Treatment of rectal prolapse (PDF 125KB)
- Therapeutic Guidelines - Functional constipation in adults