HNY Policy and Pathway Repository - Humber

The Bladder and Bowel Health Service is available for adults 18 years and over with a Hull or ER GP.

The service provides a community-based comprehensive assessment and treatment plans for Bladder and Bowel conditions such as pelvic floor muscle weakness, mild to moderate pelvic organ prolapse, urinary incontinence, overactive bladder, voiding dysfunction, constipation, faecal urgency, faecal incontinence and defecation difficulty

The service consists of a specialist team of nurses who will provide a comprehensive assessment, physical examinations such as pelvic floor muscles, vaginal, rectal, skin, abdominal, urinalysis by multistick and bladder scan.

Treatment plans include;

Education, pelvic floor muscle rehabilitation (including use of neuromuscular electrical stimulation therapy/biofeedback), medication advice, bladder retraining, behavioural interventions, lifestyle changes, Intermittent self-catheterisation, Trans Anal irrigation

Please NOTE: Incontinence pads will not be provided for treatable medical conditions.

Patients who are currently purchasing their own Incontinence pads should not be referred into the service with the expectation that the service will provide them.

Where treatment is not possible containment pads may be provided according to patients clinical needs

NICE Guidance - Suspected Cancer: recognition and referral NG12

https://www.nice.org.uk/guidance/ng12/resources/suspected-cancer-recognition-and-referral-pdf-1837268071621

see above guidance for Urological cancers / Colorectal cancers & Gynaecological cancer symptoms 

Exclude Red Flag Symptoms

For Urological cancer / Colorectal cancer & Gynaecological cancer symptoms must be referred to Secondary care

Do Not Refer 

• Inflammatory Bowel Disease – Refer to secondary care / inflammatory bowel disease specialist nurses
• Acute urinary retention – refer to Secondary care
• Stoma – Refer to Stoma care nurses in Secondary care
• Indwelling catheterisation – refer to community nursing team
• End stages of life – refer to community nurses for incontinence issues

Other referral exclusions for Bladder and Bowel Service ;

• Individuals who are not willing to participate in active treatment
• Currently under care of Urology/Colorectal services etc. for their bladder/bowel dysfunction
• Pelvic radiation (within the last 12months)
• Incontinence with associated pain
• Severe pelvic organ prolapse 
• Palpable bladder
• Rapid onset of lower urinary tract symptoms in males
• Patients whose only desired treatment option is containment pads

Patients presenting with new urinary symptoms should have routine urinalysis to exclude urinary tract infection as a cause of their symptoms and treated before referral.

Patients can self-refer by telephone on 01482 247111.

GP referrals to be made by the referral form (available on ARDENS)

Hull and ERY BB Clinical Guidance Communications (opens in download button at top of page)

• Adults 18+
• Registered to a Hull or East Riding GP
• Relevant Bladder and/or Bowel symptoms

Referrals 

GP/HCP via referral form ERS or email chcp.247111@nhs.net

Self-Referral (without the need to be seen by a Healthcare Professional prior to referral) – via telephone 01482 247111.

Appointments will be made direct with the patient. Clinics are held at various locations across the East Riding and Hull area.

Home visits are available and subject to criteria

Guidance for Referrers (opens in download button at top of page)

Information to Include

Bladder & Bowel referral should contain enough relevant information to enable us to make a triage decision as to how the patient is best managed, without us needing to examine their medical records, or return the referral to you requesting further information. The following details should always be included where possible:

• Bladder symptoms
• Bowel symptoms
• Relevant history relating to reason for referral – such as investigations, urinalysis, recurrent UTIs, skin integrity issues
• Any relevant cancer history or other clinical red flags

CHCP Bladder & Bowel Website - https://www.chcpcic.org.uk/chcp-services/bladder-bowel-health

Bladder and Bowel UK Website - https://www.bbuk.org.uk/

NICE Guidance Pathway: Lower Urinary Tract Symptoms in Men https://www.nice.org.uk/guidance/cg97/chapter/recommendations

NICE Guidance Pathway: Urinary Incontinence in Women https://www.nice.org.uk/guidance/ng123/

Association for Continence Professionals Website - https://acpcontinence.co.uk/education/

NHS England: Excellence in Continence Care Guide - https://www.england.nhs.uk/wp-content/uploads/2018/07/excellence-in-continence-care.pdf