Bladder & Bowel Services

Overview

This is a clinically-led, specialist service which works to support Adults (age 18+) with bladder and bowel problems and promote healthy living. Children's Bladder & Bowel services support patients from 0 - 17 years of age.

They provide a full assessment of the individual’s needs, which will include a detailed medical and surgical history and examination/bladder scan if indicated. The aim is to help individuals understand the nature of their continence problem and work collaboratively to develop an appropriate treatment/management plan. They work very closely with Community Integrated Network Teams (previously known as District Nurse/Rapid Response Teams), GPs and other professionals.

The service is based across the BNSSG area running clinics and occasionally visiting patients in their own home when appropriate.  Referrals are accepted from GPs and other HC Professionals. Please use the referral form (see below) and provide as much detail as possible regarding urinary/faecal symptoms and highlight any red flags in the list below. Red flag patients are triaged as priority with the aim being for contact within 6 weeks:

1. Poor flow/feelings of incomplete bladder emptying/Recurrent UTIs/History of Sepsis
2. Neurological condition eg. MS/Spinal Cord Injury/Autonomic Dysreflexia
3. High risk of falls due to bladder/bowel problem eg. frequent trips to toilet at night
4. Pressure sore/moisture lesion present or high risk
5. Faecal incontinence/Poorly managed constipation

GPs should consider recommending the Bladder & Bowel self-care CONfidence App as a first line intervention

Referral Criteria

Stress incontinence. If the patient has previously had stress incontinence surgery or bulking injection, refer to Urology.

• Urinary Urgency and frequency – only when general lifestyle advice has not proved effective
• Recurrent UTIs
• Chronic (not acute) Voiding difficulties/Incomplete bladder emptying
• Urinary/faecal problems associated with neurological condition
• Faecal Incontinence
• Constipation/evacuation difficulties – only when appropriate dietary advice and lifestyle changes have been recommended and failed and or initial treatment with appropriate laxative medication has not proved effective
• Nocturia/Nocturnal Enuresis
• Intermittent Self Catheterisation/Rectal Irrigation – for teaching and support 

We cannot accept referrals for:

• Blood in urine or faeces or numbness in “saddle” area (Cauda Equina)
• Housebound patients – please refer to relevant Integrated Network Team via SPA on 0300 1256789
• ISC for dilatation – direct to Urology
• Catheter insertion/management/troubleshooting/TWOC. We support Community Teams with complex catheters but the route for accessing this support should be to contact SPA on 0300 1256789.
• Primary urinary stress incontinence with no other symptoms – patients can self-refer to Pelvic Health Physio.
• We do not see women who are pregnant or up to 1 year post natal.  They need to be referred to the Pelvic health physios
• If the patient has previously had stress incontinence surgery or bulking injection, refer to urology. 
• Female recurrent or persistent stress urinary incontinence (those who have already had a surgical/bulking injection treatment, but symptoms have returned or persist) – see Female Urinary Incontinence
• Patients in Care Homes – referrals do not come via GP but follow a separate referral pathway via Care Home
• Pad requests – all referrals requesting pads will be rejected. Please refer the person using the referral criteria above as pads are a management option that is only available to patients who meet the strict criteria. Pads will be the last resort within the patient’s care progress in the Bladder and Bowel service.
• As from 1 July 2021 – Please note we are no longer accepting self-referrals directly from patients/carers. We will continue to offer general advice and guidance to members of the public. However, if their symptoms or concerns require further investigation or assessment we will be asking them to have a conversation with their GP in the first instance.

Please consider these useful resources people can be sign posted to:   

• Bladder & Bowel UK (BBUK)
• Confidence APP
• Azheimers UK
• Age UK  
• Bladder Health UK
• Hartmanns – for self-purchase of containment products

Referral

Please ensure you complete ALL aspects of the referral form and attach relevant information to prevent the referral being rejected and treatment being delayed. 

Please note that if referring for voiding difficulties, please ensure that a DRE to check prostate size / vaginal examination to check for large anterior wall prolapse has been done by an appropriately trained clinician prior to referral. This enables the GP to identify those patients who should be referred directly to Urology / Uro-gynae.

If referring for constipation, please ensure that a DRE and abdominal palpation is completed to check for impaction by an appropriately trained clinician prior to referral. This enables the GP to start a disimpaction regime with the patient if impaction is identified.

Contact email address for BNSSG Bladder and Bowel Service:

sirona.bladderandbowel@nhs.net

We can also be contacted by phone to discuss if a referral is appropriate on: 01275 885185

Resources

Useful Links:

https://www.nice.org.uk/guidance/cg171    NICE - Urinary Incontinence in Women

https://www.nice.org.uk/guidance/cG49     NICE - Faecal Incontinence

https://www.nice.org.uk/guidance/cg97      NICE - Lower Urinary Tract Symptoms in Men

https://www.nice.org.uk/guidance/cg61      NICE - Irritable Bowel Syndrome in Adults

https://pathways.nice.org.uk/pathways/constipation  NICE - Constipation in Adults Pathway

Purewick External Catheter System - this product is still in clinical trial phase and has not yet been approved for NHS prescription. Please see the linked document for further information.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.