Pathway

Community female continence service 

A physiotherapy led service for the management of patients with women’s health / urinary incontinence conditions.

Aims & objectives 

The principal aims & objectives of the pathway are:

• To provide specialist physiotherapy assessment and early intervention of various women’s health conditions such as urinary incontinence, specialist pelvic floor, low key bladder dysfunction and postnatal problems.
• To provide a fast, flexible and integrated community based out-patient service from multiple sites across the locality and reduce waiting times for women’s health physiotherapy
• To provide advice and treatment to women who may not previously have sought continence advice
• To enable patients with women’s health problems to manage their condition more effectively to improve their quality of life
• To improve the patient pathway by developing localised protocols and referral documentation as well as facilitating joined-up and holistic working between primary care, community services and secondary care.
• To make the most appropriate use of secondary care hospital resources by ensuring that those patients referred into secondary care are appropriate and optimally prepared for surgery to achieve the best possible outcomes.
• To provide optimal pre-operative preparation e.g. physiotherapy that enables patients to manage their condition better, and/or to prepare for surgery, as well as reducing post-operative recovery times and improving post-operative outcomes.
• To provide a cost-effective and integrated service
• To accept referrals from GPs, secondary care hospital Consultants and the Community continence service. To onward refer to the Community continence service and secondary care continence specialities.
• When patients are referred to the service, clear information is given. Patients are provided with sufficient information and the opportunity to discuss their options in order to make a fully informed choice.

Exclusion criteria 

The service does not accept referrals for the following conditions:

• Patients under the age of 16 years

Patients with; 

• A neurological condition requiring specialist neurological physiotherapy
• Microscopic haematuria
• Patients unable to give informed consent
• Pelvic masses

Urgently refer women with urinary incontinence directly to specialist services who have any of the following;

Neurological emergencies for example inability to pass urine, saddle anaesthesia etc.

Microscopic haematuria in women aged 50 years or older

Visible haematuria

Recurrent or persisting UTI associated with haematuria in women aged 40 years and older.

Suspected malignant mass arising from the urinary tract

Community Continence Service: 

Our specialist women’s health physiotherapists work closely with the community continence team to contribute to the development of the patients final care plan.

The services aims to ensure adequate communication is maintained with all GP practices and letters outlining the patients care will be sent after initial assessment and on discharge.

Our specialist physiotherapists are able to refer directly to the urogynacological consultants at West Suffolk Hospital and attend the Multi disciplinary meetings at the hospital to discuss complex cases.

Service Delivery: 

• The service is delivered by our specialist physiotherapists
• Following a referral the patient is seen within 3 weeks
• All patients are sent an advice leaflet prior to their initial appointment along with a bladder diary to complete
• Where clinically indicated, the patient will receive a full vaginal assessment as part of their initial clinical assessment
• After the initial assessment, the Physiotherapist and patient agree a care plan which is documented
• The patients receive a minimum of 3 appointments. The initial appointment will be for 1 hour
• The Physiotherapists will provide pelvic floor exercise and education, bladder control, diet, weight loss and smoking cessation advice
• The aim of the physiotherapy program is to support the patients to manage their condition

Referral Process: 

• Via a referral form

The service shall accept referrals for the following conditions: 

• Vaginal prolapse – cystocele, rectocele, urethrocele, uterine prolapse, vault prolapse, cervix prolapse
• Prolapse, large pre-surgery input
• Post prolapse surgery input
• Post anterior / posterior repair input
• Stress incontinence
• Urgency incontinence
• Mixed incontinence
• Pelvic floor weakness
• Lack of sensation postnatally
• Postnatally, e.g. following tear etc.
• Vaginismus / pelvic floor spasm
• Can see patients with rectal incontinence if part of a mixed picture i.e. with urinary incontinence, not purely for rectal incontinence as not a colorectal service currently.

Physiotherapy referral to secondary care: 

Our specialist physiotherapists regularly attend Multidisciplinary meetings at the West Suffolk Hospital where complex cases are discussed. If required the physiotherapist are able to refer directly to the urogynacological consultants at West Suffolk Hospital.

Discharge Process: 

• If a patient completes the 3 months of assessment and treatment and their symptoms are resolving they will then be discharged from the service to continue self management
• The patient can self- refer back to the service for assessment should their symptoms deteriorate.
• The GP will receive a discharge letter notifying them of the patients diagnosis and outcomes.