Coventry Guidance 
CWPT Community Continence Service (Bladder & Bowel Service)
Referral Criteria
Adults aged ≥ 18
Registered with a Coventry GP
Symptoms of bladder or bowel dysfunction including:
- Symptoms of stress urinary incontinence
- Symptoms of over-active bladder dry and wet (frequency, urgency and urge incontinence)
- Symptoms of outflow obstruction including neurogenic bladders and Benign Prostatic Hyperplasia (PBH) that have had red flags ruled out or previously investigated
- Functional issues requiring support with on-going Continence Management e.g containment products, sheaths, commodes
- Management of chronic constipation / faecal incontinence
- Trial without catheters (TWOC) as part of the TWOC pathway see below
Please ensure all red flags have been investigated prior to referral:
- Recurrent UTI’s
- Unexplained haematuria
- Unexplained neurological symptoms e.g Cauda Equina, undiagnosed Multiple Sclerosis
- Unexplained outflow obstruction symptoms
There are a range of investigations that are available that help us to determine the best course of treatment, based on an individual patient needs.
About the Service
Delivered by specialist bladder and bowel care nurses and wider team, in community settings and also providing domiciliary visits to patients’ homes
Patients currently under the care of District Nursing Services (Place Based Teams) will be assessed by their district nursing team. The Continence team will support Place based teams with specialist advice where required.
What should a patient expect from the specialist Continence service?
Before the appointment they may be asked to complete self-assessment documentation to help the assessment process
Meet with a nurse in clinic, at home, via video or telephone call, to receive a holistic nursing assessment which will take at least an hour to complete
This may involve the patient undergoing investigations, relevant to their symptoms including vaginal pelvic floor assessment, bladder ultra-sound scan or rectal examination
Once the assessment has been completed and type or types of incontinence have been diagnosed a treatment plan will be discussed and agreed with the patient
Treatment may include:
- Lifestyle changes
- Pelvic floor exercises or referral on the Women’s Health Specialist Physiotherapy
- Bladder re-training
- Prescription medication-based treatment
- Support with continence management, including the use of containment products
- Teaching of intermittent self-catheterisation
- Signposting to other services
- Management of constipation and/or faecal incontinence
- Implementation of specialist bowel care regimes, including rectal irrigation
Referral Process
Complete the linked referral form and email as instructed (see link
The referral will be triaged through the Integrated Single Point of Access (ISPA). LINK to Integrated Single Point of Access form for CWPT
Ensure reason for referral, current symptoms, relevant medical history and medication are included
Contact
Service available 8.30 – 4.30pm Monday to Friday
Continence Specialist Nurse – Anna Hancock
Continence Service administrators & Containment Product Delivery Service Tel 02476 961428. Patients to ring this number to order continence products once an assessment has been completed
Email: Continence.service@covwarkpt.nhs.uk
Further Patient Information
Expert Self Care Information: Link to CONfidence App
Trial Without Catheter TWOC Pathway
Referral Criteria
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Continence Physiotherapy
- Incontinence of bladder and/or bowel
- Prolapse
- Weak pelvic floor muscles
- Overactive bladder
- Loss of sexual sensation
Procedures include vaginal examination, bowel examination, bladder scans, urinalysis, neuromuscular stimulation and biofeedback. The clinical lead is Ms Charlotte Leung, Specialist Physiotherapist for Women’s Health, Charlotte.Leung@uhcw.nhs.net Please refer to “Women’s Health” via Choose and Book.
Guidance for Housebound Patients
If the patient is under the care of the Community Nursing Service please arrange an assessment through them.
If your patient is not under the care of District Nurses complete and email the correct referral form
Follow link for clinic information for patents
Follow link for continence information including products and pelvic floor exercises
Rugby & South Warwickshire Guidance
Aims to promote continence wherever possible, through our continence assessment and treatment programme. For some patients this is not always achievable and so we provide management options to improve their quality of life and independence.
We have three community continence teams based in Nuneaton, Leamington and Rugby and an Acute hospital team based at Warwick Hospital. Patients with bladder or bowel dysfunction from the age of 16 can be referred for a clinical continence assessment via GP or the hospital.
Contact and location
South Community Team (Alcester, Ellen Badger, Henley, Southam, Stratford Healthcare)
Royal Leamington Spa Rehabilitation Hospital
Tel: 01926 600820
North Community Team (Camphill Clinic, Bedworth Clinic, Springhill Clinic, Coleshill Clinic, Polesworth Clinic, Atherstone Clinic)
Camphill Community & Family Centre
Tel: 0247 6390032
Rugby Continence Service
The Orchard Centre
Tel: 01788 555105 or fax the referral form to 01788 55104
Their Team: Terry Holland, Specialist Nurse for Continence
Barbara Sheehan, Continence Staff Nurse
Donna Haycox, HCA for Continence
Helen Leddingham, Administrator for Continence (Rugby)
Exclusion Criteria
Female:
- Failed previous gynaecological surgery
- Symptoms of obstructive outflow
- Unexplained vaginal bleeding
- Haematuria
- Abdominal mass
- Prolapse
- Voiding difficulties
Male:
- Raised Prostate Specific Antigen (PSA) in line with the patients age group
- Haematuria
- Abdominal mass
- Voiding difficulties
Whilst there are patients in the exclusion criteria the service will be happy to see and support the patients as long as they have either been seen and investigated or whilst they are awaiting an appointment for secondary care.
Patients with Bowel problems:
- As above these patients are also welcome to be referred as long as complex bowel disorders such as inflammatory bowel disorders and malignancy have been excluded. Or to support the patients where such diagnosis has been made
Preparing for appointment
For community appointments, patients are usually sent some charts to complete and will be asked to bring a fresh sample of urine and a current list of medication.
We provide appointments for continence assessment in the most suitable setting including acute hospital, clinics and patients’ homes (if unable to leave their home) within Warwickshire.
Related links
SWFT Clinical Services
SWFT Clinical Services works in partnership with South Warwickshire NHS Foundation Trust to deliver the continence service across the county.
The key role of SWFT Clinical Services is the operational management of the continence service from order through to delivery. Once a clinical assessment has taken place, patients and Residential Homes place orders for pads via a dedicated pad order line which is managed by the Outpatient Pharmacy at Warwick Hospital. Once placed, all orders are tracked and them delivered by West Midlands Ambulance Service straight to the door.
Please see link in right hand panel for further information on the Continence Advisory Service for Rugby and referral form.
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