Paediatric Bladder and Bowel Care Service (PBBCS)
The paediatric bladder and bowel care service (PBBCS) is a team of specialist children's nurses who provide treatment, support and advice for children with bladder and bowel difficulties.
They specialise in the treatment of constipation, daytime wetting and nocturnal enuresis (night-time wetting).
The service provides:
- A continence promotion service for children with additional needs
- Sees and assess children who are eligible for continence products because of their learning or physical disability
- Provide toilet training / healthy bladder and bowel advice to schools and pre-schools
- Teaches parents specialised treatments, such as intermittent catheterisation and trans-anal irrigation to manage their child's bladder and bowel.
Children can be referred to the specialist service at tier 2 level, once they have had the recommended support and intervention at tier 1 level and there has been little or no improvement (as per the Paediatric Continence Forum commissioning guide for NICE - August 2014).
The paediatric bladder and bowel care service provide specialist training, education and support to primary and community care staff delivering services at tier 1.
Early years Setting and Schoolsmay find this Guide produced by ERIC useful (clickon the image to take you straight to the document)
There is also a link to the Right to Go resources page at the bottom of this page
Who to contact
- 01392 208044
Where to go
- EX2 9HS
- Referral required
- Referral Details
Referals are accepted by relevant healthcare profesionals (e.g. school nurses, health visitors, community nurses or GPs) after initial failure/non-response to treatment at tier 1 level (as detailed below)
Tier 1: Pre-Service
This would normally be undertaken by nurses competent in providing advice and information on nocturnal enuresis, constipation and toilet training problems and initiate first line treatments. These could be school nurses, health visitors, community nurses or GPs.
This includes basic advice e.g. signposting to ERIC, and support to, for example, help promote "healthy" bladders and bowels – to reduce the risk of problems, such as constipation, developing, or, once developed, being missed. It would also include toilet training programmes, assessing and reviewing input and output charts (bladder/bowel/fluid diaries) and introducing first line treatments, including; toileting and fluid/diet advice, treatments for bedwetting e.g. enuresis alarm or medication and treatments for constipation e.g. use of stimulant laxatives or macrogols ( via the GP or a nurse prescriber) They would be expected to follow treatment pathways and NICE Guidelines prior to referral to tier 2 – for minimum 3 months.
Tier 2: The Paediatric Bladder and Bowel Care Service (PBBCS)
The PBBCS assesses and treats children and young people with daytime wetting and those with special needs and more complex bladder/bowel problems. It also treats children and young people where first line treatment (pre –service, tier 1 and above) has not led to a resolution of the problem.
Tier 3: Onward referral to Consultant Paediatrician/Consultant Paediatric Urologist if red flags present/medical review
NICE guidance recommends the following children should be referred to and seen by a specialist continence service (Tier 2):
- A child who has not responded to treatment:
- NICE clinical guideline CG99 on constipation in children and young people recommends referring children and young people with idiopathic constipation who do not respond to initial treatment within 3 months to a locally identified practitioner with expertise in the problem. NICE clinical guideline CG111 on nocturnal enuresis recommends referring children and young people with bedwetting that has not responded to courses of treatment with an alarm and/or desmopressin for further review and assessment of factors associated with a poor response
- A child who has 'red flag' symptoms:
- NICE clinical guideline CG99 on constipation in children and young people recommends that children and young people with 'red flag' symptoms that indicate an underlying disorder or condition that is not idiopathic constipation should be referred urgently to a healthcare professional with experience in the specific aspect of child health that is causing concern.
- A child who is suspected of being maltreated:
- Children and young people may develop problems such as bedwetting as a response to emotional difficulties. NICE clinical guidelines CG99 on constipation in children and young people, CG111 on nocturnal enuresis and CG89 on when to suspect child maltreatment identify when child maltreatment should be considered. Local pathways should identify the action that should be taken if maltreatment is suspected.
- A child who has not responded to treatment: