PPHS Self-Referral

You are about to complete a self-referral to the Women's Health Physiotherapy Team. This is part of the Perinatal Pelvic Health Service (PPHS). Women and birthing people can self-refer at any point during pregnancy, and up to 12 months after birth.

We accept referrals for the following problems: leaking of urine (wee) and/or stool (poo), pelvic organ prolapse (lump or buldge in the vagina), pain with sexual intercourse or birth injuries to the area between the vagina and anus.

Please complete all sections of this referral form to the best of your ability. This will ensure it is triaged correctly by our team.

Please be aware we are not an emergency service. If you are experiencing any of the symptoms below, please contact your GP or 111.

• Loss of sensation/pins and needles between your thighs or genitals (private parts)
• Loss of sensation/pins and needles below the waist or down either of your legs
• Pain or weakness in both of your legs
• Change in bladder control - unable to wee or loss of sensation when you pass urine
• Changes in bowel control - loss of sensation when you have a poo or leaking from the bowel
• Loss of sensation with sexual intercourse
• Signs of urinary tract infection
• Signs of wound infection or breakdown – this may include increase in pain, new bleeding, puss like discharge, beginning to feel unwell