When should I consider referring a patient with proctitis to a specialist for further evaluation?

Consider referring a patient with proctitis to a specialist for further evaluation if:

• Symptoms persist despite initial management and conservative treatment.
• There is suspicion of underlying conditions such as colitis or malignancy that require specialist assessment.
• The patient meets criteria for a suspected cancer pathway, necessitating urgent referral.
• Specialist investigations such as endoscopic, radiological, or anorectal physiology studies are needed but cannot be arranged in primary care.
• There is ongoing faecal incontinence or other complications that require specialised management beyond primary care capabilities.

Referral should be considered to enable specialist diagnostic procedures (e.g., endoscopy, imaging) and tailored management plans.