Current care for proctological complaints and pelvic floor physical therapy in a one-time consultation: an exploratory survey among general practitioners, surgeons, gastroenterologists, and pelvic floor physical therapists

Proctological complaints are common and can substantially impair quality of life. Little is known about how these problems are currently managed by general practitioners (GPs). While most cases improve with conservative treatment, some persist or recur and require specialist referral. GPs rarely assess pelvic floor dysfunction, despite its potential contribution to recurring symptoms. A one-time consultation with a pelvic floor physical therapist (PFPT) could help close this gap and improve care efficiency. The proposed consultation is intended for selected patients with chronic, recurrent or treatment-refractory symptoms. This study aimed to evaluate current GP practices in managing proctological complaints, such as haemorrhoids, chronic anal fissures, and faecal incontinence. Additionally, it assessed healthcare professionals’ willingness to implement a one-time consultation with a PFPT. GPs completed a questionnaire on diagnostic approaches, treatment, and referral habits. Gastrointestinal surgeons, gastroenterologists, PFPTs, and GPs were also surveyed about their attitudes towards introducing a PFPT consultation. Gastrointestinal surgeons and gastroenterologists were pooled as secondary care specialists. Responses were received from 73 GPs, 33 secondary care specialists, and 56 PFPTs. Thirty-six percent of GPs almost always or always asked about urological problems, compared with only 7% who did so for sexual complaints. Digital rectal examination was almost always or always performed by 47% of GPs, and only 3% almost always or always assessed the pelvic floor muscles. At least 59% of GPs advised on lifestyle and toilet behaviour. The proportions expressing definite willingness to explore implementation were 82%, 79% and 88% respectively, with no significant differences among groups (χ² (2) = 1.26, p = 0.533; Cramér’s V = 0.09). Key reasons included time constraints, knowledge gaps, improved care, and potential cost savings. Several self-reported management practices were consistent with Dutch GP guideline recommendations. Among respondents, there was broad support for integrating a one-time PFPT consultation for selected patients with chronic, recurrent or treatment-refractory anorectal complaints. Further research is needed to establish the feasibility, clinical effectiveness, and cost-effectiveness of this consultation before broader implementation.