Peristeen® Light Referral Form

Referrer's Details
Patient Information
Patient consented to referral to contact for training and supplies from Coloplast?*

Have you assessed and excluded any contradictions? e.g. any anticoagulants / recent surgery / diverticulitis, etc.*

Which item would you like to recommend for this patient?*




Drugs Payment Scheme (DPS)

 

The Drugs Payment Scheme (DPS) is a HSE support scheme that helps reduce the cost of prescribed medicines in Ireland. If you do not have a medical card, you can apply regardless of income. Once registered, you and your household will pay no more than €80 per month in total for approved prescribed medicines and certain appliances — not per person, but for the whole family combined — with any additional costs covered by the HSE.
This can provide reassurance and financial protection if you or your family need ongoing treatment. Simply present your DPS card at your pharmacy when collecting your prescriptions.


  1. Sharma A, Yuan L, Marshall RJ, et al. Systematic review of the prevalence of faecal incontinence. The British Journal of Surgery. 2016;103(12):1589-97.
  2. Barberio B, Judge C, Savarino EV, et al. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. The Lancet Gastroenterology & Hepatology. 2021;6(8):638-48.
  3. Vriesman MH, Koppen IJN, Camilleri M, Di Lorenzo C, Benninga MA. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol. 2020; 17(1):21-39.
  4. Assmann S L, Breukink S O and Keszthelyi D. Mistakes in faecal incontinence management and how to avoid them. UEG Education 2023; 23: 1-3.
  5. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology. 2021;160(1):99-114.e3.
  6. Magnuson FS, Christensen P, Krassioukov A, et al. Neurogenic bowel dysfunction in patients with spinal cord injury and multiple sclerosis An updated and simplified treatment algorithm. J Clin Med. 2023;12(22).
  7. Emmanuel, Krogh, Perrouin-Verbe et al., 2025, Consensus on safe initiation and monitoring of transanal irrigation to optimize adherence with therapy, Neurogastroenterology & Motelity.
  8. S. Assmann, D. Keszthelyi J. Kleijnen et al. UEG Education 2023; 23: 1-3.

* Coloplast data-on-file: N=104, 95% Confidence Interval; [90 - 99 %]

** Coloplast data-on-file: N=104, 95% Confidence Interval; [76 - 91%]

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