Continence assessment

There are different types and causes of incontinence. A continence assessment helps to determine what the problem is and what treatment is required. It includes details of the individual’s signs and symptoms and a physical examination may be indicated. The consent of the individual to an examination must be gained; however, if there is any doubt about the individual’s capacity the intervention should only be undertaken in the person's best interest. It is important to identify why the person is seeking advice at this time. Points to consider include:

  • how often the person goes to the toilet to urinate and defecate and whether this is a change to their normal routine
  • current or previous medical history (including pregnancy and urine infections)
  • possibility of physical or sexual abuse, including FGM (female genital mutilation)
  • a rough estimate of the amount of urine passed
  • visual description of the faeces (normally based on Bristol Stool Chart)
  • if there is leakage, whether it is urine or faeces
  • information about diet and fluid intake
  • any medications being taken (both prescribed and over the counter)
  • lifestyle factors, including recreational drugs, alcohol, smoking and weight
  • ability – for example, whether the person can feed, dress and bathe on their own
  • mobility – physical or environmental factors
  • capacity – does the person recognise the need to go to the toilet or do they forget where the toilet is?

Red flags

National Institute for Health and Care Excellence (NICE) guidelines (2015) suggest that a referral should be made for urgent or specialist investigation if an individual has any of the following ‘red flag’ symptoms:


  • haematuria (blood in the urine)
  • recurrent urinary tract infections (3 or more in last 6 months)
  • loin pain (pain in the lower back)
  • recurrent catheter blockages
  • hydro nephrosis or kidney stones on imaging
  • biochemical evidence of renal deterioration.


  • rectal bleeding
  • mucous present on defaecation
  • altered bowel habit (frequency or consistency)
  • unexplained weight loss.

Recent travel to other countries (particularly third world) should be identified.

Any possible safeguarding issues should be identified and managed according to local protocols.

Bristol Stool Chart

People have different bowel habits and most who regularly “go” three times a week and pass good stools (not too hard or soft) are considered to have normal bowels.

To help health care professionals determine what is “normal”, a visual guide was developed to identify the type of stool passed. The Bristol Stool Chart is an assessment tool designed to classify human faeces into seven categories.

What each type means?

Type 1-2 indicate constipation
Type 3-4 are ideal stools
Type 5-7 may indicate diarrhoea and a need to empty the bowels urgently

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