Continence assessment (Assessment of urinary and bowel continence)
An assessment to find out why you are leaking urine or struggling with bladder or bowel control, and to offer treatment, because incontinence is common but treatable and is not simply a normal part of ageing.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- It works out why you are having bladder or bowel control problems and offers treatment — incontinence is common but treatable, not just a part of ageing.
- Different types (stress, urgency, mixed, or overflow) need different treatments, so identifying the type matters.
- Simple steps come first, such as a bladder diary, treating constipation or infection, reviewing medicines, pelvic floor exercises and bladder training.
- Your dignity matters; a good assessment is respectful, and a sudden change or blood in the urine should be checked promptly.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Identifies the type and likely cause of bladder or bowel control problems.
Specialist tests such as urodynamics are not needed for everyone and should be reserved for selected cases, such as when the type is unclear or before...
You keep a bladder diary for a few days, which guides the assessment.
A clear plan starting with simple, effective measures and realistic expectations.
You keep a bladder diary for a few days, which guides the assessment.
History, examination, a urine test, and often a bladder scan. First advice and treatments are usually explained...
Pelvic floor exercises, bladder training and lifestyle changes take effect gradually. Any infection or...
Progress is reviewed, treatment is adjusted, and specialist tests or procedures are considered only if simpler...
What is a continence assessment?
Continence means being able to control your bladder and bowels. Incontinence — leaking urine, leaking stool, or struggling to get to the toilet in time — is very common as people get older, but it is not something you simply have to put up with. It is treatable or can be greatly improved in most people, and it deserves to be taken seriously.
A continence assessment is a careful, respectful look at what is happening and why. A specialist or continence nurse asks about your symptoms, reviews your medicines and other health problems, examines you where appropriate, and uses simple tests such as a bladder diary and a urine check.
There are different types of urinary incontinence — for example leaking with coughing or lifting (stress), a sudden urgent need (urgency or overactive bladder), or a mix of both — and the right treatment depends on which type you have. The assessment sorts this out.
The assessment can identify the cause and point to treatment, from pelvic floor exercises and bladder training to medicines or, in some cases, procedures. It treats your dignity as central. What it should never do is dismiss the problem as 'just your age'.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
History and symptom review
A careful, sensitive discussion of your symptoms, how they affect daily life, your fluid intake, your medicines and any related problems such as constipation or mobility.
Bladder diary
A simple record, usually over a few days, of how much you drink, how often you pass urine, and any leaks. It is one of the most useful parts of the assessment.
Examination and urine test
An examination where appropriate, and a urine test to check for infection or blood. A bladder scan may measure how much urine is left after you go.
Identifying the type of incontinence
Distinguishing stress (leaking with coughing or effort), urgency or overactive bladder (sudden strong need), mixed, or overflow, because treatment differs for each.
Preparing for your test
- Keep a bladder diary for a few days beforehand if asked, recording drinks, toilet visits and any leaks.
- Bring a full list of your medicines, including water tablets, which can affect the bladder.
- Note when leaks happen — with coughing or lifting, with a sudden urge, at night, or on the way to the toilet.
- Mention any constipation, as a full bowel can worsen bladder symptoms.
- Note how the problem affects your daily life, sleep, confidence and activities.
- Bring details of any previous childbirth, pelvic or prostate surgery, or relevant conditions.
- Bring your glasses and hearing aids, and feel free to bring someone you trust for support.
What happens
The specialist or continence nurse asks about your symptoms in a respectful, unhurried way, reviews your bladder diary, medicines and health problems, and examines you where appropriate. A urine sample is usually checked for infection or blood.
They work out the likely type of incontinence and look for things that can be put right simply, such as a urine infection, constipation, or a medicine that is making things worse. A small handheld scan may measure how much urine stays in the bladder after you go.
For many people, first treatments start straight away: advice on fluids and caffeine, pelvic floor exercises, bladder training, managing constipation, and practical aids if needed. Medicines or referral for specialist tests and procedures are considered where simpler measures are not enough.
You should leave understanding the likely cause, the recommended plan, and what to do if symptoms change. Throughout, your dignity and comfort should come first.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Specialist tests such as urodynamics are not needed for everyone and should be reserved for selected cases, such as when the type is unclear or before surgery.
- It is the wrong first step if symptoms point to an emergency, such as being unable to pass urine, which needs urgent care.
- It is not the right route if visible blood in the urine is the main feature — that needs a specific, prompt pathway.
- Bladder-relaxing medicines may be unsuitable for some older people because of side effects such as confusion.
Delay or rearrange if…
- You have a current urine infection — treat that first, as it can cause or worsen symptoms.
- You are badly constipated — managing the bowel often improves bladder symptoms.
- You are acutely unwell or have an unstable medical problem.
- A medicine review is outstanding, as some medicines directly affect continence.
Alternatives to discuss
- Conservative measures alone: pelvic floor exercises, bladder training and lifestyle changes.
- The NHS continence service, often nurse-led, as the standard route.
- A medicines review to stop or change treatments worsening symptoms.
- Managing constipation or mobility problems that contribute to incontinence.
- Dignity-focused practical support and products while treatment takes effect, without further testing if not needed.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Identifies the type and likely cause of bladder or bowel control problems.
- Picks up simple, treatable contributors such as infection, constipation or a medicine.
- Starts effective first treatments such as pelvic floor exercises and bladder training.
- Improves dignity, confidence, sleep and quality of life for many people.
- Flags when a procedure or specialist test is appropriate, and when it is not yet needed.
Risks & complications
- Embarrassment talking about a private problem, although clinicians do this routinely.
- Discomfort during examination or when giving a urine sample.
- Needing to keep a bladder diary and try lifestyle changes before improvement is seen.
- Improvement that is gradual rather than immediate, especially with exercises.
- Side effects from bladder medicines, such as a dry mouth, constipation or confusion in older people.
- Discomfort or a urine infection after specialist tests such as urodynamics.
- Finding a problem that needs further investigation, such as blood in the urine.
- Treatments that help only partly, so the plan needs adjusting.
- A serious underlying cause found during assessment, such as a bladder problem needing specialist care.
- Urinary retention (being unable to pass urine), which is a medical emergency.
- Complications from any procedure later recommended, discussed separately at that stage.
Most continence problems are managed safely with simple measures, but some symptoms need prompt attention: visible blood in the urine, being unable to pass urine at all, or a sudden change in bladder or bowel control with back pain or numbness. Bladder medicines need care in older people because some can cause confusion or worsen other conditions, so the benefits and risks should be discussed before starting.
Published figures to discuss
How well continence treatments work varies with the type of incontinence, the cause, how consistently exercises and training are done, and other health problems. Success is often partial improvement rather than complete cure, and results build over weeks. Because outcomes are so individual and depend on adherence, exact percentages are not quoted here; your clinician can explain what is realistic for your type of incontinence.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Treatable causes of new incontinence | Common, including infection, constipation, medicines, mobility limits and high fluid/caffeine intake | New or worsening symptoms should not be written off as ageing without a basic assessment. | NICE — Urinary incontinence topic overviewnice.org.ukSource-linked context |
| Anticholinergic bladder medicines causing confusion, dry mouth or falls | Clinically important in older people, especially with cognitive impairment or polypharmacy | Medication choice should consider anticholinergic burden and alternatives such as bladder training, pelvic floor therapy or mirabegron. | Guide sourcesClinical context |
| Urine dipstick overdiagnosing UTI in older adults | Common because asymptomatic bacteriuria is common with age | A positive dipstick alone does not prove infection; symptoms and clinical context matter. | NICE — Urinary incontinence topic overviewnice.org.ukSource-linked context |
| Skin damage, falls and social isolation from unmanaged incontinence | Common in moderate to severe symptoms | Good care includes skin protection, toileting access, mobility support and dignity, not just pads. | Guide sourcesClinical context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery from the assessment itself. Afterwards, improvement usually comes gradually as you work through the plan — exercises, bladder training, and any medicines — with review to see what is helping.
- Gradual rather than instant improvement, especially with exercises and bladder training.
- Needing to stick with a plan for several weeks to judge whether it helps.
- Adjusting fluid and caffeine habits.
- Trying more than one approach before finding what works best for you.
Aftercare
- Do pelvic floor exercises and bladder training as advised, and stick with them.
- Drink sensibly — not too little and not too much — and cut down on caffeine and alcohol if advised.
- Treat and prevent constipation, as it worsens bladder symptoms.
- Take any bladder medicine as prescribed and report side effects, especially new confusion.
- Use continence products for dignity and comfort while treatment takes effect, if needed.
- Keep follow-up appointments to review progress and adjust the plan.
- Seek prompt help for blood in the urine, inability to pass urine, or sudden changes in control.
- Completed bladder diary for a few days
- Full medicine list, including water tablets
- Notes on when and how leaks happen
- Record of any constipation or bowel changes
- Details of previous childbirth or pelvic/prostate surgery
- Questions about treatment options written down
- Note of who to contact and when to seek urgent help
⚠ Get urgent help if…
- Visible blood in your urine — get this checked promptly.
- Being unable to pass urine at all, with a painful, full bladder — this is an emergency.
- Sudden loss of bladder or bowel control with back pain, leg weakness or numbness around the back passage — seek emergency care.
- Fever, severe lower tummy or back pain, suggesting a kidney or serious urine infection.
- New, rapidly worsening incontinence with feeling generally unwell.
- Severe side effects from bladder medicines, such as marked confusion in an older person.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good assessment ends with a clear understanding of the type and likely cause of your symptoms and a treatment plan that fits. Many people improve significantly with simple measures, and quality of life, sleep and confidence often improve with them.
Results take patience. Pelvic floor exercises and bladder training work gradually, and the first plan may need adjusting. The aim is meaningful improvement and dignity, not necessarily a complete and instant cure, and your clinician should be honest about what is realistic for your situation.
How long the benefit lasts depends on the cause and on keeping up helpful habits. Pelvic floor and bladder-training gains can fade if exercises stop, so they often need to continue. Symptoms can change with age, new medicines or new health problems, so the plan may need review over time.
Related tests, treatments or support
A continence assessment in older people often sits alongside a falls and mobility review (because rushing to the toilet causes falls), a medicines review, and management of constipation. In men, prostate problems may be assessed too. After the assessment, physiotherapy for the pelvic floor is commonly combined with bladder training.
Follow-up & long-term care
You should be told the likely cause, the plan, and when progress will be reviewed. Follow-up checks whether exercises, training or medicines are helping, manages side effects, and decides whether specialist tests or a procedure are needed. Make sure you know who to contact, including for urgent symptoms.
- Continuing pelvic floor exercises and bladder-training habits.
- Ongoing attention to fluids, caffeine and preventing constipation.
- Reviewing any bladder medicine for continued benefit and side effects.
- Periodic reassessment if symptoms change or new problems develop.
- Maintaining dignity-focused practical support where helpful.
Repeat, follow-on and what comes next
- First treatments often need adjusting, and more than one approach may be tried before the best result is found.
- The type of incontinence is sometimes reclassified once a bladder diary or tests are reviewed.
- Medicines may be changed or stopped if side effects outweigh benefit, especially in older people.
- Specialist tests or a procedure may be considered later if conservative measures are not enough.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A clear plan starting with simple, effective measures and realistic expectations.
- A named contact and an easy route to review progress and adjust treatment.
- Support with pelvic floor exercises and bladder training, such as physiotherapy.
- Monitoring of any medicine for benefit and side effects.
- Clear advice on urgent symptoms and dignity-focused practical support meanwhile.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The assessment time and whether it is nurse-led or specialist-led.
- Urine tests and a bladder scan.
- Specialist tests such as urodynamics, where needed.
- Pelvic floor physiotherapy sessions.
- Follow-up appointments to review progress.
- Any medicines or later procedures, which are separate costs.
- The assessment fee and who carries it out.
- Urine tests, bladder scan and any specialist tests.
- Pelvic floor physiotherapy if recommended.
- Follow-up appointments to review the plan.
- Cancellation policy and what happens if results are inconclusive.
- What any later procedure would involve and cost, if one is recommended.
On the NHS? Continence assessment and treatment are available on the NHS, including nurse-led and specialist continence services; private routes are mainly used for speed or choice.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Dismissing incontinence as an inevitable part of ageing instead of assessing it.
- Jumping to medicines or surgery before trying simple, effective measures.
- Starting bladder medicines in older people without weighing confusion and other side effects.
- Not explaining that improvement is often gradual and may be partial.
- Overlooking dignity, privacy and the person's own goals for treatment.
Marketing red flags
- Promising a quick or guaranteed 'cure' for incontinence.
- Pushing surgery or devices before conservative treatment has been tried.
- Selling expensive tests like urodynamics routinely to everyone.
- Marketing 'bladder' supplements with no good evidence.
- Treating incontinence as purely cosmetic rather than a health and dignity issue.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What type of incontinence do I have, and what is the likely cause?
- Which simple treatments should I try first, and how long before I know if they work?
- Could any of my medicines, or constipation, be making this worse?
- If a medicine is suggested, what are the benefits and the risks for someone my age?
- Do I need specialist tests such as urodynamics, and why?
- What should prompt me to seek urgent help?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Isn't leaking just a normal part of getting older?
Will I have to have embarrassing tests?
What treatments might be offered first?
Are bladder medicines safe for older people?
When should I worry and seek help quickly?
Can I get this on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: British Geriatrics Society — CGA: urinary incontinence NICE — Urinary incontinence topic overview NICE NG123 — Urinary incontinence and pelvic organ prolapse in women: recommendations NICE QS77 — Urinary incontinence in women: initial assessment NHS England — Excellence in Continence Care
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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