Domain 3 of 12
Continence
Bladder and bowel function, catheter and stoma care, and skin-integrity impact.
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What does the Continence domain measure?
The Continence domain captures bladder and bowel function — including catheter management, stoma care, and bowel-management regimes. Continence routinely interacts with Skin & Tissue Viability (incontinence-associated dermatitis, pressure damage) and Mobility (toileting transfers). The Continence descriptor table has 4 levels — no Severe, no Priority — so the scoring fight is typically Moderate vs High.
How is Continence scored? (DST wording)
| Level | DST descriptor |
|---|---|
| No needs | Continent of urine and faeces. |
| Low | Continence care is routine on a day-to-day basis; Incontinence of urine managed through, for example, medication, regular toileting, use of penile sheaths, etc. AND is able to maintain full control over bowel movements or has a stable stoma, or may have occasional faecal incontinence/constipation. |
| Moderate | Continence care is routine but requires monitoring to minimise risks, for example those associated with urinary catheters, double incontinence, chronic urinary tract infections and/or the management of constipation or other bowel problems. |
| High | Continence care is problematic and requires timely and skilled intervention, beyond routine care (for example frequent bladder wash outs/irrigation, manual evacuations, frequent re-catheterisation). |
What evidence moves the Continence score up?
- Continence assessment by a district nurse or continence specialist
- Pad change frequency log — number per 24 hours, soiling pattern, skin-condition notes at change
- Catheter care records — type, change frequency, bypassing or blockage incidents, urinary tract infection history
- Stoma care records and any complications (retraction, prolapse, parastomal skin damage)
- Bowel management regime — manual evacuation, suppositories, rectal medication, frequency
- Tissue viability nurse referrals and notes on incontinence-associated dermatitis
- Hospital admissions for catheter-related UTI or bowel obstruction
- Care plan section describing dignity-preserving toileting routine and the staff time it consumes
How do ICBs commonly under-score Continence?
Pattern: Assessor scored Low because incontinence is 'managed' by routine pad changes.
Rebuttal: Routine pad changes are the intervention, not the absence of need. The Moderate descriptor turns on continence care requiring monitoring to minimise risks — including urinary catheters, double incontinence, recurrent UTIs, or bowel-management issues. Per paras 162–166, score the present-day need.
Source: para 162-166 + DST Section 2 – Care domains, Continence Moderate descriptor
Pattern: Assessor scored Moderate where catheter requires regular trained-nurse intervention for bypassing or blockage.
Rebuttal: The High descriptor turns on continence care being problematic and requiring timely and skilled intervention beyond routine care — frequent bladder wash outs/irrigation, manual evacuations, or frequent re-catheterisation are the named examples. Routine trained-nurse response to catheter bypass/blockage meets that test.
Source: DST Section 2 – Care domains, Continence High descriptor
Pattern: Assessor scored Moderate where bowel management requires manual evacuation by trained staff.
Rebuttal: Manual evacuation is one of the High descriptor's named examples of timely and skilled intervention beyond routine care. Bowel-management regimes requiring manual evacuation meet the High descriptor.
Source: DST Section 2 – Care domains, Continence High descriptor
How do you challenge a low Continence score? (4-line template)
Continence rarely secures eligibility on its own
The Case Strength Report (£47) maps your existing records against all 12 DST domains and tells you whether the combination is strong enough to pursue formal CHC assessment.
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