ESA points for incontinence – Question 9 

What is Question 9 from the ESA form about?

How many ESA points for incontinence can you score and do you meet the criteria?

Read on to find out.

Question 9 from the ESA form

Question 9 from the ESA form is about controlling your bowels and bladder and using a collective device.

By answering this question you can get 8 ESA points for incontinence, which is enough for Standard Rate Care, on incontinence alone.

Question 9 from the ESA form has a great relevance for people with conditions like IBS and Crohn’s disease.

How to answer Question 9

Question 9 requires an answer if you  have a problem with your bladder or bowels while you’re awake.

This question is not about any problems you may have while you’re asleep.

Incontinence problems have many causes including medication side effects or a different illness or disability, and you should not feel embarrassed when letting the DWP know about your issues.

No one can control his/her bladder when having an epileptic seizure, for example.

Here is how the question looks like:

• “Do you have to wash or change your clothes because of difficulty controlling your bladder, bowels or collecting device?”

You should let the DWP know any of the struggles you have because of your incontinence issue.  

Here are some useful tips from Citizens Advice on how to answer Question 9: 

• “If  you have to clean yourself and change your clothes due to incontinence, say how often this happens.”
• “If it hasn’t happened, but you’re worried that it could, or it hasn’t happened because you stay near a toilet, you should tick the last box (Yes – but only if I cannot reach a toilet quickly).”
• “If you can manage your condition with incontinence pads, for example, you should tick “no”. If there’s a reason why you don’t use them, or if you sometimes still have to change your clothes tick “yes” and explain in the box.”

What to write in the available space

It’s important to give as many examples as possible and to clarify your situation in the available space. 

You should explain things like:

• what happens if you can’t reach a toilet quickly
• how often you need to wash or change your clothes because of difficulty controlling your bladder or bowels
• whether you carry spare clothes around in case of emergencies
• if you take medication to control your bladder or bowels, and whether it works
• the problems you have if you want to go out – for example, if you need to stay close to a toilet to avoid accidents
• how often you have flare-ups, for example, if your Crohn’s disease is usually well controlled with medication, but you get severe diarrhoea once every 6 months

If you have a condition that changes a lot (for example irritable bowel syndrome), it’s important to tell the DWP as much as you can about how it affects you.

Make your best to explain your symptoms and how the condition is changing in time. 

Question 9 – Descriptors

The descriptors that relate to question 9 are:

1. At least once a month experiences: (i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or (ii) substantial leakage of the contents of a collecting device, sufficient to require cleaning and a change in clothing.  – 15 points
2. The majority of the time is at risk of loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder, sufficient to require cleaning and a change in clothing, if not able to reach a toilet quickly. – 6 points
3. Neither of the above applies. – 0 points

Question 9 considers the ability to maintain continence of bladder or bowel, or prevent leakage from a collecting device.

The descriptors take into account loss of continence while a claimant is awake/conscious and the loss of continence must lead to ‘extensive’ leakage of urine or faeces which is likely to require the person to have to wash and change clothing.

Absence or loss of control whilst conscious leading to extensive evacuation of the bowel and/or voiding of the bladder, other than enuresis (bed-wetting), despite the wearing or use of any aids or adaptations which are normally, or could reasonably be, worn or used.

At least once a week experiences

(i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or (ii) substantial leakage of the contents of a collecting device.

Someone who had such frequent and significant loss of bowel or bladder control would mean that work-related activity would no longer be considered reasonable for the person.

Medical confirmation is likely to be required to confirm the extent of the problem. 

At least once a month experiences

(i) loss of control leading to extensive evacuation of the bowel and/or voiding of the bladder; or (ii) substantial leakage of the contents of a collecting device; sufficient to require cleaning and a change in clothing 

These descriptors take into consideration loss of continence while the claimant is awake/conscious.

Any problems with incontinence that occur during sleep or during episodes of altered consciousness such as during seizures or under the influence of alcohol or drug misuse would not fulfil the criteria for these descriptors.

The descriptors relate to substantial leakage of urine or faeces – such that there would be a requirement for the person to have to wash and change their clothing.

The descriptors do not refer to minor degrees of leakage that could be managed by the use of pads and not necessitate a full change of clothing.

ESA points for incontinence urgencies

Urgency, as typically associated with prostatism, will not usually meet the criteria for `incontinence’ or `loss of control’, as it can be controlled by regular voiding.

Detrusor instability can cause significant symptoms, however, the condition is likely to be controllable with the use of aids and pads in which case the scoring descriptors would not apply. 

Claimants with gastrointestinal problems such as dumping syndrome should be considered as possibly meeting the criteria when their problem is unpredictable to the extent that they would become incontinent if they did not leave their work immediately or within a very short space of time and this is a regular occurrence.

Irritable bowel syndrome can usually be controlled with medication and/or lifestyle changes and is not often associated with such urgency that a scoring descriptor is likely to apply.

It should be noted that in 2014, an Upper Tribunal decision determined that mobility issues must be taken into account when considering continence.

Therefore in cases where a continence problem is evident, HCPs must consider the impact of impaired mobility and provide advice accordingly. 

If a claimant is incontinent because they are unable to reach the toilet quickly enough as a result of mobility issues then they should score against the relevant descriptor.

So, for example, if a claimant with urge incontinence has to change their clothes at least once a month despite the use of incontinence aids because they are unable to reach the toilet quickly enough as a result of a lower limb/back problem then the HCP should consider advising descriptor C. 

The key issue is that the Healthcare Professional (HP) must now take into account the impact of impaired mobility and how this impacts on the continence problem.

As before, the claimant must have a medical condition affecting bladder or bowel function in order for the continence activity to be considered. 

When considering a claimant with a medical condition affecting bladder/bowel function who in addition has impaired mobility, the HP has to consider whether their mobility issue is sufficiently severe that their ability to access toilet facilities in a normal working environment, with reasonable adjustments, would be compromised.

This assumes that toilet facilities are within a reasonable distance and on the level. 

If the history given is of continence issues where they have been unable to reach toilet facilities upstairs or a considerable walking distance away then it is not relevant.

Within the history of daily activities, the HP will enquire about adaptations that they might be expected to have made to ensure they are not incontinent. 

The HP would also look to demonstrate issues around their ability to rise from a chair and move within the examination centre – if there are none then it seems unlikely that they would suffer continence issues due to mobility restriction within a workplace. 

As in all activity areas, careful exploration of history is required to assess functional limitations and whether there are any reasonable adjustments or aids or appliances that should be considered.

Details of activities of daily living: The HP will consider the frequency and length of any journeys or outings undertaken, together with any problems encountered in undertaking these activities, e.g.: Shopping trips, visits to friends or relatives.

The claimant may show to the HP pads or extra change of clothing which they carry with them when they go out.

If the claimant has to leave the room during the assessment to visit the toilet, this information will be documented in the relevant sections of the report.

Conclusions

Question 9 from the ESA form is about whether somebody has a problem with his or her bladder or bowels while awake.

If you meet the criteria (see the descriptors), you get up to 8 ESA points for incontinence, which is enough for Standard Rate Care, on incontinence alone. 

We would like to hear how you experience with the ESA application form is going so far. Don’t hesitate to let us know in the comments section below. 

FAQ regarding ESA points for incontinence 

Recommendations

1. Utopia Bedding Quilted Waterproof Incontinence Pad/Underpad
2. Medline Extrasorbs Drypad Underpads Air Permeable
3. Amazon Brand – Solimo Incontinence/Bladder Control Pads for Women
4. Medline Heavy Absorbency Underpads
5. Premium Quality Bed Pad, Quilted, Waterproof, and Washable

References

1. Activity 9: Evacuation of the bowel and/or bladder (LCW) – wcainfo
2. Q9 – controlling your bowels and bladder and using a collective device – Citizens Advice