Continence and Constipation assessment form

Author: Sona Matthai, Consultant Paediatrician with an interest in Gastroenterology and Complex Care

Trust lead for Continence.

 Date Published: March 2025

Date to Review: June 2026

Continence and Constipation assessment form to help guide both medical and nursing teams in basic continence and constipation advice for families.

Please use this form when you see a child with continence or constipation concerns.

The assessment form includes advice and guidance to ensure that treatment is not delayed if required.  There are additional forms available for families to use to monitor and track children’s toileting.

The form also gives support as to where onward referrals should be made.

If after advice, treatment where appropriate and monitoring, a referral to the specialist Continence service is required, please send the following.

• Referral form and details of what has been done so far

• Continence and constipation assessment form

• Any additional completed diaries/charts in relation to a child’s toileting.