WCA Activity 9: Continence - Bowel and Bladder Control

Activity 9 is one of the 17 activities in the Work Capability Assessment (WCA), the test that decides whether you have Limited Capability for Work for Employment and Support Allowance or Universal Credit. Its full title is "Absence or loss of control leading to extensive evacuation of the bowel and/or bladder". In plain terms, it asks how often you lose control of your bowel or bladder badly enough that you have to clean yourself and change your clothing - or how often you would, if you could not reach a toilet in time. You score points on this activity by showing how frequent, or how likely, those episodes are.

This is a physical activity, and it is one of the most under-claimed in the whole assessment. The reason is simple: continence problems are deeply embarrassing, so people leave them off the form or play them down. That is a mistake worth thousands of pounds a year, because the higher descriptor on this activity is worth the full 15 points - enough on its own to establish Limited Capability for Work.

The exact Activity 9 descriptors and points

These are the verbatim descriptors and point values from Schedule 2 of the Employment and Support Allowance Regulations 2013. Only the single highest-scoring descriptor that applies to you counts towards your total.

There are only two scoring descriptors here. The higher one, (a), is worth 15 points and turns on frequency - "at least once a month". The lower one, (b), is worth 6 points and turns on risk - being likely to lose control if a toilet is not close by.

What the descriptors mean in plain English

Descriptor (a) - at least once a month (15 points). If, at least monthly, you actually lose control and have a substantial accident - of the bowel, the bladder, or both - that needs you to clean yourself and change your clothes, you meet this descriptor. It also covers "substantial leakage of the contents of a collecting device", meaning a stoma bag, catheter or similar that leaks badly. One full episode a month is enough. Fifteen points clears the threshold for Limited Capability for Work on its own.

Descriptor (b) - at risk most of the time (6 points). This is for people who do not necessarily have a monthly accident but who, for the majority of the time, are at real risk of one unless they can get to a toilet quickly. Think of severe urgency where you have only seconds of warning: you usually make it, but only because a toilet is always within reach. In a workplace, where you cannot always drop everything and run, that risk becomes an accident. Six points here combines with points from other activities.

The urgency trap - and why work changes everything

Many people with bowel or bladder urgency manage at home because they have organised their whole life around a toilet. They never travel far from one, they go before they leave, they know where every public toilet is. This can hide how disabling the problem really is. The WCA does not ask whether you cope in a home built around your condition - it asks whether you could work reliably and safely. In a job you cannot guarantee a toilet within seconds, you cannot always leave a task, and you cannot control when urgency strikes. That is exactly the situation descriptor (b) is written for, and it is why you should describe what would happen at work, not just how carefully you manage at home.

A worked example: how a real difficulty maps to points

Points only make sense when you see how an everyday difficulty turns into a descriptor. Here is a composite example built from the kind of facts an assessor weighs. The point values are exactly those written into Schedule 2.

Imagine someone with Crohn's disease in an active phase. On bad days the urge to empty their bowel comes with almost no warning. About twice a month they do not reach a toilet in time and have a full accident that needs them to clean themselves and change their clothes. Most other days they are constantly at risk and only avoid accidents because they stay within reach of a toilet at all times.

• Descriptor (a): they "at least once a month experience loss of control leading to extensive evacuation of the bowel... sufficient to require cleaning and a change in clothing". Twice a month is comfortably "at least once a month". That is 15 points, enough on its own to establish Limited Capability for Work.
• They would not separately also claim descriptor (b), because you take the single highest descriptor that fits - and (a) at 15 points is higher than (b) at 6. But the constant at-risk picture supports (a) if the frequency were ever disputed.

Now a milder case: someone with overactive bladder and severe urgency who has not had a full accident this year, only because a toilet is always nearby, but who is plainly at risk most of the time if one is not. That is descriptor (b), 6 points. On its own that is not enough, but added to points from another activity - for example mobilising, or a mental-function activity - it can carry the claim towards the 15-point threshold.

The reliability test applied to Activity 9

The single most important rule across the whole WCA is that you must be able to do an activity reliably, repeatedly, safely, in a reasonable time, and the majority of the time. For continence this test is decisive, because the problem is by nature intermittent and unpredictable:

• Reliably. Staying continent only because you have arranged constant toilet access is not staying continent reliably. The descriptor for being "at risk the majority of the time" is built on exactly this point.
• The majority of the time. If urgency or risk affects you on more than half the days, you are assessed as you are on those days. Flare-ups and bad weeks count - do not describe only your settled days.
• Safely and with dignity. An accident at work is not just unpleasant, it is a real, repeated risk that affects your ability to function. Describe the practical and dignity impact honestly.
• In a reasonable time. If managing the problem means frequent, lengthy toilet breaks, changes of clothing or stoma care during the day, that itself interrupts sustained activity.

Which conditions commonly score on Activity 9

• Crohn's disease and ulcerative colitis (inflammatory bowel disease), where flares bring sudden, severe bowel urgency.
• Irritable bowel syndrome (IBS) of the urgency or diarrhoea-predominant type.
• Multiple sclerosis, Parkinson's disease and spinal cord injury, where nerve damage affects bowel and bladder control.
• Overactive bladder and severe urge incontinence.
• People with a stoma or catheter who experience substantial leakage from the device.
• After bowel or bladder surgery, including cancer treatment that has affected continence.

Evidence to gather for Activity 9

A continence problem cannot be observed in a brief consultation, and it is the kind of difficulty assessors may underestimate, so evidence matters. Build it in layers:

• A continence or symptom diary. The single most useful document - record the date of each accident or near miss, how much warning you had, whether bowel or bladder, and that you had to clean and change. A few months of this shows frequency far better than a sentence.
• Letters from your specialist - gastroenterologist, urologist or colorectal surgeon - confirming diagnosis, severity and treatment.
• Your continence nurse, if you have one, who can describe the day-to-day impact and the products you need.
• Your GP record, which often logs the history, medication and referrals.
• Confirmation of products and devices - pads, a stoma bag, a catheter, prescriptions for relevant medication - and that they do not fully prevent episodes.
• A witness statement from someone who knows how often accidents happen and how you manage them.

Send copies, never originals, and keep a list of everything you submit.

Common mistakes on Activity 9

• Leaving it off the form out of embarrassment. This is the biggest mistake. The assessor cannot score what you do not tell them, and a monthly accident is worth 15 points.
• Describing how well you cope at home. Coping at home with a toilet always nearby hides the problem. Describe what would happen at work, where you cannot.
• Assuming pads or a stoma disqualify you. The descriptor expressly covers leakage from a collecting device - the question is whether episodes still happen.
• Counting only the very worst accidents. "At least once a month" is the test for the top descriptor - you do not need them weekly.
• Ignoring the at-risk descriptor. Even with no recent full accident, being at risk most of the time without quick toilet access scores 6 points.

How Activity 9 combines towards 15 points - and the Support Group

You reach Limited Capability for Work (LCW) by scoring 15 points in total across the 17 activities, adding physical and mental descriptors together. Because descriptor (a) of Activity 9 is worth 15 points, a monthly accident meets the threshold on its own. If you only meet descriptor (b) for 6 points, you need a further 9 points from elsewhere - and that is common, because continence problems rarely travel alone. Someone with Crohn's disease, MS or a spinal injury usually also has fatigue, pain or mobility difficulties that score on other activities.

Activity 9 does not have its own matching Schedule 3 descriptor, so it does not place you in the Support Group (LCWRA on Universal Credit) by itself. Two routes to the higher group remain. First, the underlying condition often meets a Schedule 3 descriptor through another activity. Second, the substantial-risk rule can apply where being expected to work would create a real risk to your health or dignity. The Support Group pays £145.90 a week against £95.55 a week for the Work-Related Activity Group, and carries no work-related requirements. See how to qualify for the Support Group for the detail.

The consultation and what to do if it goes wrong

Most assessments are now by telephone or as a paper-based review, though a face-to-face appointment is still possible. A continence problem cannot be seen in a consultation, so your written account, your symptom diary and your specialist letters carry a great deal of weight. It is an uncomfortable subject to discuss, but be plain and specific - how often, how much warning, bowel or bladder, and what you have to do afterwards. You can bring a supporter, and you can ask for a break.

If the decision is wrong - a nil score when you clearly meet a descriptor - you can challenge it. Ask the DWP for a copy of the assessment report and check it against what you said; with a sensitive subject, important details are often missed or recorded wrongly. The challenge runs in two stages: first Mandatory Reconsideration, normally within one month, setting out which descriptor you meet and why with any fresh evidence; then, if needed, an appeal to the independent First-tier Tribunal, which overturns a large share of WCA refusals because a panel can take the time to understand a fluctuating, intermittent condition that a brief call cannot.

Official sources

This guide reflects the official Work Capability Assessment rules. For the source material, see:

• GOV.UK - Employment and Support Allowance
• GOV.UK - Health conditions, disability and Universal Credit
• The Employment and Support Allowance Regulations 2013 (Schedule 2 - WCA descriptors)
• Citizens Advice - Employment and Support Allowance

Guidance only, not legal advice. The WCA is under reform with changes from 2025 onwards - always check GOV.UK for the latest.

Frequently Asked Questions

How much could your ESA be worth?

The amount depends on whether you reach the 15-point threshold for Limited Capability for Work, and whether you qualify for the Support Group (LCWRA). As a rough starting point, enter your main condition below to see the kind of figure a successful claim can reach. It is only an estimate - your real award depends on how the Work Capability Assessment scores your difficulties across the 17 activities.

For the official figures, see our free WCA points calculator and what ESA is and how much it pays.