Medical assessor guidance note 24

The urinary and reproductive system: assessment of incontinence

This material is issued by the State Insurance Regulatory Authority (SIRA) under s.65(2) of the Motor Accidents Compensation Act 1999 (the Act) in the interests of promoting accurate and consistent medical assessments under the Act. The interpretation provided here is not legally binding but represents the clinically recommended interpretation in an area where more than one interpretation of existing provisions may be possible. This recommended interpretation is publicly available. Any medical assessment which does not adopt this interpretation should be accompanied by clinical justification for the interpretation adopted, supported by full, robust reasons.


  1. The Permanent Impairment Guidelines: Guidelines for the assessment of permanent impairment of a person injured as a result of a motor vehicle accident, 1 October 2007 (PI Guidelines): Chapter 4 Spinal impairment pages 21-29, clauses 4.26, 4.27, 4.42 pages 27-28 and Chapter 5 Nervous system impairment page 32, clause 5.18, and the Urinary and reproductive system page 51, clauses 8.21 and 8.22.
  2. The American Medical Association Guides to the evaluation of permanent impairment, Fourth Edition (AMA 4 Guides): Chapter 4.3d Urinary Bladder Dysfunction, Table 17, page 149 and Chapter 11.3-11.4 and pages 254-262.


The PI Guidelines state that Chapter 11 of the AMA 4 Guides provides clear methods for assessment of impairment of the urinary and reproductive systems.

Issue requiring clarification

The PI Guidelines at Clause 4.27 state that:

Chapter 11 (The Urinary and reproductive System of the AMA 4 Guides) should only be used to assess impairment for impotence where there is direct injury to the urinary tract. If this occurs the impairment for impotence could be combined with a spine related whole person impairment. An example is provided in the AMA 4 Guides (p257) where there is a fracture and dissociation of the symphysis pubis and a traumatic disruption of the urethra.

While the PI Guidelines give clear direction that sexual dysfunction related to neurological impairment is only assessable where there is objective evidence of injury to the nervous system, there is no such statement in regard to the assessment of incontinence due to neurological impairment. There is a reference to demonstrated bowel or bladder dysfunction in clause 4.42 as it relates to the assessment of cauda equina syndrome, which is assessed using the spinal chapters.

Preferred interpretation

Objective evidence of neurological impairment is necessary to assess incontinence related to spinal injury (AMA 4, Chapter 4, 4.3d). For assessment of incontinence due to injury to the bladder and urethra (AMA 4, Chapter 11, 11.3 and 11.4) there needs to be evidence of a frank injury to these structures that would be medically expected to be associated with urinary incontinence.

Justification for preferred interpretation

The preferred interpretation and methodology as outlined above is suggested to promote consistency of assessment of impotence and incontinence.

Injury Prevention and Rehabilitation
December 2016