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Symptoms related to bladder, bowel and sexual dysfunction are common in patients with neurological diseases and are associated with significant morbidity and impacts on quality of life. However, compared with other neurological problems, they are often less visible, under-ascertained and under-treated. This review aims to provide neurologists with an evidence-based, structured approach to evaluating bladder, bowel and sexual dysfunction in patients with neurological disorders. As with any other presenting concern, this requires a structured approach to history, examination and the judicious use of investigations.