6.6 Toileting and Incontinence Care
Key Takeaways
- Use a fracture pan (narrow end under the buttocks) for residents with hip fractures or back pain
- Clean and dry the skin immediately after every incontinence episode, then apply barrier cream as ordered
- Incontinence is NOT a normal part of aging; it has underlying treatable causes
- Scheduled toileting every 2-4 hours and prompted voiding can manage functional and urge incontinence
- Document and report the time, amount, color, and consistency of urine and bowel movements
Toileting and Incontinence Care
Assisting with elimination protects dignity, supports independence, and prevents two major complications: falls (residents rush to the toilet) and skin breakdown (prolonged contact with urine and stool). Accurate measuring and reporting of output also help the nurse catch dehydration, infection, and bowel problems early.
Toileting Equipment
| Equipment | Description | Used For |
|---|---|---|
| Standard bedpan | Deeper pan under the buttocks | Bedridden residents who can raise the hips |
| Fracture pan | Flatter pan with a thin lip; narrow end under buttocks | Hip fractures, back pain, casts, limited movement |
| Urinal | Bottle-shaped container | Male residents voiding in bed |
| Bedside commode | Portable chair with a removable pan | Residents who can transfer but not walk to the bathroom |
| Elevated toilet seat | Raised seat over a regular toilet | Hip-replacement and limited-mobility residents |
| Grab bars | Wall-mounted safety rails | Anyone needing stability at the toilet |
Bedpan Procedure
- Provide privacy and put on gloves
- Raise the bed to a safe working height to protect your back
- Have the resident bend the knees and raise the hips, then slide the pan under with the wide end toward the back
- If the resident cannot raise the hips, roll them to the side, position the pan, and roll them back onto it
- Raise the head of the bed for a natural position, give the call light and toilet paper
- Step out for privacy if it is safe to do so
- When finished, hold the pan steady as the resident raises the hips, then provide or assist with wiping
- Note the color, amount, odor, and consistency of urine and stool
- Empty, rinse, and clean the pan; offer hand hygiene to the resident; remove gloves and wash your hands
For a fracture pan, slide the thin narrow end under the buttocks; it requires far less lifting and protects a fractured hip or sore back.
Understanding Incontinence
Incontinence is the involuntary loss of urine (urinary) or stool (fecal). It is not a normal part of aging; it stems from causes such as infection, weak pelvic muscles, an enlarged prostate, medications, or mobility and cognitive barriers, many of which are treatable.
| Type | Description | Common Cause |
|---|---|---|
| Stress | Leaks with coughing, sneezing, laughing | Weak pelvic floor muscles |
| Urge | Sudden strong urge, cannot reach the toilet in time | Overactive bladder, UTI |
| Overflow | Bladder never fully empties, constant dribbling | Enlarged prostate, nerve damage |
| Functional | Bladder works but barriers prevent reaching the toilet | Mobility loss, dementia |
| Mixed | Combination of the above | Multiple causes |
Skin Care and Bladder Training
The top priority after any episode is the skin. Clean and dry the skin immediately, using a gentle perineal cleanser rather than harsh soap, pat dry rather than rub, apply a moisture-barrier cream if ordered, and change the brief or pad promptly. Inspect for redness and breakdown each time.
Continence can often be improved, not just managed:
| Strategy | Description |
|---|---|
| Scheduled toileting | Take the resident to the toilet every 2-4 hours on a routine |
| Prompted voiding | Regularly ask if they need to go and assist promptly |
| Bladder retraining | Gradually lengthen the interval between voids |
| Pelvic floor (Kegel) exercises | Strengthen muscles that hold urine |
Products and Documentation
Match the product to the need: incontinence briefs for heavy loss, pads for light protection, underpads (chux) to protect linens, an external (condom) catheter for males, and an indwelling catheter only when ordered by the physician. Document and report the time, amount (measured if the resident is on intake and output, I&O), and characteristics of each void and bowel movement, the resident's ability to sense the urge, the skin condition, and any episodes of incontinence so the care team can adjust the plan.
Bedside Commode and Urinal Details
A bedside commode gives a more natural sitting position than a bedpan, empties the bladder more completely, and helps preserve independence. Lock the wheels, place it close to the bed, transfer the resident with a gait belt, and make sure the feet are flat and the resident is stable before stepping away with the call light in reach. For a male urinal, position the opening so the penis is inside, leave the call light, and when finished note the amount and characteristics before emptying and rinsing.
After any toileting, offer the resident the chance to wash the hands, since hand hygiene is a frequently scored exam step and a basic infection-control habit that residents are entitled to.
Observation, Falls, and Reporting
Toileting is a leading moment for falls because residents feel urgency and may try to stand alone, so respond promptly to the call light and never rush a resident off a commode or toilet. While assisting, observe the urine for color (dark, cloudy, or bloody), odor (strong or foul), and amount, and observe stool for color, consistency, blood, or mucus, reporting black, tarry, or bloody stool and very dark or bloody urine right away as these can signal bleeding. Note constipation (no bowel movement for three days or hard, dry stool) or diarrhea, both of which the nurse needs to know about.
Accurate intake and output records, painstaking skin checks, and prompt reporting turn routine toileting into early detection of dehydration, urinary tract infection, and bowel obstruction, which is exactly the observant care the exam expects.
Which device is appropriate for a resident with a hip fracture who needs to use the bedpan?
What should a CNA do FIRST after a resident has an episode of incontinence?
A resident leaks small amounts of urine when coughing or sneezing. Which type of incontinence is this?