5.2 Toileting: Bedpan, Commode, Urinal, Bowel/Bladder Training, and Observation

Toileting: Bedpan, Commode, Urinal, Training, and Observation

Quick Answer: Offer toileting at least every 2 hours, never ignore a call light for toileting, and use the right device: bathroom for residents who can walk, commode for those who can stand/transfer but not walk, bedpan for residents who cannot get up, and urinal for males who cannot get up. Report no bowel movement for 3+ days, blood in stool or urine, diarrhea, or sudden incontinence immediately.

Toileting is a basic need and a dignity issue. Many residents are embarrassed about needing help. Always be calm, respectful, and discreet. Offer toileting regularly — do not wait for the resident to ask. A regular toileting schedule prevents incontinence, falls, urinary tract infections, and skin breakdown.

Choosing the Right Toileting Method

Bedpan Procedure

1. Wash your hands and put on gloves. Explain what you are doing. Close the door and pull the curtain.
2. Lower the head of the bed to flat (or as low as the resident can tolerate). This makes it easier for the pan to slide under the buttocks.
3. Have the resident bend their knees and push their hips up if able. For a regular bedpan, sprinkle powder on the rim (if facility policy allows) so it slides easier. For a fracture pan, slide the slanted end under the buttocks — the flat end goes toward the resident's back.
4. If the resident cannot lift their hips, have them roll to the side, place the pan against the buttocks, and roll them back onto the pan.
5. Raise the head of the bed to a sitting position (Fowler's) so they can use the bedpan comfortably.
6. Leave the call light within reach. Step out and close the curtain. Respond promptly when they call — never leave them on the pan for long, as pressure on the skin causes breakdown.
7. To remove: lower the head of the bed, have the resident lift their hips (or roll to the side), and slide the pan out. Cover the pan.
8. Provide perineal care if needed. Offer a warm washcloth for hands.
9. Empty the pan in the toilet (never in the sink), rinse it, and store it clean. Remove gloves, wash your hands.
10. Document: the time, whether they voided or had a bowel movement, the amount if measured (I&O), the color, odor, and any abnormal appearance. Report abnormalities to the nurse.

Urinal Procedure (Males)

1. Wash hands, gloves on, privacy.
2. Hold the urinal so the penis is fully inside the opening. For a resident in bed, place it between the legs and angle it.
3. Leave the call light within reach and step out. Respond promptly when called.
4. After use, measure the urine if on I&O, empty it in the toilet, rinse the urinal, and store it within the resident's reach.
5. Offer a warm washcloth for the resident's hands. Remove gloves, wash hands, document.

Trap callout: Never leave a resident on a bedpan or commode for an extended period — pressure and moisture cause skin breakdown and pressure ulcers. Respond to the call light promptly. Also, never put a urinal or bedpan on the overbed table or food tray — it is a contamination hazard. Place it on a clean barrier or in the bathroom.

Bowel and Bladder Training Programs

Bowel and bladder training (also called bladder retraining or scheduled toileting) is ordered by the doctor and planned by the nurse. The goal is to help the resident regain continence or establish a regular elimination pattern. The CNA's role is to follow the schedule, offer toileting at the set times, keep a record, and report results.

Bladder Training

• Offer toileting on a set schedule — typically every 2 hours during the day, then gradually increase the interval (to every 2.5, then 3 hours) as the resident gains control.
• If the resident is incontinent before the next scheduled time, shorten the interval. If they stay dry, lengthen the interval.
• Keep a bladder diary: time of each voiding, amount, whether it was continent or incontinent, and any leaks between toileting.
• Encourage fluids during the day (unless restricted) and limit fluids 2 hours before bedtime to reduce nighttime incontinence.
• Praise continent voids. Never scold or shame for incontinence.

Bowel Training

• Establish a regular time for bowel movements, usually after breakfast (the gastrocolic reflex is strongest after a meal and warm drink).
• Offer toileting at that same time every day.
• Encourage fluids (6–8 glasses a day unless restricted) and high-fiber foods (fruits, vegetables, whole grains).
• Encourage activity and walking if able — immobility causes constipation.
• Keep a bowel record: date, time, amount, consistency, color, and any complaints of pain or straining.
• Report no stool for 3 or more days — this is constipation or possible impaction and the nurse must be notified.

Incontinence Care

Incontinence (loss of bladder or bowel control) is common in LTC. The CNA must provide care promptly and with respect.

• Respond promptly to a call light or a soiled resident. The longer urine or stool stays on the skin, the worse the skin damage.
• Clean the perineal area with mild soap and warm water, or per facility protocol. For females, always clean front to back to prevent urinary tract infections. For males, clean from the tip of the penis outward.
• Pat dry — do not rub. Skin is fragile.
• Apply barrier cream (zinc oxide, petroleum jelly) only if ordered by the nurse or doctor. Do not apply it without an order.
• Change soiled linens and clothing promptly. Wash your hands before and after.
• Use incontinence briefs or pads as needed. Change them as soon as they are soiled — do not let residents sit in wet briefs.
• Never blame or shame the resident. Say nothing that suggests the incontinence is their fault. Many residents are humiliated by it. Preserve their dignity at all times.
• Document the time, what you found (urine, stool, both), what care you provided, and the skin condition.

Bowel Movement Observation and Reporting

CNAs observe and document every bowel movement. Normal stool is brown, soft, formed, and has a mild odor. Report the following immediately:

Trap callout: Removing a fecal impaction (digitally disimpacting the rectum) is NOT a CNA task in Indiana — it is a nurse procedure. Report the sign (resident says they need to have a bowel movement but cannot, liquid stool leaking around a hard mass) and let the nurse handle it.

Bladder Observation and Reporting

Normal urine is pale yellow or amber, clear, and has a mild odor. Report the following:

• Blood in the urine (hematuria) — red, pink, or tea-colored urine
• Cloudy urine — possible infection
• Very strong or foul odor — infection
• Pain or burning with urination (dysuria) — infection
• Very small amounts (oliguria) or no urine (anuria) for a shift** — dehydration or kidney problem
• Very large amounts (polyuria) — diabetes or kidney problem
• Incontinence that is new or suddenly worse — possible UTI or new medical problem
• Urgent, frequent urination — infection or inflammation

Key Points for the Skills and Written Exam

• Respond promptly to toileting call lights. Never leave a resident on a bedpan or commode.
• Use the fracture pan for residents who cannot lift their hips (cast, hip surgery, spinal injury, very weak).
• Front-to-back perineal care for females prevents UTIs.
• Bowel/bladder training depends on a regular schedule and a careful diary. CNAs are the key to it working.
• Document time, amount, and character of every void and stool.
• Never remove a fecal impaction — that is a nurse task. Report it.
• Preserve dignity: close the door, pull the curtain, never shame a resident for incontinence.